Premature Baby: Hospital Care

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KEY POINTS

• Premature babies are born more before 37 weeks of pregnancy. The earlier a baby is born, the more health problems the baby is likely to have.
• Because your baby is small and born early, she will be cared for in the neonatal intensive care unit (NICU) for several weeks. In the NICU, your baby will be in a special bed that keeps babies warm by heating the air. She will be attached to a heart and breathing monitor while in the NICU. The monitor sounds an alarm if there is a big change in your baby's heart rate, breathing rate, or level of oxygen.
• Visit your baby as much as you can. Your presence helps your baby grow and get strong.

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What is prematurity?

Premature babies are born more before 37 weeks of pregnancy. The earlier a baby is born, the more health problems the baby is likely to have. Premature babies may need to be cared for in the hospital until close to their due dates.

What is the cause?

The cause of premature birth is often not known. Sometimes a baby may need to be delivered early if you or your baby has a medical problem. It is common for twins or other multiple births to be born early.

What happens after the baby is born?

Because your baby is small and born early, she will be cared for in a specialized nursery called the neonatal intensive care unit (NICU) for a few days to a few months. Many specialists will help care for your baby during the stay in the NICU.

Visit your baby as much as you can. Your presence helps your baby grow and get strong. Skin-to-skin care (STS) may be offered soon after birth. With STS, your baby is dressed in a diaper and hat, and then the mother or father holds the baby against the skin on their chests (under clothing) covered by a warm blanket. This helps your baby in many ways:

• It helps keep your baby’s temperature, heart rate, and breathing rate within normal ranges.
• It helps your baby gain weight.
• It helps your baby start breastfeeding, and helps you produce more milk.
• It reduces your baby's stress and helps him sleep better.
• You and your baby give comfort to each other. STS helps deepen the bond between you and your baby.

Sometimes the baby is so sick that you may not be able to hold her at first. You can still hold your baby’s hand, and touch and talk to her. The older and more mature your baby is, the more you will be able to handle and care for her.

In the NICU, your baby will be in a special bed that keeps babies warm by heating the air. Your baby will be attached to a heart and breathing monitor while in the NICU. The monitor sounds an alarm if there is a big change in your baby's heart rate, breathing rate, or level of oxygen.

What problems do premature babies have?

There are many problems that a premature baby faces during the first weeks. Most problems of prematurity improve as your baby grows.

• Breathing problems. Your baby may need oxygen, a machine to help with breathing, and medicines to help her lungs work better. Most children outgrow these lung problems during the first several months of life. Some children may continue to have problems with wheezing and infections, but they usually get better as they get older.
• Feeding. At first your baby may be too weak or have too much trouble breathing to nurse or feed from a bottle. Your baby will be given IV fluids and nutrition right after birth. It may take several weeks before she is ready for breast milk or formula feedings. Because your premature baby cannot yet nurse, if you want to breastfeed, you will need to pump your breasts to provide breast milk for your baby. Breast milk helps protect babies against infection and it is easily digested. Mothers of premature babies make special breast milk that is helpful to babies who are born early. Very premature babies do not know how to suck on a nipple. A tube may be placed into your baby’s stomach through the nose or mouth until she learns to suck on a nipple.
• Jaundice. Bilirubin is a substance that is made as red blood cells break down. Normally the liver removes bilirubin from the blood, but a newborn baby’s liver doesn’t do this well right after birth. When there is a lot of bilirubin, the skin and whites of the eyes get yellow. This is called jaundice. Jaundice is treated with special blue light. Your baby will lie on a soft pad under the lights wearing just a diaper and goggles or eye patches to protect his eyes from the light. The lights will not hurt your baby's skin. Some babies are under the lights for a day or less. Others may be under the lights for several days.
• Infection. Premature babies cannot protect themselves against infections very well because their defenses are weak. Once infected, your baby can get sick very quickly. If the healthcare provider suspects an infection, your baby will have blood tests and be treated with antibiotics.
• Bleeding in the brain. Very premature babies are at risk for bleeding in the brain. Ultrasound scans of your baby's head will be done to check and follow-up for any sign of bleeding.
• Eye problems. In some premature babies, abnormal blood vessels may start to grow inside the eye. This may be a minor problem, but it could also be very serious. All premature babies will have their eyes checked soon after birth, and regularly as they grow up.
• Anemia. Every premature baby has too few red blood cells during the first 2 months of life. Most babies who are sick and often need blood tests, or who weigh less than 2 and a half pounds at birth, will need a blood transfusion to keep the blood count normal. You may be able to donate blood if your baby needs a transfusion. Talk with your healthcare provider about this.

What follow-up care does my child need?

If you need to have special equipment at home, the hospital will help you arrange for it. They will teach you how to care for your baby at home. Once home, your baby will need frequent feedings.

Most very premature babies grow up to be normal, healthy children. However, low-birth-weight babies are at greater risk for problems with learning, growth, or behavior than babies who are not premature. Physical therapy, occupational therapy, speech and swallow therapy, and other programs may help to lessen the risk of problems. Premature babies also may need special medical care during the first year of life.

• Keep all appointments for checkups after your baby is home from the hospital. Your child’s healthcare provider needs to make sure that your baby is gaining weight and developing well.
• Your baby should have vision check-ups regularly after leaving the hospital. As your child grows up, your child may have eye muscle problems and may need glasses to correct this problem.
• Have your baby’s hearing tested at least once during the first year to make sure that she does not have hearing problems.
• Make sure that your baby gets childhood immunizations to protect against infection.
• It’s also a good idea for your family to learn infant cardiopulmonary resuscitation (CPR) before the baby goes home. Even if you never use CPR, it is best to be prepared.