Ten Hints for Providing Care for Premature Babies

Providing care for babies who have hurried to come into the world requires a bit more sensitivity, especially in the early stages. Stating that a great duty falls upon parents after premature births, about 25 percent of which have unknown causes, Yeditepe University Kozyatağı Hospital Pediatrics/ Neonatal Specialist Prof. Dr. Filiz Bakar drew attention to the points that should be considered in the care of premature babies.

There Are Things to Be Considered in the Post-Discharge Care of Premature Babies

A healthy pregnancy period has to be completed at an average of 40 weeks. Births that occurred before the end of this period are defined as premature. Although the cause of this condition is not fully known, the presence of especially urinary tract and genital infections in the mother, problems in the mother's uterus, high blood pressure, diabetes, heart disease, multiple pregnancies in the mother, the fact that the amniotic fluid surrounding the baby is excessive, placenta problems, the fact that the maternal age is under 18 or over 40, the fact that the mother has had a premature birth before, and stress are listed among the risk factors that can lead to premature birth.
Yeditepe University Kozyatağı Hospital Pediatrics Specialist Prof. Dr. Filiz Bakar reminds us that babies born prematurely start life in a risky situation in many respects compared to babies born on time. She lists the precautions that should be taken against possible risks as follows:

1.    The Baby Must be Protected From the Infections

Anemia and jaundice are more common in premature babies. Antibodies that protect the baby against infections are passed to the baby in the last three months of pregnancy. Since these antibodies are insufficient in premature babies, they can contract infections more easily. Infections are more common and more severe among these babies as they have a longer hospital stay and are exposed to too many interventions during hospitalization. Although it is not possible to eliminate infections completely, it is possible to minimize them. In this respect, following the disinfection rules, especially washing hands, in all care applications, all approaches, and interventions, is crucial during the babies' hospital stay.

2.    They Must be Fed With Breast Milk

Drawing attention to the fact that especially babies born before the 34th week may experience feeding problems because their jaw muscles are not sufficiently strengthened and they are born before their sucking-swallowing reflexes and breathing coordination are fully developed, Prof. Dr. Filiz Bakar gave the following information: “In babies with such problems, according to the week of birth, intravenous protein, sugar, and fat support are administered in the first days. Meanwhile, tiny amounts of breast milk are also initiated. Babies staying in the intensive care unit are fed through the probe descending from the mouth or nose to the stomach until their suction-swallowing reflexes develop. After their suction-swallowing-inhalation coordination has developed, suckling is initiated. Especially breast milk is a very valuable food source for premature babies. Mothers should be supported when it comes to expressing breast milk. If there is no breast milk, formulas are used.”

3.    A Pacifier May Be Preferred To Improve Suction

Premature babies are fed on average every three hours during their hospitalization. Saying that although this routine continues at home, there may be deviations, Prof. Dr. Filiz Bakar said, "Sometimes they get hungry earlier, and sometimes they can extend the interval to 4 hours. The baby must be hungry for effective feeding. Parents should observe their babies very well and read the hunger signals correctly. At first, the feeding interval may be 30-40 minutes, but then it will get even shorter. Breaks may be given in during feeding. Babies can be fed through alternating methods of breastfeeding and bottle-feeding, as recommended by their doctor. The amounts of feeding should be adjusted according to the doctor's recommendations. A pacifier can be used to improve sucking, and strengthen the jaw and cheek muscles in premature babies."

4.    Eye Examination Should Be Performed at Regular Intervals

As babies are born before the eye vessels have yet to develop, a disorder called Retinopathy of Prematurity can develop in their veins in the retinal layer. Prof. Dr. Filiz Bakar explains that to detect this condition before it progresses, during their hospital stay, babies' regular eye examinations should be performed to start four weeks after birth, and treatment should be scheduled, as needed. In cases where treatment is delayed, this problem is important as it can result in blindness. However, hearing problems are also common in premature babies. Hearing screening tests should be performed and repeated at the age of one.”

5.    Diapers Should Not Be Changed Immediately After Feeding To Prevent Reflux

Some digestive problems may be seen in premature babies because their intestinal system has not matured either. Such conditions bear the risk of progressing to severe problems called necrotizing enterocolitis. In addition, some precautions may be needed because reflux, which occurs as a result of the stomach contents escaping back into the esophagus, is more common in premature babies. For this reason, babies should not be laid down immediately after feeding and kept on the lap for a while, and diapers and clothes should not be changed immediately after feeding. In addition, with the recommendation of their doctors, as needed, feeding intervals can be prolonged, and feeding amounts can be reduced. Again, with the doctor's recommendation, special formulas can be used, and drug treatments can be administered, as needed.

6.    Those Who are Interested in Baby Sitting Should Also Get Vaccinated

Stating that vaccinations of premature babies are also performed during a similar period as babies born on time, Prof. Dr. Filiz Bakar remarked, "However, premature babies need to get a respiratory syncytial virus vaccine once a month during the winter. However, it is recommended that people who will care for the baby at home should also get a pertussis vaccine before the baby is discharged. On the other hand, If the baby is born in the winter season, people who will be at home should also get a flu vaccine.”

7.    Appropriate Hygiene and a Care Environment Should be Ensured at Home

Since these babies are more susceptible to infections, hygiene rules at home must be tightened a little more. In addition, the house must be cleaned and ventilated at regular intervals, and the people who will touch the baby must show sensitivity to hand hygiene.

8.    The Temperature of the Environment Should Be Kept Constant

Since these babies are more sensitive to heat loss, the indoor temperature must be kept around 23-24 C, the baby must wear one more layer of clothes than others, and it must be properly dressed when going out and must wear gloves and a hat.

9.    Stay Away from Crowded Environments As Much As Possible

Explaining that premature babies should not be taken to crowded environments outside the home because they are prone to infections, Prof. Dr. Filiz Bakar said, "Those who visit the home should also be warned. If there is anyone with flu, they must not contact the baby. In addition, anyone who will touch the baby should wash their hands very well and must not smoke next to it.”  

10.     A Safe Sleeping Environment Should Be Created

Underlining that creating a quiet and safe sleeping environment is also essential for the healthy development of premature babies, Yeditepe University Hospital Pediatrics Specialist Prof. Dr. Bakar said, "To reduce the risk of sudden infant death, no covers, toys, and pillows should be kept on the bed, sleeping bags should be used, and the baby should be made to lie on their back. Respiratory arrest, which we call apnea, is more common in premature babies, and taking these measures will reduce this condition.”

The Required Frequency of Doctor Visits 

Premature babies should be evaluated considering their developmentally and physically adjusted ages. In other words, if a baby is born two months prematurely, its adjusted age will actually be one month when three months pass after birth, and it will exhibit the physical and developmental characteristics of a one-month-old child. What does this mean exactly? Routine doctor visits should be made for such babies more frequently after the discharge and once a month thereafter. Apart from routine visits, it is necessary to consult a doctor as soon as disease symptoms such as vomiting, cough, bruising, and fever appear.

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