How Mediclinic doctors help your preemie
Posted on 27 July 2018
Not all babies born prematurely will have complications, but those born under 28 weeks, are at greater risk. Dr Aziza van der Schyff, a paediatrician at Mediclinic Constantiaberg, explains how preterm babies are cared for at a Mediclinic Neonatal Intensive Care Unit (NICU).
When you are about 32 weeks pregnant, your placenta acts as a barrier to infection and allows the transfer of your antibodies to your unborn baby. A premature baby loses out on the above in-utero protection and has an under-developed immune system. This makes them more prone to infection and at higher risk of that infection spreading to the bloodstream (causing sepsis).
Preterm babies often require special care in the neonatal intensive care unit (NICU). And advances in neonatal care and treatments for preterm babies have greatly increased the chances for survival of even the smallest babies.
There are strict infection prevention and control measures in place inside the NICU and hand hygiene is very important. Only necessary staff are allowed into the NICU and visitors are restricted to reduce the infection risk.
Here is what happens in NICU
- After birth, your baby is stabilised and assessed for the immediate complications that need to be treated.
- His or her temperature, blood pressure, heart rate, breathing rates and oxygen levels are monitored.
- Blood tests are done to monitor glucose, electrolytes, infection markers and to check for anaemia. Bilirubin tests are done to exclude jaundice.
Treatments and medication
NICU staff provide life-saving treatments, including administering surfactant (a fluid with is naturally present in babies over 37 weeks gestation). Surfactant helps keeps the lungs open and allows them to expand and contract. Medication to prevent apnoeas (when your baby stops breathing) is started immediately after birth and is continued until the equivalent of what would have been 35 weeks of gestational age when the risk of apnoea usually resolves. If an infection is suspected, antibiotics are given plus glucose and electrolyte replacement when needed. Phototherapy (fluorescent lights) is used to treat jaundice.
Respiratory distress is treated with oxygen given via nasal prongs; CPAP (continuous positive airway pressure) which provides oxygen and pressure to help the lungs expand and contract; or with mechanical ventilators which do the work of breathing for the baby. The more premature babies (< 28 weeks) would need more intensive support and mechanical ventilation.
Premature babies are nursed in temperature-controlled beds (open warmers and incubators) which are used to help maintain the baby’s temperature and prevent hypothermia.
When oral feeds can’t be given, a premature baby will need intravenous lines (drips) or specialised catheters placed into the umbilical cord to provide fluids. These are also used for medications such as antibiotics and to draw blood to monitor electrolyte and glucose levels.
A specialised tube is inserted through the nose and into the stomach called a nasogastric tube. This is used to administer expressed breast milk and formula to the baby until they develop the ability to suck and are able to breastfeed and take bottles.
NICU staff promote Kangaroo Mother Care, which is a technique used to care for preterm babies by using skin-to-skin contact with the parents. This promotes bonding, growth and feeding.
Breast milk has many advantages for premature babies as it contains mom’s antibodies and many important nutrients. The NICU staff will assist and educate you about expressing breast milk and will provide information on donor expressed breast milk when breast milk is not available.
Special investigations and neurodevelopmental care
Special investigations, such as X-rays, are used to check nasogastric or umbilical tube placement and to visualise and diagnose problems within the chest and abdomen. An echocardiogram (ultrasound of the heart) assesses the anatomy of the heart and checks for Patent Ductus Arteriosus, otherwise known as a hole in the heart.
An ultrasound of the brain checks for bleeding or fluid build-up and can be used to check the abdomen and kidney functioning.
NICU staff practice neuro-developmental care by nursing premature babies in nests that keep them in a position that simulates the position in the womb. They also decrease light exposure and keep noise at a minimum level.
Moving to an open crib
Once the baby is able to maintain its own temperature they graduate to an open crib. NICU nursing staff can then help mothers breastfeed and bottle-feed. They also explain basic infant care including CPR.
Premature babies need an eye examination and hearing test before being discharged.
A neurodevelopmental physiotherapist will assess the baby and teach you strategies to promote the best neurodevelopmental outcome.
Some NICU’s offer mothers the chance to stay overnight in the ward as a trial run to help them adjust to caring for their premature babies at home. Nursing staff are on hand to assist and reassure the mothers prior to discharge.
Once you’re home
- Breastfeed as much and as long as possible and use formula when needed.
- Monitor the amounts of wet nappies, stools and reflux episodes.
- Prevent exposure to illness by handwashing and avoiding crowded places and smoking environments.
- Creche-going siblings and unwell family members should limit contact with your baby or delay their visits.
- Vaccinate your baby according to the immunisation schedule. If advised and approved by your medical aid, your baby can receive prophylaxis against the respiratory syncytial virus (RSV), a major cause of bronchiolitis and pneumonia.
- Babies should sleep on their backs to prevent SIDS, choking and aspiration.
- Never place your baby on his or her side or stomach for sleep or naps.
- Allow your child tummy time when you are watching and supervising.
- If there are signs of illness (irritability, fever, poor colour) follow your instinct and see your paediatrician.
- Regular check-ups with your paediatrician will assess growth, feeding and developmental milestones.
Continue with neurodevelopmental physiotherapy visits once your baby is discharged as preemies are prone to developmental delay.