BENGALURU: Caring for a newborn, especially for first time parents, can be challenging. When a baby is born preterm and has to stay in the neonatal care unit for a few weeks, the joy of finally taking the baby home could be coupled by a lot of trepidation. With adequate planning, you will be better prepared. Firstly, remember, that a preemie will not be discharged unless the doctor deems baby fit.
Baby should have reached a certain weight, criteria of which differs as per hospital guidelines, should be able to suckle well at the breast and accept expressed breast milk. He or she should maintain temperature independently in a crib, for at least 48 hours and should have gained weight steadily for at least 2-3 days prior to discharge. Usually a baby who has crossed 36-37 weeks of gestation is able to achieve this, however, if baby has required intensive care or ventilatory support, this timeline may vary.
Here are steps to keep in mind:
1 Feeding: Breastfeeding is advised once baby is independent of the feeding tube and able to swallow pumped milk by paladai – usually preferred to bottles, to minimise infection, nipple confusion and overfeeding. However, some babies may take time to suckle well, especially if they’ve been sick or extremely preterm, or if mom has flat or retracted nipples. Do not be discouraged, they will eventually get there with some help. Make sure that you are confident of feeding expressed milk before going home, apart from direct breastfeeds, as baby would require measured feeds for a few weeks till weight gain is adequate.
2Infections: The immune system of a preterm is immature, putting them at risk of catching infections easily. This can be minimised by strict handwashing before handling baby, restricting the number of caregivers, and minimising visitors. Follow up with the paediatrician for vaccinations.
3 Temperature control: Ensure that the room you have prepared for your preemie is kept warm. In very cold climates, a room heater may be advised, and baby should be wrapped adequately. If an air conditioner is used, set the ambient temperature to above 26°C. Your paediatrician may advise to postpone bathing and continue only sponging till the baby reaches an adequate weight. Oil massages are beneficial in development and sleep.
4 Kangaroo mother care (KMC): Skin to skin contact in the “kangaroo care” position has been proven to have several benefits. Apart from thermal protection, it aids in effective weight gain, better sleep, mother-baby bonding, and promotes exclusive breastfeeding. Fathers are also encouraged to participate in kangaroo care. KMC can also be given soon after bath and on cold nights. Learn the technique before discharge.
5Respiratory problems: Sometimes preterm babies are more prone to apnea (cessation of breathing for a few seconds, which is usually reversible by stimulation, unless it goes unnoticed for a longer period of time). Some babies may be started on medications to prevent apnea. Your baby will be discharged only when the risk of apnea is negligible. However, make sure that you learn how to position the baby’s head and neck while sleeping to minimise this, and to recognise danger signs. Aspiration of feeds is another cause of respiratory distress, which can be minimised with proper positioning during feeds and burping the baby after, followed by keeping baby to sleep in a semi-inclined position with head end of the crib slightly elevated. Avoid soft bedding, pillows and loose blankets around the baby. Sleeping on the tummy is not advisable in the neonatal period and early infancy, as it can lead to a higher risk of SIDS (sudden infant death syndrome).
6 Danger signs: if baby shows signs like poor feeding, lethargy, breathing difficulty, convulsions or inability to maintain normal temperature, visit your doctor immediately.
The author is a neonatologist, Fortis La Femme Hospital, Richmond Road