Even though I wasn't in their lives yet, two of my adopted sons were born significantly prematurely and I dealt with the consequences of their fragile start. One son was born before even beginning the third trimester! A premature infant is technically one who is born before 37 weeks gestation, as full term is 40 weeks.
According to the Mayo Clinic, preemies as classified as follows: Late Preterm (34 to 36 weeks); Moderately Preterm (32 to 34 weeks); Very Preterm (less than 32 weeks); and Extremely Preterm (born at 25 weeks or earlier.)
The majority of preemies fit in the first category of late preterm. Because a preemie hasn't "finished cooking," yet, they will not look or behave like a regular newborn. With a fine fuzz covering the body, a premature infant is likely to have a big noggin compared the body and will not have fat-softened features like the usual new babies you've seen. But the most shocking part of having preemie will be seeing your new baby being cared for in the NICU, or neonatal intensive care unit.
This specialized area of a hospital will be bustling with activity, and much of it sort of scary looking to the uninitiated. There are alarms, tubes, incubators and all kinds of hospital staff. It's OK to be fearful or confused, but there will be people who can answer your questions and help you understand what is happening and what to expect.
13 Being Exposed To A Lot Of Pain
In April of 2017, the Food and Drug Administration issued a warning on repeated use of general anesthesia on children younger than 3 years of age and its possible dangers. However, preemies frequently undergo procedures that would be unduly painful to endure without it. One of the major drugs used for procedures is morphine, and it is associated with smaller cerebellum growth as well as neurodevelopmental problems later. But so do alternative drugs used for NICU procedures.
However, pain can affect babies' brains as well. Researchers are concerned much more research needs to be done to protect the preemies from both pain in procedures and future risks. Anesthesia is used for tube insertion for breathing or feeding, and many NICU residents require surgeries. If baby needs a procedure or surgery, anesthesia is also necessary so for now the best practice is to use what is required, and not be gratuitous with surgeries, and to have close follow up as the child grows to make sure early intervention services are utilized if needed.
12 Being Surrounded By Infections
Newborns are already so vulnerable, but a premature baby is by definition especially fragile, having not been ready for the outside world yet. One of the biggest dangers to a NICU resident will be infection. They just don't have a well-functioning immune system to fight off things stronger babies can. Some examples are infections passed on from mom to baby during birth, like a group B strep infections. Others are called nosocomial infections, or infections that are acquired in the hospital, and the most common is Staphylococcus aureus, which can include the antibiotic resistant type, MRSA.
This is often due to repeated invasive procedures like IVs, catheters and such and through the skin these infections invade baby's skin. Hand-washing, adequate spacing of incubators and proper hygiene are very key in prevention, as is being vigilant about identifying infection as soon as possible. Overuse of antibiotics, as preventatives, is not recommended.
11 Having Trouble Breathing
Breathing problems are another very common danger to babies residing in the NICU area of the hospital. This is primarily due to the fact that one of the last things to fully develop in a newborn are those lungs. They are also not able to regulate breathing as well as older infants, thus they are subject to apnea or spells of not breathing. Monitors and supplemental oxygen are necessary for this. BPD is another risk, which is bronchopulmonary dysplasia. It's a chronic lung disease that arises from respiratory distress syndrome, which is when the small air sacs in the lung collapse.
Oxygen and possibly tubes into the windpipe may be required. Of course, all these problems may give rise to pneumonia, or lung infection. This is a big danger for NICU babies. Treatment includes antibiotics and oxygen.
10 Facing Anemia
Anemia in premature babies is quite common, as they miss out on those final days of gestation when they build up iron stores to produce red blood cells. With a lacking supply, and then repeated procedures such as blood tests, it's not unusual to need iron supplementation or even blood transfusions. Also, according to the March of Dimes, there are drugs that help babies with red blood cell production, a boon for preemies in the NICU. If anemia went untreated it would prevent proper growth in the newborn, in both weight and overall growth. Anemic babies are more lethargic, and move less.
They also can have rapid heart rates and become developmentally delayed. These delays could be a longterm issue, if not treated appropriately. However, since it's an expected complication today, most babies need not get to the point of being delayed, with treatments available.
9 Learning How To Eat
Digestive issues are a major hurdle most preemies have to overcome in their time in the NICU. The reason why this is so common is that preemies are not developed enough to manage swallowing and breathing well in coordination. Usually before 34 weeks gestation it's too difficult a task for them. While breastmilk is ideal and easily digested, very tiny newborns may not be able to adequately suck, and will need IV feedings initially.
Then they may be given breast milk, or sometimes formula, through a tube inserted in either the nose or mouth that runs to the stomach. Sometimes the tube is left in place, and other times it is only inserted for feedings. Babies this young do not have gag reflexes so it's not as difficult as it would seem. Once baby is swallowing and sucking well while breathing properly, it's time to begin breast or bottle feedings.
8 Living With PICC Lines
Another risk of the NICU for preemies is having a PICC line inserted. Also called a central line, PICC stands for percutaneously inserted central catheters. These thin, flexible plastic tubes are inserted in a major vein typically in the leg or arm and run to one of the major veins near the heart. Nutrients and medications can be delivered more directly and without risk to smaller and more vulnerable veins that may become irritated. While it can be scary for parents, ultimately the risk of infection and upset to baby is less because there won't be so many repeated pricks or sticks.
