What to Expect the First Year (131 page)
Read What to Expect the First Year Online
Authors: Heidi Murkoff
Wondering about when to start solids? Like full-term babies, preemies should start receiving solids at about 6 months. But for preemies, that date is based on adjusted age rather than chronological age (which means a preemie who was born 2 months early might not be ready for solids until 8 chronological months). Because some preemies experience delays in development, solid feedings should not be started until there are signs of readiness (
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), even if the corrected age says it's time to bring on solids. Some preemies have a more difficult adjustment to solidsâespecially once they graduate to chunkier foodsâoften because of negative oral associations picked up earlier. Working with a speech or occupational therapist can help a baby overcome oral aversions and move on to a lifetime of healthy eating.
Bonding
“How will I ever bond with my preemie if she's spending the first few months of her life in the NICU?”
Your baby was whisked away moments after birth and before you even got a good look at her, she's too fragile to breastfeed, and she spends more time being poked and prodded by the hospital staff than snuggling in your arms. It's no wonder you're feeling as if bonding with your new babyâsomething that may seem so easy and natural to parents of full-termersâis an impossible goal to reach. But here's the real truth about bonding: The love and attachment between mom, dad, and baby develop over many months and years, blossoming over a lifetime rather than bursting into full bloom during the first few moments of life. So if you didn't get the chance to bond with your preemie newborn the way you had dreamed of, all is not lostâin fact, nothing at all is lost. Plus, there are plenty of ways to start the lifelong process nowâeven while your baby is still in the hospital. Here's how:
Ask for a picture, along with a thousand words.
Baby's not with you? Sometimes preemies have to be moved to another hospital for upgraded intensive care while mom's still stuck in the hospital postdelivery. If that's the case with you and your new bundle, have your spouse (or the hospital staff) email or text you some pictures and videos of your baby so you can enjoy looking at them until you're able to look at the real thing. Even if more tubing and gadgets are visible than baby, what you see will likely be less frightening and more reassuring than what you might have imagined. As helpful as a picture may be, you'll still want those thousand wordsâfrom your spouse, and later the medical staffâdescribing every detail of what your baby is like and how she's doing.
Be hands-on.
You may be afraid to touch your tiny, fragile babyâand you may even feel that he or she is better off not being touchedâbut studies have shown that premature infants who are stroked and lightly massaged while they
are in intensive care grow better and are more alert, active, and behaviorally mature than babies who are handled very little. So, assuming the neonatologist gives the okay (some very early preemies can't tolerate touch and find any kind of handling stressful), let your hands do the bonding. Start by gently touching those arms and legs, since they are less sensitive at first than the trunk. Try to work up to at least 20 minutes of stroking a day.
Care like the kangaroos do.
Skin-to-skin contact can not only help you get close to your baby, it can help with her growth and development. In fact, studies have shown that babies who receive so-called kangaroo care are likely to leave the NICU sooner. To cuddle your baby marsupial-style, place her on your chest under your shirt so that she's resting directly on your skin (she'll probably be wearing only a diaper and a hat, which prevents heat loss via the head). Loosely place your shirt over her to keep her even warmer, or cover her with a blanket. See
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for more.
It turns out kangaroos are more than just cuteâwhen it comes to caring for their new babies, research shows they're smart, too. Snuggling a baby (particularly a preemie) skin-to-skin is a marsupial-inspired parenting practice that comes with many substantial benefits, right from the start and continuing throughout the NICU stay and beyond. For your baby, and for you.
You can start skin-to-skin contact, known as kangaroo care, as soon as the neonatologist determines that your baby is stable enoughâeven if she is very sick or very small, and hooked up to machines. Not only can't the snuggling hurt your baby, it can help in so many ways. Your baby will be comforted by your heartbeat, your scent, and the rhythm of your voice and your breathing. Kangaroo care will help maintain your baby's body warmth, regulate his or her heart and breathing rates, and speed weight gain and development. It'll also encourage deeper sleep, and help your baby spend more of his or her awake time quiet and alert instead of stressed and cryingâall of which help boost development.
The benefits of kangaroo care extend to you, too. Being close to your baby (even when you're not feeding) can help improve a mom's milk supply and your chances of breastfeeding success. It'll also, not surprisingly, help nurture bonding between you and your baby while building your confidence as a new parent. (It will be something you can do for your baby, in a NICU where most of baby's care is provided by strangers.)
What's more, both you and your baby will collect on the benefits of skin-to-skin contact even if it's only for short periods of time each day. Have the time, and protocol and treatment permit? The more kangaroo careâideally at least an hour at a timeâthe better.
Moms and dads can both offer kangaroo careâthere's no special equipment required (and dad's hairy chest definitely doesn't disqualify him). Simply hold your diapered baby upright on your bare chest (between your breasts if you're the mom), positioned tummy to tummy with a blanket or your clothes draped over your baby's back. Then breathe in your baby's scent, close your eyes, and relax. You're doing a world of good for your tiny bundle of joy, and for yourself.
Carry on a conversation.
