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The premature baby - Caring for your baby in the NICU
A seemingly endless list of healthcare professionals is involved in providing newborn intensive care.
Neonatologists are pediatricians with several years of extra training in caring for newborn infants with illnesses and birth defects. They act as team leaders but rely heavily on the advice and experience of other members of the team. Nurses are the constant care providers of patients in the NICU. They perform frequent assessments, administer medications, feed, bathe, and perform a myriad of other activities at the bedside. The number of babies a nurse may be assigned ranges from one to four depending upon the severity of illness. For a description of other team members in the NICU, click here.
The kind of care a premature baby will receive in the NICU will depend upon the baby’s gestation and his conditions related to prematurity. The most common conditions afflicting premature babies are related to problems with breathing, infections, and nutrition.
Respiratory distress syndrome (RDS) is a condition caused by a lack of a substance in the lungs called surfactant. Babies with RDS are usually treated with artificial surfactant and may require a ventilator or CPAP. For the very smallest infants, ventilators may be required for weeks; such infants can experience injury from the use of the ventilator itself and develop a condition called chronic lung disease of prematurity or bronchopulmonary dysplasia.
A much milder breathing problem that premature babies can have is called transient tachypnea of the newborn (TTN). It’s a condition caused by persistence of fluid in the lungs that is normally absorbed before birth. Babies with TTN rarely require a ventilator but may need to be treated with CPAP or extra oxygen. In any case, recovery within two to three days is the rule.
Another breathing problem that many premature infants experience is not breathing. Not breathing is called apnea. For parents, apnea can be frightening because monitor alarms sound and the baby may need stimulating to begin breathing again. Premature infants with apnea are often treated with caffeine (the same substance in tea or coffee) as it stimulates respiratory centers in the brain to breathe more regularly. Fortunately for babies and parents, premature infants outgrow the episodes of apnea before going home.
Premature infants are not well equipped to combat infections caused by bacteria, viruses, and fungi that normally don’t cause illness in older children and adults. As a result, such infections are an ever-present threat, especially to the most premature infants, and can be life threatening. Antibiotics and antiviral drugs are used frequently in the NICU and often at the slightest hint of infection because delay in treatment can mean the difference between life and death. As most infections are spread by direct contact, staff members and anyone touching the baby or his equipment must use appropriate hand hygiene using soap and water or, preferably, alcohol hand sanitizers. Mothers of premature infants can significantly reduce the risk of infections in their babies by pumping their breasts and providing their own milk.
Another challenge for the premature baby is receiving adequate nutrients to allow essential body functions and growth. While still inside his mother, everything necessary for body function and growth comes from her. The stomach and intestines of most premature babies are not ready to take in and digest milk in sufficient quantities. Furthermore, premature infants can’t suck and swallow competently until 32 to 33 weeks so they must be fed by a tube inserted in the nose or mouth and placed in the stomach when they are ready to be fed. Advancing the volume of milk to an amount that can provide complete nutrition can take two to three weeks for the smallest babies.
Intravenous nutrition is used to bridge the gap between the time of birth and when milk feeds are adequate. Sometimes called hyperalimentation (‘hyperal’ for short) or parenteral nutrition, the nutrition is administered via umbilical vein catheters or specially inserted catheters that are usually placed in an arm or leg and passed into large veins near the heart. Mother’s milk or human milk obtained from Milk Banks provides the best nutrition for premature infants. Frequently, the staff will add fortifiers to human milk to make it even more advantageous for them. For the mother who can’t provide enough of her milk or when human milk can’t be obtained from a Milk Bank, commercial formulas designed specifically for premature babies can be used.
Parents often describe the experience of having a premature infant in the NICU as similar to the experience of being on a roller coaster. There are frequent highs matched by frequent lows. Parents can learn to adapt to the process by taking an active role in their baby’s care and by being a strong advocate for their child. It’s helpful for them to record important events in a journal and to keep a section in which to write questions for their baby’s care-givers. Participating on daily team rounds is an important parental activity that can provide a sense of control during a time when things often seem out of control.
What was your experience in NICU?
