Inpatient and post-discharge care for premature babies

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

When a couple has a child, mom and dad spend all their time on him, because without proper care, the baby simply cannot develop normally, and maybe even survive. What if the baby was born prematurely? Care for premature babies should be special, because sometimes such crumbs cannot even breathe and eat without help.

Until quite recently, doctors did not undertake to resuscitate and save the life of a baby whose birth weight was less than a kilogram. Now everything has changed, and experts can give a chance to a baby who was born the size of a palm and weighs half a kilogram. We will talk about caring for premature babies in intensive care, maternity hospital, at home after discharge and in other conditions in this article.

Premature babies: features

Term babies are those born between the 37th and 42nd weeks of pregnancy. If the baby was born earlier than expected, then it is considered premature. The main problem of such babies is the underdevelopment of internal organs, and the earlier the birth occurred, the more thorough care the child will need. Nursing care for premature babies begins from the first minutes of his life, the mother will be able to start taking care of her child on her own only after the permission of the pediatrician, but more on that later. So far, we are interested in the features of the physiology of an infant who was born prematurely. How fast can a mother hug her baby? It all depends on the degree of his prematurity. There are three degrees in total:

1. Extreme prematurity - weighing less than a kilogram.
2. Deep prematurity - weight from a kilogram to one and a half.
3. Prematurity - weight from one and a half kilograms to two and a half.

The main features of a premature baby are:

• light weight;
• small stature (up to 46 cm);
• disproportionately folded body (large head, short legs, neck, navel displaced to the inguinal side);
• the shape of the skull is rounded, with a clearly visible fontanel and sutures;
• ears are tightly pressed against the head, very soft;
• skin is very thin and wrinkled, all veins can show through;
• the surface of the body is covered with a small fluff;
• completely missing fat layer;
• on the arms and legs may be underdeveloped nails, or even absent;
• Undescended testicles in boys and uncovered genital slit in girls.

It is worth noting that all the above signs must be in the aggregate. Only in this case can we talk about the features of caring for premature babies. If one thing manifested itself, this indicates a pathology, and notabout prematurity.

Behavior of a premature baby

Newborns born at the wrong time also differ in behavior. They are inactive, there is a reduced muscle tone. Babies are drowsy (this is noticeable even against the background of the fact that full-term babies sleep almost constantly), they shudder for no reason and begin to move randomly. Particularly complicating the care of premature babies is the lack of a sucking reflex. The little one is hungry but doesn't know how to eat.

Caring for premature babies in brief

We propose to consider the intricacies of caring for a baby, and then we will go through each item in more detail.

Nursing care for premature babies, as we have already written, begins from the first seconds of his life. First of all, it is taken in a warm diaper and, if necessary, ventilation is done. This is the most important procedure. An infant's breathing may be disturbed or even stop, as an early-born baby does not produce enough surfactant, the substance responsible for proper breathing. Therefore, the lung tissue cannot fully expand.

The second problem is that premature babies are completely unprepared for a physiological existence in this world, they have an insufficient layer of subcutaneous fat, so thermoregulation is imperfect. Babies quickly overcool and overheat, as the ambient temperature varies greatly from that in the womb.

In the old days, this problem was solved by wrapping the baby in cotton wool or putting it on a warm stove. Now the problem of regulating the body temperature of a newborn is solved differently: a premature baby is placed in an incubator, or, in simple words, an incubator. A sufficient amount of oxygen enters there, it is isolated from extraneous noise and light. The temperature and humidity in the incubator are regulated, creating conditions similar to those in utero.

No problems with feeding either. Features of nursing care for premature babies are swaddling, monitoring the general condition and, of course, feeding. Medical personnel take the expressed milk from the mother, add the necessary vitamins, proteins and minerals to it. If a woman does not have milk, then infant formulas are used, designed specifically for babies born prematurely. Feeding the baby, if he has a poorly developed sucking reflex, is carried out with a syringe.

