Special Care Needs for Premature Babies

A premature baby, born after 28 weeks gestation, has an excellent chance of surviving, thanks to advances in medical care and knowledge. There are still special considerations for the care of a premature baby however, and the more you know, the better equipped you’ll be if it happens to you.

What is premature birth?

A baby born before 37 weeks gestation is considered to be premature, or preterm. There are several categories of preterm babies:

• Extreme preterm – born at less than 28 weeks gestation
• Very preterm – born at 28-32 weeks gestation
• Moderate to late preterm – born at 32-27 weeks gestation (Source)

With a premature birth, the baby is essentially not fully developed. For example, women in labor before 34 weeks should have a steroid injections to stimulate the development of baby’s lungs. Without this, a baby born with underdeveloped lungs will have difficulty breathing on their own and could end up with a lifetime of breathing difficulties.

A preemie will weigh less than a full term baby, be smaller and have far less body fat, which means they get cold easily. They will also cry more softly than a full term baby because of their underdeveloped lungs. For preemies that are more than 6 weeks premature, this lack of oxygen into the body can cause issues for other organs. That’s why a very premature baby is monitored so closely.

The World Health Organization has put together guidelines for the care of premature babies, to ensure the best possible outcome for these babies:

“The guidelines include interventions provided to the mother – for example steroid injections before birth, antibiotics when her water breaks before the onset of labor, and magnesium sulfate to prevent future neurological impairment of the child – as well as interventions for the newborn baby – for example thermal care, feeding support, kangaroo mother care, safe oxygen use, and other treatments to help babies breathe more easily. (Source)

Why do preemies need special care?

The first reason is simple: complications resulting from being born prematurely are the leading cause of death in children under age 5. (Source) That alone is a very good reason to provide special and enhanced care for premature babies.

But premature babies are typically underdeveloped in the lungs, digestive systems, and immune systems. They can also face a host of other postpartum developmental issues, including physical and learning disabilities, hearing and vision problems and more. High quality care from the moment the baby is born is essential to limit or even eliminate these potential issues.

What kind of care will a preemie receive in the hospital?

It’s likely that a preemie will be evaluated and sent to the NICU—Neonatal Intensive Care Unit. This place can be overwhelming for new parents who have had a premature baby. There is a lot of equipment, staff and it all seems a little like something out of science fiction. But the point of the NICU is to be able to provide optimal care for a baby who cannot yet function on their own.

If your premature baby is in the NICU, they might have a number of interventions, including:

Assistance with breathing, either through a tube, ventilator, C-PAP machine or oxygen pumped into a closed hood. They might need a feeding tube via the umbilical area, intravenous lines, or an oral tube. They will likely be placed in an incubator to ensure warmth, as premature babies cannot regulate their body temperature the way a full term baby can. Bili lights might be used if there is jaundice.

A baby that is moderately premature—perhaps only two weeks—might have less issues but still be a low birth weight and at risk of infection. A very effective technique with these babies is to start them off right away with kangaroo care. This is a skin-to-skin positioning of baby on mom, so that baby can hear mom’s heart beat. This helps with regulating body temperature, which is often low in preemies; better sleep for baby, which they need to keep developing and gaining weight; and breastfeeding.

Can a premature birth be prevented?

Not really. The cause of premature birth isn’t always known. There are some known ‘triggers’, such as multiple pregnancies, infections in the mother and chronic illnesses such as diabetes can be a contributing factor. Sometimes, a woman is induced or given a caesarean birth for medical reasons. In those cases, it’s known that the birth is preterm and all precautions can be taken to care for the baby. Many times however, the preterm birth is unplanned.

What happens when baby is released from the NICU?

Typically, when a baby in the NICU is breathing on their own, maintaining a normal body temperature, feeding properly, gaining weight steadily and is free of infection, they are ready to go home.

When that day finally comes, parents are overjoyed… and a little scared. Suddenly, they’re going to have to care for their premature baby at home, possibly with little help. I’ve written before about the basics of what you need to leave the hospital with, in terms of equipment and a care plan.

Having a postpartum doula who is trained to deal with and care for medical devices—a G-tube, for example, for feeding baby—can provide a safety net for you and your baby. After all, they have seen many babies and will give you the comfort of knowing what’s okay and what needs to be investigated medically. Don’t forget to take care of yourself: preemies need a lot of extra TLC and you’ll be able to help them best if you are able to take of you too.