PICC lines can be used for 2 to 3 weeks at a time, sometimes even longer. There are risks with PICC lines, such as infection (which is dangerous given the proximity to the heart), infiltration when the IV wears at the wall of the blood vessel and the IV liquids leak into the surrounding tissues of the body, and breakage of blood vessels. However, these are not terrifically high risks statistically.
7 Facing Severe Brain Problems
NICU residents are particularly vulnerable in the most complex area of our development; our brains. NICU babies are prone to seizures, meningitis, and stroke, as well as intraventricular hemorrhage or IVF, hydrocephalus or water on the brain, and infections of the nervous system. With IVF, the most affected are babies weighing 3.5 pounds or less. These are graded from level I (least serious) to level IV (most serious.) Most babies are in level I or II, and will recover fully.
More serious brain bleeds mean possibility for more severe complications and some will require observation throughout infancy and childhood. Some infants may have brain malformations that require treatment, or careful monitoring. Neural tube defects are also brain related conditions that may impact a preemie in NICU. If baby's brain is affected, parents can expect to work with a team of experts in the field to care specially for baby.
6 Not Being Able To See
Babies born too soon or in the NICU are often diagnosed with ROP, or retinopathy of prematurity, which is where tiny babies have irregular blood vessels in the eyes and this affects the retina. ROP is an eye disorder that can cause blindness or significant vision loss, and it hits the smallest babies the hardest. Those weighing 2 3/4 pounds or less are most likely to develop ROP. About 90 percent of babies with ROP fall in the mild category.
Around 15,000 preemies get ROP, and of those, about 500 become legally blind from the condition. Babies with ROP are more prone to other eye conditions such as nearsightedness, retinal detachment, and crossed eyes, as well as lazy eye and glaucoma. There are effective treatments for ROP, including laser therapy and cryotherapy.
5 Learning To Regulate Their Core Temperature
From the ultra high-tech methods to some basic hacks, hospitals around the world struggle to keep preemies warm enough. Babies lose heat 4 times faster than adults, and while all newborns have trouble staying warm, preemies and low birthweight infants have a very difficult time maintaining body heat due to a lack of body fat. Babies use oxygen and energy to warm themselves, and stressful conditions make babies use up their oxygen sometimes at dangerous rates in the NICU.
This is another reason why temperature regulation is key. Incubators or isolettes are enclosed boxes that babies may be placed in during a NICU stay, while others may be kept warm in a open radiant warmer. However, many hospitals are using plastic bags to keep babies warm enough. This is a great boon to areas where high tech warmers or even NICU's aren't available.
4 Living With An Underdeveloped Liver
If your preemie looks a bit like a banana or lemon, don't think labor has affected your eyes. Yes, preemies often have a tinge or more of yellow coloring to their skin and eyes due to jaundice. According to the March of Dimes, this yellowish appearance is caused by the build up of bilirubin in the blood. Essentially what happens is that bilirubin is a byproduct of the body's breaking down of red blood cells. Before birth, your liver did the job for baby and got rid of this yellow substance left over from the breakdown. But after birth, baby's liver might not quite be keeping up.
While a number of factors can contribute to jaundice in newborns, being a preemie is a major one since the liver may not yet be fully developed. Treatment is pretty straightforward and simple, for example, using special lights on your baby. More serious cases may require treatment with blood products or a transfusion.
3 'Failure To Thrive'
Failure to thrive sounds quite dire, and while that certainly can be the case, it doesn't necessarily have to be. Failure to thrive is basically not growing or gaining weight as expected. Since preemies come into the world too early, of course their growth and weight is likely to be out of sync with other age mates. It's important to correct for the age they were due to to be born, for one thing. However, some do struggle to grow and gain weight due to problems related to prematurity.
Some preemies have other health issues that can affect feeding or weight gain, so should a NICU infant be FTT diagnosed, efforts will be made to see if other factors are complicating eating. Also, before being discharged from the NICU adequate growth will need to be made, and a plan for nutrition and observation will be shared with the parents.
2 A Heightened Risk Of SIDS
The Mayo Clinic defines SIDS as an "unexplained death," usually during sleep and typically in infants under age 1 who otherwise seemed healthy. It used to be called crib death as well. SIDS stands for "sudden infant death syndrome." It's believed there is a problem in the brain maturity that controls breathing that is behind these tragic deaths. Being premature ups the likelihood that such a brain immaturity or irregularity would exist in the child. Other factors are respiratory illnesses or conditions and low birth weight, both issues that commonly are seen in preemies.
Not all NICUs are entirely compliant on safe sleep standards as outlined by the American Academy of Pediatrics. If you see your baby sleeping on his side or tummy, ask for baby to be placed on his back. While baby is monitored closely in the NICU, this is no guarantee that nothing can go wrong. Ask questions of the NICU caregivers until you feel satisfied with the answers regarding your baby's health.
1 The Heart Trying To Keep Baby Alive
A common area of concern with preemie residents in the NICU is the heart. There are a number of cardiac related problems, such as PDA-which is not public display of affection but rather patent ductus arteriosis where major heart blood vessels don't close properly. This can lead to respiratory issues, or even heart failure. Another heart related problem is low blood pressure or hypotension. Other congenital heart defects are also rather common in preemies, and may actually influence premature birth.
My son was born with such an anomaly, but thankfully it resolved itself before surgery was required. Some malformations of the heart, will however required surgical procedures to save the baby's life. Other times simple monitoring and perhaps medication will do the trick.
Sources: MarchOfDimes.org, Chop.edu, nei.nih.gov, Parents.com, MerckManuals.com, KidsHealth.org, FDA.gov, MayoClinic.org
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