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 for new parents. 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. Baby should maintain temperature independently in a crib, for at least 48 hours, without an external source of heat like an incubator. Baby 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.
- Feeding: Breastfeeding is advised once baby is independent of the feeding tube and able to swallow pumped milk by paladai. Every mother longs for the day when her baby starts breastfeeding. However, some babies may take time to suckle well on the breast, 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 a little perseverance and help.
Make sure that you are confident of feeding baby expressed milk before going home, apart from direct breastfeeds, as baby would require measured feeds for a few weeks till weight gain is adequate. A feeding device called “paladai” is usually preferred to bottles, to minimise infection, nipple confusion and overfeeding which can occur with bottle-feeding.
- Infections: The immune system of a preterm is immature compared to an older baby. This puts 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. Ensure that you follow up with the paediatrician timely for vaccinations.
- 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 helping baby’s overall development and sleep.
- Kangaroo mother care (KMC): skin to skin contact in the “kangaroo care” position has been scientifically 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, to bond with their baby and to give mum a break! KMC can also be given soon after bath and on cold nights, to keep baby warm. Ensure that you learn the technique of kangaroo care before discharge.
- Respiratory 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. Ensure that the bed is firm , avoid soft bedding, pillows and loose blankets around 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).
- Danger signs: if baby shows signs like poor feeding, lethargy, breathing difficulty, convulsions or inability to maintain normal temperature, visit your doctor immediately.
Caring for a preemie in the weeks following discharge can take a toll mentally and physically. Ensure that you get adequate rest, healthy diet, treat yourself to an occasional massage! Be ready to accept help from family and friends to take care of housework or routine chores, so that you can focus on the baby and yourself. Some mothers experience post-partum blues. Do not hesitate to seek professional help if you feel depressed or overwhelmed. At the end of the day, a relaxed and happy mother equals a happy baby!
(Disclaimer: The writer is Dr Marie Shalini Chico, Paediatrician & Neonatologist, Fortis La Femme Hospital. Views expressed area a personal opinion.)