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When Your Baby's Born Premature (for Parents)

What Is Prematurity?

Babies born more than 3 weeks earlier than their expected due date are called "premature." Premature babies (preemies) didn't have enough time to grow and develop as much as they should have before birth.

Why Was My Baby Born Early?

Most of the time, doctors don't know why babies are born early. When they do know, it's often because a mother has a health problem during pregnancy, such as:

• diabetes (high blood sugar)
• hypertension (high blood pressure)
• heart or kidney problems
• an infection of the amniotic membranes or vaginal or urinary tracts

Babies also may be born early if:

• there's bleeding, often due to a low-lying placenta (placenta previa) or a placenta that separates from the womb (placental abruption)
• the mother's womb is not shaped typically
• they're part of a multiple birth (twins, triplets, or more)
• their mother was underweight before pregnancy or didn't gain enough weight during pregnancy
• their mother smoked, used drugs, or drank alcohol while pregnant

Does My Baby Need Special Care?

Yes, preemies may have many special needs. Younger and smaller babies tend to have more health problems than babies born closer to their due dates. So they often need care in a neonatal intensive care unit (NICU).

Why Must My Baby Stay Warm?

Preemies don't have enough body fat to hold their body temperature. Incubators or radiant warmers keep them warm in the NICU:

• Infant warmers: These small beds with heaters over them help babies stay warm while being monitored. Because they are open, the team has easy access to babies to provide care.
• Incubators: These small beds are enclosed by clear, hard plastic. Temperature in the incubator is controlled to keep a baby's body temperature where it should be. Doctors, nurses, and others can give care to the baby through holes in the sides of the incubator.

What Are My Baby's Nutritional Needs?

Breast milk is the best nutrition for all babies, especially preemies. It has proteins that help fight infection. Most preemies can't feed straight from the breast or bottle at first. Mothers pump their milk and it's given to babies through a tube that goes through the nose or mouth and into the stomach.

If that is not an option, doctors may suggest giving the baby donor milk from a milk bank, which is safe.

If you don't breast feed or pump milk, your baby will get formula. Preemies need more calories, proteins, and other nutrients than full-term babies do. So extra nutrients called fortifiers may be added to pumped milk or specially designed preterm formulas may be used to help your baby grow.

Preemies are fed slowly because they can get necrotizing enterocolitis (NEC), a serious intestinal problem that affects preemies.

Some babies who are very small or very sick get their nutrition through intravenous (IV) feedings called total parenteral nutrition (TPN). TPN has a special mix of nutrients like proteins, carbohydrates, fats, vitamins, and minerals that can fully support a baby’s growth until they can feed.

Doctors and dietitians watch the diets of preemies very carefully and make changes when needed to make sure the babies get the nutrients needed to grow.

What Health Problems Can Happen?

Because their organs aren't fully ready to work on their own, preemies are at risk for health problems. In general, the earlier a baby was born, the greater their chances of health problems.

These problems include:

• anemia, when babies don't have enough red blood cells
• apnea, when a baby stops breathing for a short time; the heart rate may lower; and the skin may turn pale or blue
• bronchopulmonary dysplasia and respiratory distress syndrome, problems with breathing
• hyperbilirubinemia, when babies have high levels of bilirubin, which is produced by the normal breakdown of red blood cells. This leads to jaundice, a yellowing of the skin and whites of the eyes.
• necrotizing enterocolitis, a serious disease of the intestines
• patent ductus arteriosus, a problem with the heart
• retinopathy of prematurity, a problem with the eye's retina
• sepsis infections that babies can get before, during, or after birth

What Else Should I Know?

Preemies often need special care after leaving the NICU, sometimes in a high-risk newborn clinic or early intervention program. Depending on their health, they may need care from specialists, such as doctors who treat problems with the brain and nervous system (neurologists), eyes (ophthalmologists), and lungs (pulmonologists).

Preemies must go to all doctor visits (including well-child checkups), get the vaccines that all babies need to stay healthy, and have routine hearing and eye exams. As your little one grows, doctors will check your baby's:

• growth
• development, including speech and language, learning, and motor skills
• muscle tone, strength, and reflexes

Looking Ahead

Caring for a preemie can be more demanding than caring for a full-term baby.