This article is an extract from our book: Caring for your newborn - How to enjoy the first 60 days as a new mom
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By Dr Robert Dillard - Dr Dillard is the Professor of Pediatrics at the Wake Forest University School of Medicine. He is the Medical Director of the Neonatal Intensive Care Unit at the Sara Lee Center for Women’s Health at Forsyth Medical Center.
The kind of care a premature baby will receive in the NICU will depend upon the baby’s gestation and his conditions related to prematurity. The most common conditions afflicting premature babies are related to problems with breathing, infections, and nutrition.
Respiratory distress syndrome (RDS) is a condition caused by a lack of a substance in the lungs called surfactant. Babies with RDS are usually treated with artificial surfactant and may require a ventilator or CPAP. For the very smallest infants, ventilators may be required for weeks; such infants can experience injury from the use of the ventilator itself and develop a condition called chronic lung disease of prematurity or bronchopulmonary dysplasia.
A much milder breathing problem that premature babies can have is called transient tachypnea of the newborn (TTN). It’s a condition caused by persistence of fluid in the lungs that is normally absorbed before birth. Babies with TTN rarely require a ventilator but may need to be treated with CPAP or extra oxygen. In any case, recovery within two to three days is the rule.
Another breathing problem that many premature infants experience is not breathing. Not breathing is called apnea. For parents, apnea can be frightening because monitor alarms sound and the baby may need stimulating to begin breathing again. Premature infants with apnea are often treated with caffeine (the same substance in tea or coffee) as it stimulates respiratory centers in the brain to breathe more regularly. Fortunately for babies and parents, premature infants outgrow the episodes of apnea before going home.
Premature infants are not well equipped to combat infections caused by bacteria, viruses, and fungi that normally don’t cause illness in older children and adults. As a result, such infections are an ever-present threat, especially to the most premature infants, and can be life threatening. Antibiotics and antiviral drugs are used frequently in the NICU and often at the slightest hint of infection because delay in treatment can mean the difference between life and death. As most infections are spread by direct contact, staff members and anyone touching the baby or his equipment must use appropriate hand hygiene using soap and water or, preferably, alcohol hand sanitizers. Mothers of premature infants can significantly reduce the risk of infections in their babies by pumping their breasts and providing their own milk.
Another challenge for the premature baby is receiving adequate nutrients to allow essential body functions and growth. While still inside his mother, everything necessary for body function and growth comes from her. The stomach and intestines of most premature babies are not ready to take in and digest milk in sufficient quantities. Furthermore, premature infants can’t suck and swallow competently until 32 to 33 weeks so they must be fed by a tube inserted in the nose or mouth and placed in the stomach when they are ready to be fed. Advancing the volume of milk to an amount that can provide complete nutrition can take two to three weeks for the smallest babies.
Intravenous nutrition is used to bridge the gap between the time of birth and when milk feeds are adequate. Sometimes called hyperalimentation (‘hyperal’ for short) or parenteral nutrition, the nutrition is administered via umbilical vein catheters or specially inserted catheters that are usually placed in an arm or leg and passed into large veins near the heart. Mother’s milk or human milk obtained from Milk Banks provides the best nutrition for premature infants. Frequently, the staff will add fortifiers to human milk to make it even more advantageous for them. For the mother who can’t provide enough of her milk or when human milk can’t be obtained from a Milk Bank, commercial formulas designed specifically for premature babies can be used.
Parents often describe the experience of having a premature infant in the NICU as similar to the experience of being on a roller coaster. There are frequent highs matched by frequent lows. Parents can learn to adapt to the process by taking an active role in their baby’s care and by being a strong advocate for their child. It’s helpful for them to record important events in a journal and to keep a section in which to write questions for their baby’s care-givers. Participating on daily team rounds is an important parental activity that can provide a sense of control during a time when things often seem out of control.
What was your experience in NICU?
This article is an extract from our book: Caring for your newborn - How to enjoy the first 60 days as a new mom
By Dr Robert Dillard - Dr Dillard is the Professor of Pediatrics at the Wake Forest University School of Medicine. He is the Medical Director of the Neonatal Intensive Care Unit at the Sara Lee Center for Women’s Health at Forsyth Medical Center.
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