Most parents of premature babies greet the day of discharge from the hospital with a mix of joy and anxiety. they’ll have waited days, weeks, or maybe months to require their premature baby home, but when the day finally arrives it are often frightening to steer faraway from the safety of the hospital nursery.
If you’re anxious about caring for your preemie reception , attempt to relax – in any case , health care professionals don’t send preemies home from the hospital until the babies are ready. You’ll be ready with a little training and planning, too.
Health Challenges of Premature Baby Infants
Babies born at but 37 weeks’ gestation are considered premature, and that they often begin life with serious medical challenges. These infants may have support as newborns for variety of medical issues, including breathing problems that need supplemental oxygen or a ventilator, temperature regulation, feeding problems, apnea (irregular breathing), or jaundice (which occurs when a baby’s immature liver initially cannot eliminate excess bilirubin, a yellow pigment within the body produced by the traditional breakdown of red blood cells). due to these needs, premature infants may need to spend weeks or maybe months during a neonatal medical care unit (NICU).
Fortunately, with support and growth, the immature organs recover and eventually are ready to function independently in most cases. By the time of hospital discharge, most preterm infants don’t require specialized medical aid , but all still need good supportive care. for a few infants, special medical needs persist even after discharge. to satisfy your infant’s needs, the medical team sending your baby home will prepare a follow-up plan of medical aid , which can coordinate care with the baby’s pediatrician and other medical specialists as required .
Requirements for Discharge
Before a preterm baby are often discharged from the hospital, the baby must meet several basic requirements which will help to make sure healthiness and fewer medical problems following discharge. Some nurseries need a minimum weight for discharge, but the NICU team will test the baby more frequently on these three criteria:
1. Can the baby maintain blood heat in an open crib?
2. Can the baby take all bottle or breast feedings without additional feedings for the tube?
3. Can the baby gain weight steadily?
The average preemie meets these criteria 2 to 4 weeks before the first maturity . Infants who have had surgery, babies born with malformations, or newborns who spent weeks on breathing machines and oxygen are the foremost likely to remain beyond their original date.
Medical Needs Premature Baby After Discharge
Although most premature infants don’t require specialized medical support after they’re discharged from the hospital, there are certain medical considerations for a few premature infants. additionally , all infants need regular medical aid and evaluation. This includes routine immunizations, usually on an equivalent schedule as that for full-term babies. a number of the more common medical problems premature babies may face within the future include:
Apnea: Premature infants commonly have episodes of apnea, or pauses in breathing, that improve because the infant matures. Babies won’t be discharged if the apnea causes a slow pulse or a change in color. Few nurseries, however, send babies home on apnea monitors if the babies have mild apnea that does not change hue or pulse or need stimulus to shape the baby breathe again. Doctors will decide if your premature baby needs a monitor; if so, anyone who are going to be alone with the infant reception will got to attend a training session on using the monitor and find out how to perform infant CPR (CPR).
Other breathing problems: Premature infants commonly have respiratory difficulties and wish supplemental oxygen or a mechanical ventilator as newborns. Most recover and don’t require supplemental oxygen by the time they graduate from the NICU. However, some premature infants develop a more chronic lung condition called bronchopulmonary dysplasia (BPD), which involves scarring and inflammation within the lungs. Infants with BPD may have supplemental oxygen and medications for a protracted period of your time even after discharge. These infants are often sent home on oxygen or medications to assist their lungs function better. If your baby will need oxygen after leaving the hospital, equipment for administering oxygen reception and in transit must be in situ . Coordinating this may be done before discharge.
Infections: Like other organ systems, the system of a premature baby doesn’t function also as that of older children or adults. This places preemies in danger for contracting infections (especially viral ones) after discharge. Although premature babies can become infected with many various viruses, there’s one infection they’re particularly susceptible to . Respiratory syncytial virus (RSV) may be a common virus infection in young children, often mistaken for a chilly or the flu. Although the virus causes few problems in adults and older children, in premature babies RSV can cause severe illness, breathing problems, or maybe death; it’s a standard cause for rehospitalization among preemies.
An immunization is out there to assist protect infants from RSV. All preemies who were but 32 weeks and any from 32 to 35 weeks with certain risk factors – someone smoking reception , time spent in day care, or contact with multiple children – should receive this vaccine. For premature babies who are discharged within the winter, the primary dose of vaccine generally is given before discharge, then monthly throughout the RSV season, which runs from late fall flat late winter or early spring. However, premature babies discharged at other times of the year (summer, for example) can also need immunizations once winter arrives. Some infants who were especially premature may have to receive the vaccine for a second RSV season also . Preemies are often given the injections reception by a nurse or within the doctor’s office. The vaccine doesn’t always prevent RSV infection but can lessen its severity. Ask your baby’s doctor whether your baby should receive RSV immunizations.