Take care of yourself by eating well, resting when you can, and getting exercise. Spend one-on-one time with your other children when you can, and get help from others. Look for support from friends, family, and support groups. You also can get support online from groups such as:

• March of Dimes
• Graham's Foundation
• Life's Little Treasures Foundation
• Hand to Hold

Reviewed by: Lynn M. Fuchs, MD

Date reviewed: October 2021

Your baby was born prematurely | Regional Perinatal Center

Premature babies

If your baby is born too early, the joy of having a baby can be overshadowed by health concerns and thoughts about the possible consequences.

Instead of returning home with the baby, holding him and caressing him, you will have to stay in the department, learn to cope with the fear of touching the baby, realize the need for treatment and various manipulations, get used to the complex equipment that surrounds him. nine0005

In this situation, not only your baby needs help, you need it too! The best assistants are your loved ones, their love and care, as well as professional advice and recommendations from doctors and psychologists. This section of articles will help you improve your knowledge of preterm infant care, development and nutrition.

Your help for the baby

Previously, parents were often not allowed into the neonatal unit and, especially, into the intensive care unit because of the fear of infection of the baby, but now the contact of the parent with the child is recognized as desirable and is prohibited only in exceptional cases (for example, if parents have acute infections)

Close communication between you and your baby is very important from the first days of his life. Even very immature premature babies recognize the voices and feel the touch of their parents.

The newborn needs this contact. Studies have shown that it greatly contributes to the faster adaptation of an immature child to new conditions and the stabilization of his condition. The baby's resistance to therapy increases, he absorbs large amounts of food and quickly begins to suck on his own. Contact with the child is important for parents. Taking part in the care of the baby, they feel their involvement in what is happening and quickly get used to a new role, especially when they see how he reacts to their presence. nine0005

By constantly and attentively observing the baby, parents can notice the smallest changes in his condition before others. In addition, communication in the hospital is a good practice that will undoubtedly come in handy after discharge. For parents, early physical contact with the baby is very valuable, because it allows them to feel him, despite the incubator and other obstacles, and show him their love.

Treatment in the neonatal intensive care unit requires parents to have full confidence in all medical staff. nine0005

Nursing premature babies in the hospital

Many premature babies cannot breathe, suckle and regulate their body temperature sufficiently after birth. Only in the last weeks of pregnancy is the maturation of the lungs, gastrointestinal tract, kidneys, brain, which regulates and coordinates the work of all organs and systems.

Fluid loss due to the immaturity of the skin of premature babies and the insufficiency of thermoregulation processes require constant attention. Modern approaches focused on nursing premature babies help to cope with these problems. nine0005

Heat regulation incubator

Premature babies are very susceptible to temperature fluctuations. At the same time, clothing can interfere with the monitoring of the baby's condition and its treatment. That is why an incubator is used to provide the conditions necessary for premature babies. It maintains a certain temperature and humidity, which change as the child grows. When the body weight of a premature infant reaches 1500-1700 g, he can be transferred to a heated bed, and after reaching a weight of 2000, most premature babies can do without this support. There are no strict rules here: when nursing children with low body weight, doctors are guided by the severity of the condition of each premature baby and its degree of maturity. nine0005

In incubators, very young premature babies are placed in special "nests" - soft hemispheres in which the baby feels comfortable and assumes a position close to intrauterine. It must be protected from bright lights and loud noises. For this purpose, special screens and coatings are used.

Critical treatments during the first days of life of premature babies with low and very low birth weight:

Use of an incubator or heated bed. nine0005

Oxygen supply for respiratory support.

If necessary, artificial ventilation of the lungs or breathing using the CPAP system.

Intravenous administration of various drugs and fluids.

Carrying out parenteral nutrition with solutions of amino acids, glucose and fat emulsions.

Don't worry: not all premature babies need such extensive treatment!