Sure, it'll be a one-way conversation at firstâyour baby won't be doing any talking, or even much crying, while she's in the NICU. She may not even appear to be listening. But she'll recognize your voice (and your spouse's) from when she was in uteroâand she'll be comforted by the familiar sound. Can't be with your baby as often as you'd like? Leave a recording of your voice, talking, singing, or reading, that the nurses can play for your baby when you're not around. Just keep the volume down whenever you're near your little one, since her ears are still very sound-sensitive. In fact, for some very small preemies, any extra sounds can be extremely disturbing, so check with your baby's doctor about how much sound is just right for her and how much is too much.
See eye-to-eye.
If your baby's eyes are shielded because she's getting phototherapy for the treatment of jaundice, ask to have the bili lights turned off and her eyes uncovered for at least a few minutes during your visit so that you can make eye-to-eye contact while you're doing your kangaroo cuddling or through the isolette (
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) walls.
Take over for the nurses.
As soon as your baby's out of immediate danger, the NICU nurse will show you how to diaper, feed, and bathe her. You may even be able to perform some simple medical procedures for her. Caring for your tiny baby will help make you more comfortable in your new parent skin, offer a sense of normalcy, and give you some valuable experience for the months that lie ahead (particularly those first few weeks at home). If staff doesn't offer to show you these basics or give you the opportunity to get some hands-on experience, ask.
You'll hear many probably unfamiliar words and terms in the NICU. The faster you learn the lingo of prematurity, the more comfortable you'll be hearing it used when referencing your baby and his or her care. The following is a glossary of some of the most common NICU terms. Ask the NICU staff if they have more information or pamphlets that might list the common terms used in their hospital (which may be more comprehensive than this list).
A's and B's.
An abbreviation referring to episodes of apnea (breathing lapses) and bradycardia (too-slow heartbeat).
Asphyxia.
A condition in which not enough oxygen is getting to the organs of the body. The brain and the kidneys are the organs most sensitive to a lack of oxygen. This may have been a problem just before birth in some preemies, making their delivery at that time an urgent matter to prevent or minimize organ damage.
Aspiration.
The breathing of liquid (such as formula, stomach fluids, meconium) into the lungs. Aspiration could lead to pneumonia and other lung problems.
Bagging.
Breathing for the babyâfilling the lungs with air by squeezing a bag that is connected to an endotracheal tube (
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) or attached to a mask fitted over the face.
Bili lights.
Blue fluorescent lights used to treat jaundice (aka phototherapy).
Blood gas.
A blood test to check levels of oxygen and carbon dioxide in the blood. Blood gases need to be in proper balance for baby to grow properly. Blood gases are checked regularly for preemies on breathing machines.
Broviac.
See Central catheter.
CBC or complete blood count.
A blood test to count the red cells (that carry oxygen), white blood cells (that fight infection), and platelets (that prevent bleeding) in the blood.
Central catheter or central line.
A small, thin plastic tube through which fluids are given or removed from the body. Broviac catheters are usually placed in the upper chest to reach the vena cava (the large blood vessel in the center of the body). PICC lines (percutaneously inserted central catheters) are usually threaded through a vein in the arm. Umbilical catheters can also be inserted into the vein or artery of the umbilical stump after birth.
Chest tube.
A small plastic tube placed through the chest wall into the space between the lung and chest wall to remove air or fluid from this space. (See
Pneumothorax
.)
Cyanosis.
A description of color changes to the skin when there's not enough oxygen in the blood. When a baby is cyanotic, the skin will turn blue.
Echocardiogram.
An ultrasound of the heart.
Endotracheal tube (ET tube).
A plastic tube that goes through baby's nose or mouth into the windpipe and is then connected to a ventilator (breathing machine) to help baby breathe.
Extubation.
Removal of the ET tube (
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).
Hematocrit (Crit).
A blood test to see how many red blood cells there are.
Intravenous (IV).
A small plastic tube placed into one of the baby's veins as a means to deliver fluids, nutrition, and medication.
Intubation.
The insertion of an endotracheal tube (
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).
Lumbar puncture (spinal tap).
A test in which spinal fluid is drawn through a small needle placed in the lower back. The spinal fluid is then tested to check for problems (bacteria, infection, and so on).
Meconium aspiration.
The inhalation of meconium (baby's first poop) into the lungs, which can lead to problems.
Nasal cannula.
Soft plastic tubing that goes around a baby's head and under the nose, where there are openings (prongs) to deliver oxygen.
Neonatologist.
A pediatrician who has special training in newborn intensive care.
Oxyhood.
A clear plastic hood placed over the baby's head that supplies oxygen.
PICC line.
See Central catheter.
Pneumothorax.
When air from baby's lungs leaks out into the space between the lungs and chest wall. This could lead to a lung collapse. Treated with a chest tube;
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.
RDS.
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.
Sepsis.
An infection of the blood. Such an infection can begin as an infection elsewhere in the body and then spread to the blood. Likewise, blood infection can spread to virtually any organ in the body.
Surfactant.
A substance that keeps small air sacs in the lungs from collapsing. Natural surfactant is lacking in preemies, which is why artificial surfactant is often given to preemies in the NICU.
Transfusion.
Donated blood that is given to the baby when baby is anemic (has too few red blood cells) or has lost too much blood.
Umbilical catheter.
A thin tube that is inserted into a blood vessel in the belly button to draw blood or give fluids, medication, or nutrients.
Ventilator.
Mechanical breathing machine.