Caring for your premature baby

BABIES born before the 37th week of gestation are considered premature (sometimes called "preemies"). Such babies need special care and attention before they can be discharged from hospital.

Some preemies will be admitted into a specialised unit of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU provides specialised care for preemies as they have had less time to grow and develop in the womb. Delivery before its due time may lead to several medical problems, and the severity of the problems faced by the baby is highly dependent on the degree of prematurity (i.e. the earlier the birth, the more problems faced).

The length of stay in the NICU will depend upon several factors, namely medical stability, consistent weight gain, the ability to orally ingest milk, and whether body temperature is stable in an open crib.

Once stable, he will be transferred to the Special Care Nursery (SCN). The baby will still require his milk feeds via a feeding tube and continuous monitoring to make sure that there are no complications, e.g. apnoea (stops breathing) or bradycardia (drop in heart rate).

This is where you will begin to interact with your baby more frequently, stroking him more often for bonding, changing his diapers, holding him in your arms for brief moments, putting on his clothes, etc.

Much of the know-how and skills for early care of the preemie at home would be taught to you by the SCN nurse. You will be increasingly involved in the daily routines of your baby whilst he is still being nursed in the SCN.

Bringing baby home

Once your baby is ready to be discharged into your care, you will need to learn about "Infant CPR" in order to be ready for any potential emergencies.

Preemies have a higher risk for various problems such as apnoea, vomiting, choking and sudden infant death syndrome (SIDS).

Some babies may be sent home with an apnoea monitor. If this happens, you will be taught how to use this device and how to respond in case of an emergency.

Get your paediatrician or SCN nurse to advise you on the exact details.

For the first few weeks at home, here are some things you should know:

Sleeping. As your preemie's brain is not as fully developed at birth as other full-term infants, you may expect your baby to sleep more than other full-term infants. You will be advised to put him to sleep in either the lateral (either on the right or left side) position or on his back. He should not be nursed on the prone (front) position to reduce the risk of sudden infant death syndrome (SIDS).

Bathing. All babies, especially preemies, have sensitive skin that gets dry very quickly. Bathe your baby daily as taught by the SCN nurse whilst in hospital.

Babies who sweat a lot or spit up often will need to be cleaned by the top and tail method as instructed.

To decide whether to give your baby a sponge bath or a tub bath, first look at the umbilical cord. If it is still attached, or there is some oozing or bleeding from the site, then give your baby a sponge bath.

The same applies if he has been circumcised and the circumcision is still healing.

Once the cord and circumcision have healed nicely, then the choice is yours. If you are not confident yet to give your baby a tub bath as he can be very slippery when wet, then choose a sponge bath.

Crying and hypersensitivity. It's normal for both preemies and full-term infants to cry for up to three hours a day by six weeks after birth. Too much light, sound, touch, movement, or even a quiet environment after living in the noisy NICU can easily disturb your preemie. Try to create a more calming environment and hold him close to you as much as possible.

Feedings. The hospital may inform you of the feeding schedule that your baby was on and this will guide you on how often to nurse or bottle-feed at home. Most preemies need eight to 10 feedings a day with no more than four hours between each session.

To avoid infant dehydration, never go longer than four hours between feedings. If your baby does three to four wet nappies daily, you can be reassured that he has had enough milk feeds.

Keep baby away from exposure to:

·Diseases and smoke. Your preemie needs more protection as his immune system is still developing and he has immature lungs at birth.

·Family members and friends who are ill.

·Public places during the first several weeks after birth, and during the colder, rainy seasons.

Protect baby from serious illness. Get your baby immunised with the mandatory vaccinations as well as other recommended vaccines if possible. The latter vaccines include protection with pneumococcal conjugate, rotavirus, and influenza vaccines. Make sure that you and your family members who will be in contact with your baby are immunised too.

With the great amount of time spent on caring for your premature infant, you and your spouse must also remember to take care of yourselves. You will depend on each other for support, and if you have other children, they would also depend on you to be physically and emotionally able to care for them.

Accept offers of help from family and friends to baby sit your other children so you can have some time to rest. Don't forget to eat well and exercise moderately.

If you feel overwhelmed or depressed, seek support and encouragement from doctors, nurses, other parents, support groups, or online communities.

> Datuk Dr Musa Mohd Nordin is a consultant paediatrician and neonatologist. This article is courtesy of the Positive Parenting Programme by the Malaysian Paediatric Association. The opinions expressed in the article are the views of the author. For further information, please visit