Mechanical ventilation and CPAP for respiratory support

When it comes to nursing, oxygen supply is of the utmost importance for premature babies. In a child born before the 34-35th week of pregnancy, the ability of the lungs to work independently is not yet sufficiently developed. The use of a constant flow of air with oxygen, which maintains a positive airway pressure (CPAP), leads to an increase in blood oxygen saturation.

This new method made it possible for the majority of even very immature children to do without mechanical ventilation. The need for intubation of children has disappeared: during treatment with CPAP, oxygen is supplied through short tubes - cannulas that are inserted into the nasal passages. CPAP or mechanical ventilation is continued until the lungs can function at full capacity on their own. nine0005

In order for the lungs to expand and remain in such a state in the future, a surfactant is needed - a substance that lines the alveoli from the inside and reduces surface tension. Surfactant is produced in sufficient quantities starting from the 34-35th week of pregnancy. Basically, it is by this time that the formation of the lungs is completed. If the baby was born earlier, modern technologies allow the introduction of surfactant into the lungs of premature babies immediately after their birth.

Parenteral nutrition - administering nutrient solutions by vein

Premature babies, especially those born weighing less than 1500 g, are not able to get and absorb enough nutrients, even when fed through a tube. For the rapid growth of the baby, a large amount of nutrition is needed, and the size of the stomach is still very small, and the activity of digestive enzymes is also reduced. Therefore, such children are given parenteral nutrition.

Special nutrients are injected into a vein using infusion pumps that deliver solutions slowly at a predetermined rate. In this case, amino acids necessary for building proteins, fat emulsions and glucose, which are sources of energy, are used. These substances are also used for the synthesis of a number of hormones, enzymes and other biologically active substances. Additionally, minerals and vitamins are introduced. nine0005

Gradually, the volume of enteral nutrition increases, and parenteral nutrition decreases until it is completely canceled.

Premature infants with gastrointestinal disease require parenteral nutrition for a longer period of time.

By the time your grown baby is discharged from the hospital, everything should be well prepared at home. And this applies not only to the environment, clothes and means of caring for the child.

All family members must be ready to receive the baby. Of course, the main care will fall on the shoulders of the parents. Although you have already gained some experience in the hospital, it is important to feel the support of others, especially in the early days.

Older children can also help. The discharge of your baby is a great joy that you want to share with all your relatives.

While you are getting used to your new role, it is important that nothing distracts you from communicating with your child. Now all the care and responsibility for the baby lies entirely with you. Everything you need to take care of him should be at hand. nine0005

Preparing for discharge from the hospital

Before discharge, you must make sure that:

• Prepared the crib, bath for bathing and a place for changing clothes, preferably a changing table. A crib should be placed in the parents' bedroom, the child should not be left alone even at night. A stroller is also required. you have baby milk that was recommended by the doctor before discharge (if the child is on mixed or artificial feeding). As a rule, this is a specialized medical product. You need a certain number of small bottles and teats of the appropriate size, as well as a sterilizer. All premature babies will need pacifiers. nine0126
• You have fully mastered breastfeeding or bottle feeding.
• If your baby is not suckling all the required amount of milk from the breast and is supplementing from a bottle, you have purchased a breast pump that you have learned to use; you may also need it if you have a lot of breast milk.
• You have asked your doctor how often your child's weight should be monitored.
• If your baby still needs medication, you have the required amount at home. And you know exactly how and when to give them to your child. nine0126
• You know which warning signs to look out for.
• After the baby is discharged, a pediatrician and a neonatologist will look after the baby, to whom you will give the discharge summary from the hospital.
• You know how the hospital from which your child is being discharged will provide follow-up care after discharge.
• You know which specialists and how often should examine your baby (oculist, neuropathologist, etc.). nine0126
• All the emergency phone numbers you need are at your fingertips.

When can a child go home

This question is very difficult to answer because all children are different. The stay in the hospital can last from 6 days to 6 months, depending on the degree of prematurity of the child, the severity of his condition, as well as the presence of certain complications.

