Newbies

Material taken from IHC Health Services, Inc., www.musckids.com &

The Preemie Parents’ Companion by Susan Madden

1. What is prematurity?2. Common problems:

-Breathing-Gastrointestinal-Brain-Heart-Vision-Nutrition & Feeding

3. Unexpected Journey (VHS)4. Home Visit Strategies

Baby born before 37 weeks of pregnancy

Chronological age is the age of the baby from the day of birth -- the number of days, weeks, or years old the baby is.

Adjusted age is the age of the baby based on his due date. If a baby is 6 months old, but was born two months early, his adjusted age is 4 months.

Here's one example:

Chronological age: 20 weeksThe number of weeks your baby was

premature: 6 weeksSubtract the number of weeks premature from

the chronological age: 20 weeks minus 6 weeks equal 14 weeks. 14 weeks is your baby's adjusted age.

Divide your baby's adjusted age in weeks by 4 to determine your baby's adjusted age in months: 14 divided by 4 equals 3 1/2 months.

When will a baby catch up developmentally?

Most premature babies "catch up" to their peers, developmentally, in two years. After that, any differences in size or development are most likely due to individual differences, rather than to premature birth. Some very small babies take longer to catch up.

KOTM Policy: Do not adjust after 24 months

small baby, often weighing less than 2,500 grams (5 pounds 8 ounces)

thin, shiny, pink or red skin, able to see veins

little body fat little scalp hair, but may have lots of

lanugo (soft body hair) weak cry and body tone genitals may be small and underdeveloped

1. Breathing Problems Respiratory distress syndrome

(RDS): caused by infants inability to produce surfactant, a fatty substance that coats the sacs in the lungs to keep them from collapsing.

Other causes can be infection or breathing

meconium or fluid into the lungs

Apnea and Bradycardia:Sometimes, a premature baby stops breathing

for Short periods of time (apnea) accompanied by a Slower –than-normal heart rate (bradycardia).

Meconium aspiration:Caused by inhaling meconium during labor andDelivery.

Nasal cannula: flexible hollow tube with two prongs that fit just bellow baby’s nose

Oxygen mask: oxygen flows through a tube into the mask at a constant rate.

CPAP: Continuous Positive Airway Pressure

2. Gastrointestinal Problems: Reflux: the muscle at the entrance the

baby’s stomach is not mature, allowing food to move back up into the esophagus.

Symptoms belching refusal to eat stomach ache fussiness around mealtime hiccups gagging choking frequent coughing coughing fits at night wheezing frequent upper respiratory infections rattling in the chest

Treatment After feedings, elevate the upper body at least

30 degrees for 30 minutes If bottle feeding, keep the nipple filled with

milk so infant does not swallow too much air. Adding rice cereal to feeding may be

beneficial for some older babies Burp the baby several times during feeding. Make sure diaper is loose Medications: can help decrease the amount of

acid the stomach makes. Another medication will help empty the stomach faster.

Necrotizing enterocolitis (NEC): an inflammatory bowel disease. The lining of the intestinal wall dies and the tissue sloughs off.

3. Brain Problems:“The brain of a premature baby is still growing and developing, so many of the blood vessels are quite fragile. Babies born 6 weeks or more early are prone to have bleeding in the brain during labor delivery, or first few days after birth. The bleeding is referred as interaventricular hemorrhage.”

Why is interaventricular hemorrhage a concern? Severe damage to cells can lead to brain damage. The amount of bleeding varies and is described in 4 grades.

Grade 1 - bleeding occurs just in a small area of the ventriclesGrade 2 - bleeding also occurs inside the ventriclesGrade 3 – ventricles are enlarged by the bloodGrade 4 – bleeding into the brain tissues around the ventricles

Grade 1 & 2 are common, Grade 3 & 4 are the most serious and may result in long-term brain injury to the baby (example: cerebral palsy)

4. Heart (PDA): “A blood vessel located just outside of the heart, called the ductus arteriosus, allows blood to bypass the lungs while your baby is still being carried in the womb. After birth, the ductus arteriosus should close, redirecting your baby’s blood flow through the lungs. If the ductus arteriosus does not close, we say it is a patent, or open. A patent ductus arteriosus (PDA) can place stress on the babies heart and lungs, and may need to be closed with medication and/or surgery.”

5. Eye Problems: Retinopathy of Prematurity (ROP):

When immature blood vessels to retina develop abnormally.

Four Stages of ROP : Mild Stage 1 to severe Stage 4 when the retina detaches in the eye.

Treatment Stage 1 & 2 resolve without treatment Half with Stage 3 and most with Stage 4 need

treatment: cryopexy (freezing to stop damage) or laser photocoagulation (create small burns creating scars to seal the borders of the retina helping to prevent detachment)

Alignment problems: Premature babies are more prone toAlignment problems of the eye, calledlazy eye or amblyopia

NPO: Baby can’t take in any foods by mouth. This can be due to too small or too sick.

Gavage Feedings: Infant is placed on a feeding tube. This occurs when infant can take food orally but may not have enough sucking strength for bottle or breast.

1. Commonly called NG – tube placed through the nose into the stomach

1. 2.

2. Commonly called NJ – tube placed through the nose into the jejunum (mid section of the small intestine)

3.3. Commonly called G tube - tube is placed directly into the stomach

The other 2 types are vary rare.

Unexpected Journey

The Earliest Days

Six States of Alertness: “Premature babies have a difficult time transitioning from one state to the next. They may make sudden leaps

from one state to the next, or get stuck in one state.” The Preemie Parents’ Companion

Calming Techniques for Self-Regulation: Visually Auditory Vestibular Tactile Gustatory/Oral Propioceptive

See Handouts for strategies

Muscle Tone (high/low/mixed tones) Sensory Integration Delayed Speech Distractibility Quiet Observer

QUESTIONS?