The baby, who has a well-developed reflex, is given a bottle. If the weight of the child is so small that he cannot even swallow, a nasogastric tube is used or nutrients are administered intravenously. The probe is inserted through the nose of the crumbs, and milk in small doses enters his stomach. In any case, feeding a premature baby is fractional and in small portions, even if its weight is more than two kilograms. Organs are not yet developed enough to work fully. Nursing care for premature babies is essential. After all, a mother can overfeed.

Inpatient care for premature babies may not be possible at first if there are he alth complications. In this case, the infant is transferred tointensive care unit.

Resuscitation care

Care for a newborn premature baby at the first stages is taken over by the medical staff of the maternity hospital. Most often, immediately after birth, the baby ends up in the children's intensive care unit, and it's good if there is one in the maternity hospital. But it happens that the hospital does not have such a department.

First of all, the baby is examined by a cardiologist, neuropathologist, orthopedist, ophthalmologist, neurosonography (ultrasound of the brain) is performed, if necessary, ultrasound of all internal organs. In addition, urine and blood samples are taken. After the procedures, the baby is placed in an incubator.

What happens if the maternity hospital does not have its own intensive care unit? Is there really no chance to "pull out" the child? Nothing like this. All maternity hospitals are equipped with the necessary equipment for the care of premature babies, there is a ventilator, an incubator, and special preparations designed to keep the crumbs alive, and a neonatologist - a specialist trained to care for babies born at the wrong time.

But still there is a problem: neonatologists not only look after premature babies, but are also required to attend each subsequent birth. And this means that there will be less monitoring of premature babies and the neonatologist may miss the moment if it suddenly becomes necessary to save the baby.

Nurses and neonatologists work in the intensive care unit, whose duties include only nursing the children already in their department. In this casethe newborn will be constantly under vigilant medical supervision.

If the baby needs resuscitation, but there is none in the maternity hospital, then after stabilization of his condition he will be transferred to another hospital where there is a necessary department. Transportation is carried out in a specialized vehicle, where there are ventilators, an incubator and other necessary devices to support life.

When the baby is in intensive care, the mother can come to him at the appointed time, but "communicate" only through the glass of the incubator (incubator). There are departments where it is possible to visit the baby at any time of the day.

Feeding

Parents of babies born early need to know all the subtleties and features of caring for premature babies so as not to worry about the child. Many couples begin to worry too much about the life of the crumbs, they think that they will not be able to cope. Of course, it is very difficult to survive a period of such difficult nursing, but progress does not stand still, and medical personnel are able to save even the smallest.

If the baby's weight reaches two kilograms and his sucking reflex is well developed, then there is the possibility of breastfeeding. Moms will often be able to hold the baby in their arms, feed and help the medical staff care for him. Only a nurse feeds from a bottle or syringe so that there are no problems with the esophagus. As already mentioned earlier, if the sucking reflex is absent or poorly developed, then the digestive organs cannot fully cope with their task and feeding shouldbe fractional.

Premature babies need plenty of fluids. Ringer's solution, diluted 1/1 with 5% glucose, is usually used to maintain the body. In addition, vitamins are needed, in the first days riboflavin, vitamin K and E, ascorbic acid, thiamine are necessarily introduced. Focusing on the individual condition of the newborn, the doctor may prescribe other vitamins.

After a while, the nutrition of the baby will be no different from the nutrition of peers. But at the first stages of nursing, special additives are needed to accelerate the development and growth of the crumbs.

As parents can see, nutrition is not something to worry about. Soon your baby will take over and turn from a thin, weak baby into a cheerful, rosy-cheeked and active toddler.

Nursing in the hospital

Caring for premature babies in a hospital necessarily begins with the neonatal pathology department. Here the baby will be constantly under the supervision of nurses and doctors, the necessary procedures and examinations will be prescribed.

The transfer of an infant to a regular ward can be made only when he gains a body weight of at least two kilograms, actively sucks milk, independently copes with the regulation of body temperature, and breathes well. The duration of stay in the incubator depends on the severity of the degree of prematurity, there are four of them:

• first degree - delivery occurred between 37 and 35 weeks;
• second degree - with34 to 32 weeks;
• third degree - 31-29 weeks;
• fourth degree - 28 or less.