Of course, all parents look forward to the moment when the baby can be brought home. Long-term nursing of a premature baby is often a difficult test for you. But we must not forget that safety comes first, and the baby can be discharged home only when the doctors are confident in the stability of his condition. It is certainly in your interest as well. nine0005

The rate of increase in body weight and length

Weight gain is the main indicator of the growth of the baby and the adequacy of the treatment. The weight of the child, especially in the first days and weeks of life, is influenced by a number of factors: the presence of milk in the stomach (immediately after feeding), the time of bowel movement, the degree of filling of the bladder, the presence of edema. Therefore, if an edematous child does not gain weight for several days, and perhaps even loses it, do not worry. It should be remembered that children grow unevenly and periods of high weight gain alternate with lower ones. It is better to focus not on weight gain per day, but on the dynamics of this indicator over several days or a week. nine0005

It is currently accepted that in the interval corresponding to 28-34 weeks of pregnancy, the normal weight gain of the child is 16-20 g/kg per day. Then it is reduced to 15 g/kg.

It is also important to take into account the rate of increase in body length. With malnutrition, at first the child gains less weight (or even loses it), and with a more pronounced deficiency of nutrients, his growth is also disturbed.

The weight must not only increase at a certain rate, but must also correspond to the length of the baby. An important parameter characterizing the development of the baby is an increase in the circumference of the head. The brain most actively increases in size during the first 12–18 months of life. But an excessively rapid increase in head circumference, as well as a slowdown in its increase, indicate neurological disorders. nine0005

A premature baby can be discharged from the hospital if:

• he is able to independently maintain the required body temperature;
• does not need breathing support and constant monitoring of the work of the respiratory and cardiovascular systems;
• can suck out the required amount of nutrition on its own;
• does not need round-the-clock monitoring and frequent determination of biochemical or other indicators; nine0126
• supportive care can be provided at home;
• he will be under the supervision of a local pediatrician and neonatologist at the place of residence.

The decision to discharge home is made for each patient individually. In addition to the state of health of the baby, the degree of preparedness of parents, their ability to provide high-level care for a premature baby is also taken into account.

Feeding a premature baby after discharge

Breastfeeding is the ideal way to feed premature babies.

However, if the baby was born much prematurely and his birth weight did not exceed 1800-2000 g, his high nutritional requirements cannot be met by breastfeeding. The growth rate will be insufficient. Moreover, over time, the content of many nutrients, including protein, in milk decreases. And it is the main material for building organs, and primarily brain tissue. Therefore, proteins must be supplied to the body of a premature infant in the optimal amount. nine0005

In addition, premature babies have a significantly increased need for calcium and phosphorus, which are essential for bone formation.

In order for the baby's nutrition to be complete even after being discharged from the hospital, special additives - "enrichers" are introduced into breast milk in a certain amount, already less than in the hospital. They make up for the lack of protein in it, as well as some vitamins and minerals. As a result, the child receives them in the optimal amount. The duration of their use will be determined by your doctor. If there is not enough milk or it does not exist at all, children born prematurely should be transferred to artificial feeding. Complementary feeding of premature babies is carried out with special children's dairy products designed for children with low birth weight. This baby milk is ideally suited to both the ability of immature children to digest and assimilate nutrients, and their needs. nine0005

Premature infant milk contains more protein, fat and carbohydrates than term infant milk, resulting in a higher calorie content. In specialized baby milk, the concentration of many minerals is higher, especially iron, zinc, calcium, phosphorus, as well as vitamins, including vitamin D. Long-chain polyunsaturated fatty acids of the Omega-3 and Omega-6 classes are introduced into such products, which are necessary for proper development of the brain and organ of vision, as well as nucleotides that contribute to the optimal development of immunity. However, when the child reaches a certain weight (2000-2500 g), you should gradually switch to feeding with standard baby milk, but not completely. Specialized baby milk can be present in the diet of a premature baby for several months. This time, as well as the volume of the product, will be determined by the doctor. He will answer all your questions about how to feed your baby. nine0005

At present, specialized children's dairy products have been developed and are being used to feed premature babies after discharge from the hospital. In its composition, it occupies an intermediate position between a specialized product for premature babies and regular baby milk. Your baby will be transferred to such baby milk while still in the hospital. You will continue to give it to your child at home, and the doctor, watching him, will tell you when it will be possible to switch to regular standard baby milk. If the baby was born with a very low body weight or is not gaining weight well, special baby milk can be used for a long time - up to 4 months, 6 or even 9months. The beneficial effect of such children's dairy products on the growth and development of the child has been proven in scientific studies.

