Premature Baby Care

If your baby was born prematurely, you may greet the day of discharge from the hospital with a mixture of joy and worry. You may have waited days, weeks, or even months to take your baby home. But when the day finally arrives it can be frightening to walk away from the security of the hospital nursery. If you're anxious about caring for your preemie at home, remember that health care professionals do not send preemies home until the babies are ready.

heartbeat

Diagnosis

After your premature baby is moved to the NICU, he or she may undergo a number of tests. Some are ongoing, while others may be performed only if the NICU staff suspects a particular complication.

Possible tests for your premature baby may include:

  • Breathing and heart rate monitor. Your baby's breathing and heart rate are monitored on a continuous basis. Blood pressure readings are done frequently, too.
  • Fluid input and output. The NICU team carefully tracks how much fluid your baby takes in through feedings and intravenous fluids and how much fluid your baby loses through wet or soiled diapers.
  • Blood tests. Blood samples are collected through a heel stick or a needle inserted into a vein to monitor a number of critical substances, including calcium, glucose and bilirubin levels in your baby's blood. A blood sample may also be analyzed to measure the red blood cell count and check for anemia or assess for an infection.

    If your baby's doctor anticipates that several blood samples will be needed, the NICU staff may insert a central umbilical intravenous (IV) line, to avoid having to stick your baby with a needle each time blood is needed.

  • Echocardiogram. This test is an ultrasound of the heart to check for problems with your baby's heart function. Much like a fetal ultrasound, an electrocardiogram uses sound waves to produce moving images on a display monitor.
  • Ultrasound scan. Ultrasound scans may be done to check the brain for bleeding or fluid buildup or to examine the abdominal organs for problems in the gastrointestinal tract, liver or kidneys.
  • Eye exam. An ophthalmologist (eye doctor) may examine your baby's eyes and vision to check for problems with the retina (retinopathy of prematurity).

Treatment

The neonatal intensive care unit (NICU) or special care nursery provides round-the-clock care for your premature baby.

Supportive care

Specialized supportive care for your baby may include:

  • Being placed in an incubator. Your baby will probably stay in an enclosed plastic bassinet (incubator) that's kept warm to help your baby maintain normal body temperature. Later on, NICU staff may show you a particular way to hold your baby — known as "kangaroo" care — with direct skin-to-skin contact.
  • Monitoring of your baby's vital signs. Sensors may be taped to your baby's body to monitor blood pressure, heart rate, breathing and temperature. A ventilator may be used to help your baby breathe.
  • Having a feeding tube. At first your baby may receive fluids and nutrients through an intravenous (IV) tube. Breast milk may be given later through a tube passed through your baby's nose and into his or her stomach (nasogastric, or NG, tube). When your baby is strong enough to suck, breast-feeding or bottle-feeding is often possible.
  • Replenishing fluids. Your baby needs a certain amount of fluids each day, depending upon his or her age and medical conditions. The NICU team will closely monitor fluids, sodium and potassium levels to make sure that your baby's fluid levels stay on target. If fluids are needed, they'll be delivered through an IV line.
  • Spending time under bilirubin lights. To treat infant jaundice, your baby may be placed under a set of lights — known as bilirubin lights — for a period of time. The lights help your baby's system break down excess bilirubin, which builds up because the liver can't process it all. While under the bilirubin lights, your baby will wear a protective eye mask to rest more comfortably.
  • Receiving a blood transfusion. Your preterm baby may need a blood transfusion to raise blood volume — especially if your baby has had several blood samples drawn for various tests.

Medications

Medications may be given to your baby to promote maturing and to stimulate normal functioning of the lungs, heart and circulation. Depending on your baby's condition, medication may include:

  • Surfactant, a medication used to treat respiratory distress syndrome
  • Fine-mist (aerosolized) or IV medication to strengthen breathing and heart rate
  • Antibiotics if infection is present or if there's a risk of possible infection
  • Medicines that increase urine output (diuretics) to manage excess fluid
  • An injection of medication into the eye to stop the growth of new blood vessels that could cause retinopathy of prematurity
  • Medicine that helps close the heart defect known as patent ductus arteriosus

Surgery

Sometimes surgery is necessary to treat a number of conditions associated with prematurity. Talk with your baby's health care team to understand which complications may require surgery, and learn about the type of surgery that might be necessary to treat them.

Taking your baby home

Your baby is ready to go home when he or she:

  • Can breathe without support
  • Can maintain a stable body temperature
  • Can breast- or bottle-feed
  • Is gaining weight steadily
  • Is free of infection

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