If by the time the mother is discharged from the maternity hospital, the child has already reached the minimum parameters under which it is possible to care for a premature baby at home, then he is allowed to go home with his mother. If the need for resuscitation is no longer there, but any he alth risk remains, the baby is transferred to the children's department. The mother herself decides how to proceed further: go to the hospital with the baby or come to the hospital for feeding.

In the hospital

A baby born prematurely is transferred to a specialized children's department according to the prescription of a pediatrician and neonatologist. Such a move is possible even if the baby is still fed through a tube and needs artificial breathing support. All care for premature babies in this case is in the hands of the medical staff.

The baby will be placed in a heated bed or an incubator. A more complete examination is carried out in the hospital, it is aimed at detecting pathologies and genetic diseases. The baby is examined by narrow specialists, the necessary tests and procedures are prescribed.

Positive dynamics usually begin to grow from the day of the expected birth, that is, from the date when the child was supposed to be born on time. The time spent in stationary conditions depends on how quickly the baby gains weight, learns to suck and swallow, and on the presence of identified pathologies. Hospital treatment maylast from a week to several months.

At home

When the baby is finally ready to go home, the doctor gives detailed recommendations to parents. Caring for a premature baby after discharge is very difficult, especially for couples who have had their first child. The difficulties lie in the fact that only nursing staff nursed the baby and parents may not even have a clue about how and what to do.

In any case, if the baby was born prematurely, patronage must be conscientious. If for some reason the pediatrician did not arrive on the scheduled day, call the clinic and demand a visit. Now let's take a closer look at all the subtleties of home care for a premature baby, which all family members living in the same room must know.

1. The first thing worth watching is the air temperature in the baby's room, it should be about +22 degrees. Keep in mind that premature babies may have problems with thermoregulation.
2. For the first time, bathing a baby at home is after the permission of the local doctor. The bathroom warms up to 24 degrees, and the water should be close to body temperature. After washing, the baby is thoroughly dried with a soft towel and dressed warmly, as babies born out of term can quickly become overcooled.
3. Walks are no different from those given to full-term babies. In the warm summer time, you can go out for a breath of air immediately after discharge, and in the cold season - after a month. The first walks last no more than half an hour,time is gradually added.
4. Breastfeeding premature babies after discharge is most often impossible, as he will already be "spoiled" by the bottle and he will be too lazy to suckle. Still, try to breastfeed or express milk as often as possible and feed it to your child, because mother's milk is the most important nutrient in the first year of life. If you don't have enough milk or if it's gone completely after the stress of worrying about your baby's life, then buy formulas designed for premature babies.
5. Caring for premature babies at home necessarily includes constant monitoring! If the baby becomes lethargic, weak, refuses to feed and spit up profusely, call the doctor immediately, these are very bad signs.

Caring for a premature baby in an outpatient setting

The plan for the examination of children born early is drawn up individually. Often premature babies suffer from diseases of the kidneys, eyes, neurological pathologies are observed. If there is any violation, then the baby is registered with the necessary doctor and will need to be visited regularly, without missing appointments.

If your little one is perfectly he althy, then you only need a monthly examination at the clinic and bypassing narrow specialists, which are performed on the "Days of He althy Children". Within a month, the district nurse will visit you to make sure that the child is well.

Developmentpremature babies

If a little man was born early, then in the first two months of his life he will sleep almost constantly, get tired quickly even with low activity. After the age of two months, the child will begin to develop faster, move more actively, which can lead to tension in the muscles of the limbs. It can be easily removed with special exercises.

We must not forget that the nervous system of premature babies is weak, so the baby can shudder for no reason, be frightened by sudden movements and sounds. Periods of restful sleep can change dramatically with bouts of arousal, again for no reason. Such children need peace and quiet, they do not tolerate meeting strangers and a change of scenery.

If the baby does not have pathologies, then he will develop and grow quite quickly. By the age of three months, he will catch up and even possibly surpass his peers in height, weight and development!