Feeding needs for premature babies

Higher caloric intake because they need to gain weight faster than term babies.

More protein as premature babies grow faster.

More calcium and phosphorus for bone building.

More trace elements and vitamins for growth and development. nine0005

A premature baby grows faster than a term baby. Nutrition for such children is calculated taking into account body weight at birth, the age of the baby and its growth rate. As a rule, the calorie content of the daily diet is about 120-130 calories per 1 kg of body weight.

It is very important that your baby continues to gain weight quickly and grow in length after discharge. To do this, feeding premature babies must be carried out using a specialized fortified diet prescribed by a doctor. nine0005

We answer important questions about preterm babies — CSM Zdravica

Every year, thousands of premature babies are born in Novosibirsk, weighing no more than one kilogram. After being discharged from the hospital, such "early" babies need special care and qualified supervision by a pediatrician.

For many years, small patients with extremely low body weight have been successfully observed in Zdravitsa. Over the past 5 years, 9 people have come out here and put on their feet23 babies.

Nadezhda Georgievna Vasilchenko, Head of the Department of Pediatrics at Zdravitsa, spoke about the special conditions created for babies in this clinic and how mothers and fathers can help the development of a premature baby at home.

When should a baby be born to be called premature?

Up to 38 weeks, 37 weeks is the upper limit of the estimate, the lower is 24 weeks. Extremely low body weight is considered to be a child weighing up to one kilogram, and very low - from one to one and a half kilograms at birth. nine0005

How is such a child different from a baby who was born at term?

This is a small child who does not keep heat very well or does not keep heat at all, whose lung tissue has not fully matured, and he cannot breathe on his own, he needs oxygen support, warming, these children are nursed in an incubator where oxygen can be given in different ways: mask, artificial lung ventilation. This is a child who can give edematous syndrome, especially if there is an element of hypothermia, these children are usually small, they cannot swallow themselves, so they are often fed through a tube. nine0005

Until what time are such children in the incubator? Are they discharged at 41 weeks?

No, when they gain weight around 2 kg, keep warm, start sucking and swallowing themselves, it's all individual. If everything goes well, and he is just premature, then he is discharged in 2-3 months.

What problems can premature babies have that parents will have to face?

The most common is bronchopulmonary dysplasia, that is, underdevelopment of the lungs, as there is not enough surfactant, this is a substance that prevents the lungs from sticking together, and because of this, the lung cannot fully open. Also dysbiosis, since colonization of the intestine is not the same as in a full-term baby. Anemia is a lack of iron / hemoglobin, since the child receives the main amount in the 3rd trimester of pregnancy, and this child was born before that time. Almost every premature baby suffers from this condition. Reduced immunity as the microbiota cannot fully develop. Due to immaturity, retinopathy of the newborn develops, or such children are at risk for retinopathy, so they are observed by ophthalmologists according to a special schedule, they are removed from the register when the gestational age approaches 40 weeks, by which time the fundus is formed. (Retinopathy is a lesion of the retina of the eyeball of any origin. The main cause is vascular disorders that lead to a disorder in the blood supply to the retina). nine0005

Is prematurity a sentence? Will the child always get sick?

No, this is the state at the time of birth. Yes, these children will be with developmental disabilities, but they always have a head start. When we evaluate the psychomotor development of a child, we focus on his post-conceptual age, that is, he was born prematurely and should be like a child of 2 months of age, although his passport age is already 6 months.

Over time, these kids are trimmed, everything is very individual. As a rule, by the age of 1.5 it is no longer possible to distinguish such a child from a full-term one. And those children who were born at 35-36 weeks, they can no longer be distinguished from an ordinary baby even in a year. We are now talking about the backlog of children who were born at a very early stage with very low or extremely low body weight. nine0005

How susceptible are these children to infections?