Preparing for Discharge
The discharge from the hospital of a preemie is not a discrete case but a phase. This method is planned to ensure that the child can live and flourish outside the hospital and that parents are prepared to take care of the child on their own.
In preparation for discharge, many hospitals will move a preemie from the NICU to an intermediate care nursery. Often called a step-down nursery, this intermediate unit is in the same hospital and might even be a section of the same NICU. What distinguishes it, however, is that it provides a higher level of care than a full-term newborn nursery but far less than the NICU. A move to a step-down nursery is a good thing because it signals that your premature baby is getting better.
Few hospitals give preemie parents a rooming-in opportunity that allows them to spend a short time with the baby in a hospital room so they can obtain more experience taking care of all the needs of the child. Although they are apart from the nursery and gaining confidence as solo caregivers, the parents have the security of knowing that help is just down the hall.
As your preemie progresses toward discharge day, you can get ready for the big day and the weeks that follow by making the following preparations.
Check Medical Records and Insurance Coverage
As soon as possible after the birth of your baby, call your insurance company and ask to have your baby added to your policy; many insurers require that you do this within a few days of the premature baby’s birth. Few providers may provide premature babies with home nursing services, or even more intensive nursing treatment for children with complicated medical conditions. Nursing providers and social service workers can help you determine what your insurance coverage will provide.
Also, set up a file for medical records, financial statements, and correspondence you are likely to have with the hospital and your insurance company.
Choose a Pediatrician and Make Medical Appointments
Choosing a doctor for their child is an important decision for parents and especially for parents of preemies. Do not wait until the last minute to choose a pediatrician. In addition to the usual questions, you should ask whether the doctor cares for many premature infants. Your baby’s hospital doctor will tell you when to schedule the first visit with the pediatrician – commonly it is 1 to 2 weeks after discharge from the hospital.
Discuss with the NICU staff whether your baby will require home nursing or visits with medical specialists other than a pediatrician. If so, ask the NICU staff for referrals and for the telephone numbers of those health care providers. In addition, your child might need to undergo routine tests, including blood, hearing, and vision tests; other tests may be scheduled as well. Make sure you understand the results of any tests and the need for studies after discharge.
Learn CPR and Receive Specialized Training
To be prepared for emergencies, consider taking a course in infant CPR before your child comes home from the hospital. (CPR training is required for all parents whose children are on apnea monitors.) Make sure your partner takes the course, as well as grandparents or other caregivers who will be alone with the baby. A curriculum could be approved by the NICU staff; in some hospitals the nursing staff also teaches preemie parents in CPR. The American Heart Association and the American Red Cross also can provide information on training locations.
If your baby is to be sent home with special equipment – an apnea monitor or oxygen tank, for example – receive training in the use of those devices until you feel confident with them. Make sure your questions about what to do if something goes wrong have been answered. Check to see whether parents of children on home oxygen earn special parking stickers from your county or State. Contact the local ambulance service to ensure they have resources to treat an immediate premature baby and, if you live in a remote area, make sure they know how to get to your home.
Make a Decision About Circumcision
If your baby is a boy, make a decision about circumcision. Full-term baby boys are usually circumcised before they leave the hospital; generally, the same applies to a healthy preemie.
Outfit Your Vehicles With Car Seats
Before heading home, your premature infant will need to be placed in an infant-only car safety seat with a three-point harness system or a convertible car safety seat with a five-point harness system. Most car seats need to be adjusted with padding or head supports to hold the head of a preemie in a position which keeps the airway open. A preemie often does not have the muscle control required to keep her head upright or to move it if she is having trouble breathing. Some hospitals ask parents to bring in their car seat for a screening, as a precaution. The baby is placed in the seat and attached to a cardiopulmonary monitor that evaluates the heart and breathing.
Some babies have respiratory problems that preclude them from traveling in a traditional infant car seat. If your child has this type of breathing problem, discuss the idea of using a special restraint system with your child’s neonatologist or doctor.
If your child will be on oxygen or an apnea monitor at home, you’ll also need to use these devices while traveling in the car. Once these devices are in the car, secure them carefully so in the event of a crash they won’t be dangerous to passengers. If you have any questions about whether your vehicle is properly outfitted for the ride home, talk to the hospital staff before departure.
Attend a Discharge Debriefing
Although it varies from hospital to hospital, expect a discharge debriefing sometime shortly before discharge. The main purpose of this is to review medical care after discharge, confirm follow-up appointments, and allow you time for questions about your baby. Both debriefings can include an in-depth conversation about taking care of your preemie while you return finished. Make sure you understand all the instructions and advice, and do not hesitate to ask questions.
