The parents guide to having a premature baby
Dec 24 '00
I have worked in a large neonatal intensive care unit (NICU) for the last two years. I not delivered a preemie myself, but I have helped many parents make it through the roller coaster ride of their NICU stay. Hopefully my experience will be helpful to some of you.
Delivering a premature baby is a heart wrenching experience. You wanted your baby, but not so soon! What will happen to the baby, will they be okay, when will I get to hold them, when can I take them home.. these are all questions that are probably going through your mind. Hopefully if you are in this situation I can give you a little idea of what to expect. If you aren't in this situation, maybe you'll find it interesting anyway. Here goes. Some of what I'm going to say applies only to extremely premature babies, babies born at 24 or 25 week gestation. Your child may not have all the tubes I am describing, but hopefully you'll get the idea.
The first trip to the NICU
This is usually the most overwhelming experience for parents. The first time you walk in, you will be greeted with a lot of alarms, strange machines and little incubators. There are a lot of nurses and doctors around and the whole place will seem very strange to you.
The first person you meet will be your baby's nurse. He or she will explain all of what you are seeing. Your baby may be on a ventilator, which is a machine that helps the baby breathe by doing a lot of the work for them. Premature babies have underdeveloped lungs and often are not able to breathe on their own at first without support. If your baby is on a ventilator, he or she will have a tube coming out of his or her mouth. This tube goes down into the trachea, which is the windpipe.
You baby will be on a monitor which will tell the nurses about their heart rate, respiratory rate (the amount of times the baby is breathing in a minute), and oxygen saturation (the amount of oxygen that is in the baby's blood, this is very important.) Your baby will have IVs (intravenous catheters) that will give the baby fluid until the baby is able to eat. He or she may have an IV in his or her belly button called an umbilical venous line. This line goes into the veins that were part of the umbilical cord. When the line is eventually pulled out, the cord will eventually fall off and you will never know it was there.
Your baby may have a special IV in an artery, either in their arm or their belly button. This is called an arterial line and is connected to the monitor. The nurse uses this line to monitor your baby's blood pressure. The nurse can also draw blood from the baby using this line, which prevents the baby from having to be poked each time the nurse needs some blood.
Your baby will be in an incubator, called an isolette. When baby is very small, they will have a little probe taped to them that will monitor their temperature and adjust the bed temperature to keep baby warm.
This will all seem very strange to you, but you will get used to it after awhile. Most parents end up talking like the nurses by the time they go home.
Can I touch my baby?
Ask your baby's nurse if it is okay to touch the baby. It is usually fine to touch, although some babies are very sensitive to stimulation and do not liked to be touched. The best way to touch your baby is with firm pressure, like putting your hand on their head or bottom. Often very tiny babies do not like to be stroked and will show signs of stress when stroked.
You can talk to your baby, they do know your voice and often it is very calming to them. It is important to remember that an extremely small infant will get cold quickly if the door on the isolette is open too long, so you may need to talk to them through the door if this is the case.
When can I hold my baby?
This varies from NICU to NICU. Ask your baby's nurse. They will tell you when you can do this.
Loss of control
At this point, many parents feel like they have absolutely no control over their child. They are in a strange environment, can't hold their baby, can't stroke their baby and all the other people around them are making decisions for them. If you feel this way, talk to you baby's nurse. In my NICU, we encourage parents to participate in baby's care as much as possible. We let parents take temperatures, change diapers and feed their babies when they are able to. We also try to keep parents informed about everything that is going on. The important thing to remember is that the NICU is a normal environment to the doctors and nurses. Things that we consider "routine" (putting in a new IV, getting an X-Ray) may not be so routine to you. If you feel that you are not being kept informed, make sure you speak up. Depending on how early your baby was born, your baby may be in the NICU for a long time. It is important to make your needs as a parent known early. Our NICU has a parent to parent support group as well as social workers available for every family.
Definition of medical terms
When you first enter the NICU, you will think that everyone is speaking a different language. Eventually, you will learn it too. Here are a few of the terms you may hear:
IV- intravenous catheter, the catheter in the baby's arm or belly button to give them fluids
Hyperal and lipids- This is actually called hyperalimentation. It is a special kind of IV fluid that has all sorts of nutrients in it to help baby grow until they are able to breastfeed or bottlefeed. It is made each day especially for your baby based on their needs. Lipids are a fat solution that are given with hyperal to add more calories to help baby grow.
Apnea, bradycardia, desats, "events", bradys, A's and B's- These all refer to the same type of thing. It is very common for premature babies to have times where they stop breathing for a second, drop their heart rate and drop their oxygen saturation. This is because they have immature neurological systems and sometimes forget to breathe. All three of these things may not happen at the same time, for example, the baby may drop their heart rate but not their oxygen saturation and still be breathing. This is terrifying for a parent to watch the first few times it happens. They are usually resolved by little gentle stimulation, such as patting the baby on the bottom. Sometimes the baby will need oxygen. We expect premature babies to do this, and they usually outgrow it by about 34 weeks gestation. Sometimes they will need medication to prevent them from doing it too much. The nurses will keep track of how often baby does it. If the events are increasing, you baby may be sick and they will do more tests.
Residual- If you baby too young or small to take a bottle or breastfeed, they will be fed through a tube in their nose, called an NG tube. Before each feeding, the nurse will pull back on the tube with a syringe to see if there is any of the last feeding left in the their stomach. If there is, this may be a sign of feeding intolerance and will be investigated further.
I had meant to write about common preemie problems here, but I see this is turning into a book, so I will stop here. Having a baby in the NICU is a roller coaster ride, you will have good days and bad days but one day you will get to take your baby home. The most important things are to believe that it will all end at some point and stay informed about your child's care. Remember, your baby belongs to you, not the hospital. Good luck and feel free to ask any questions.
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LauraRN
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Location: Rochester, NY
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Nurse practitioner seeking employment.
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