In different ways, sometimes such children are cared for in very comfortable conditions and, for example, if there are no older children in the family, then they may not get sick at all, but we are talking about the first year of life. If we take an older age, then these children need special supervision, so it all depends on what such a child is fed, breast milk is very important for strong immunity. Yes, these children will be at risk, this does not mean that they will get sick. nine0005

How to properly feed premature babies? Are the timing of complementary foods shifting? What are the children fed in the couveuse?

As a rule, for such children, the ideal option is breastfeeding or native, native is formula, breast milk and formula. Such feeding is important, because we populate the flora of the child and his intestines begin to work and perform their function in nutrition, the intake of nutrients and the formation of immunity. For feeding premature babies, there are special mixtures that belong to the PRE group. These are mixtures for small premature babies with a higher concentration of proteins and fats, due to which children gain well in weight and equalize with the weight gain of full-term babies. The time of transfer to a regular formula is individual for each child; at each examination by a pediatrician, the doctor must calculate the amount of food. In the introduction of complementary foods, we focus on the post-conceptual age, for example, a child is 8 months old, a full-term baby at this age would already receive 3 meals of complementary foods, and in premature babies, we only introduce the first complementary foods, focusing on how ready the child is for its use. nine0005

Can they be vaccinated?

These children must be vaccinated, as their immunity is weaker. Usually they begin to vaccinate them in the hospital, and then, if there are no contraindications and the child is healthy, then they are vaccinated according to an individual vaccination schedule.

How are premature babies observed in Zdravitsa? What should mom do after being discharged from the hospital and what kind of help will she get here?

We have several programs for monitoring premature babies, depending on birth weight. Supervision programs include all necessary services for a child of this age. Of course, these children are special and they have their own individual observation schedule, which includes all the necessary specialists. The attending physician and the head of the department will monitor the well-being and development of the baby. Moreover, it can be both receptions at home and calling a specialist at home. Mandatory consultations of specialized children's specialists - an ophthalmologist, neurologist, cardiologist, surgeon, otorhinolaryngologist, orthopedist, pulmonologist, dentist, immunologist. Random people do not work in our children's department, our team consists of only highly qualified specialists with in-depth knowledge and extensive and successful practical experience. 14 pediatricians of our clinic completed a refresher course in gastroenterology, and all pediatricians, without exception, learned baby massage with a specialist. Now, at the reception, they can show parents a number of basic massage movements, exercises and exercise therapy techniques. nine0005

Can a mother, while the child is still in the hospital, ask for help so that the doctor is always in touch with her?

Of course, it can, but in this case it is better not to buy the program yet, but just come to me for a consultation and then keep in touch. Or use the online consultation service. You need to understand that the doctor cannot influence the stages of observation and management of the child in the hospital, cannot influence his treatment. But a doctor can support a mother, advise on breastfeeding, prepare for the baby at home, prevent the risk of allergies, hypothermia, give advice on how to equip a nursery, and so on. nine0005

Is there a time in your history when you saw a premature baby and then he made some progress?

Yes, there are such stories, there was a case when a child was born with a weight of 600 grams, spent a long time in a children's hospital, during the examination it turned out that almost all body systems were involved in the pathological process she herself was scared how the child would get out of this state. But the parents believed in him, invested a lot of time and effort, there were various consultations of doctors and various interventions, as a result, at 1.5 years old, the child walked, was very active at the reception, rolled cars, looked at toys, tried to communicate, and not with the help of gestures that he had long mastered, but with the help of words, and this communication was conscious. Therefore, a very small premature baby is not always a sentence. nine0005

How can parents know if their child is developing normally?

You need to be monitored regularly, in the first six months it is 2 times a month, then every month you go through all the narrow specialists, and if one of the doctors suspects that something has gone wrong, then you need to intervene in a timely manner and not put off treatment indefinitely. Here, feeding and timely introduction of complementary foods, obtaining all the nutrients are of great importance, which contributes to a sufficient set of muscle mass, brain mass.

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