When you leave with your baby, make sure you have the telephone number for the NICU. These practitioners can be a helpful resource, especially in the period between the day of discharge and the first medical appointment for the infant.
At Home With Your Premature Baby
Imagine at first living peacefully with your preemie. Because their immune systems are still underdeveloped, preemies are more susceptible to infections than other newborns are. Therefore, you need to take some precautions. Visits outside the home should be limited to the doctor’s office.Since doctors’ offices typically have many children with viral infections, try to plan your appointment on the first day, or you can have to wait for an exam room instead of the main waiting room.
Taking the baby to the mall, supermarket, or other crowded public places can expose her to people with infections (such as colds or flu) that may cause serious illness in premature infants. Most experts recommend not visiting public places with these young infants. The same applies for visitors to your home: if Grandma has a cold or Aunt Susie has a virus, they should not visit. In addition, nobody should smoke in your home, and all visitors should wash their hands before touching the baby. Talk to your child’s doctor about specific recommendations – some family visits may need to be postponed to allow your child’s immune system to grow stronger.
The quality of babies in eating and sleeping counts for their welfare. Most premature babies need 8 to 10 feedings a day with no more than 4 hours between each feeding – any longer and the baby may become dehydrated. Six to eight wet diapers a day suggest that the infant gets ample breast milk or formula. You should expect your preemie to sleep more than a full-term baby, but to sleep for shorter intervals. To minimize the chance of sudden infant death syndrome ( SIDS) all infants, including preemies, should be put to sleep on their backs.
Take advantage of these relaxed weeks together to enjoy the touch between the mouth and the stomach, also known as kangaroo treatment. Most intensive care nurseries encourage parents to begin kangaroo care prior to discharge; the nursing staff can show you how. To practice kangaroo care with your infant, dress her in only a diaper in a warm room. Place the baby between the mother’s breasts or in the center of the father’s chest so that there is contact between the parent and child’s skin. Turn your baby’s head to one side so that her ear is against your heart. Research shows that kangaroo care will promote parent-child attachment, encourage breastfeeding and improve the wellbeing of a preemie.
Special Care for Premature Baby
Although most premature infants do very well and grow up as healthy children without any disability, some premature infants do have special needs. Babies born very prematurely (less than 29 weeks’ gestation) or those who are particularly ill as newborns may need close follow-up during their first years and even later. Very premature infants do have a heightened risk of delays in development, problems with muscular coordination, and learning problems. Some have more profound disabilities, including cerebral palsy, mental retardation, and blindness.
Brain imaging, commonly performed in the NICU for premature infants, provides general information on potential risks for your baby, but there is no precise method for predicting how your baby will develop physically or mentally. Many factors other than prematurity, including home and school environment as well as genetics, will significantly influence growth and development. For this reason, appropriate developmental follow-up is important for very premature babies. The purpose of developmental follow-up clinics is to identify any children who have special needs and help to intervene as early as possible. Most ex-preemies continue to see clinicians, including early childhood physicians, neurologists, ophthalmologists and physical therapists, monitoring the progress of their abilities in vision, hearing, voice and motor skills for several years.
Taking Care of Yourself
You will spend a tremendous amount of time caring for your preemie during the first few months at home, but it is also important to remember to be good to yourself. Mothers of preemies should not underestimate the stress they have experienced by delivering earlier than expected. Women are expected to have 6 to 8 weeks to rest and heal after giving birth, but premature delivery of a baby will shorten the period for recovery. In addition, do not underestimate the physical and emotional toll those long days in the NICU have taken.
Parents of preemies may feel many emotions during the initial months of their babies’ lives. When you have serious medical issues with your preemie, you may feel upset that the baby is ill or grieved over the lack of the good, happy baby you dreamed of taking home. And as for all women emerging from pregnancy, preemie mothers may suffer baby blues hormone changes or more severe postpartum depression.
To make life with your new baby easier to adapt, embrace family and friends support offers-they can provide babysitting for your other kids, execute orders or clean the house so you have time to take care of the baby or relax. Treat yourself well by trying to get enough rest, nutrition, and moderate exercise. Find physicians, nurses, retired parents, community groups or online forums to assist and inspire. And if you are overwhelmed or depressed, do not hesitate to get professional help for yourself so you can enjoy your child’s infancy.
Because of potential breathing problems, it is generally recommended that parents limit the time a premature infant remains in a car seat to an hour or so. If you require more prolonged periods of travel, ask your pediatrician if it is appropriate for your baby.
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