It is fairly impossible to write a generalised medical article about prematurity. Every prem baby has a different story, a different path and a different outcome. The ones who are expected to face complications often sail through, and the ones who ought to do well land up experiencing setbacks.
There’s no magical formula. Luckily there are “magic” neonatologist paediatricians who tackle all these challenges head-on and hopefully produce a happy ending.
My little D is one such happy ending.
Pregnancy number one was uneventful, uncomfortable but uneventful. Pregnancy number two was a disaster and my little princess was not strong enough to survive a 25-week delivery combined with a severe infection, so there was much anxiety when my “rainbow baby” was miraculously conceived. And the anxiety proved founded when at 21 weeks I had to go in for an emergency cervical stitch followed by nine weeks of strict bedrest.
Little D arrived at 30 weeks. We had bought him nine extra weeks in the womb and had had enough time to administer steroids to help mature his lungs. Out he came, squawking, all 1.6kg of him. I was given a few brief seconds to kiss his tiny little head and then the paediatrician whisked him away.
At 30 weeks, D was considered “very preterm”.
The World Health Organisation (WHO) categorises premature babies as follows:
- Those born before 28 weeks are extremely preterm.
- Those born between 28 and 32 weeks are very preterm.
- Those born between 33 and 37 weeks are moderate to late preterm.
The complications one expects with a prem baby are largely dependent on their level of prematurity. These complications are those experienced in the neonatal unit and those you can expect as the child grows up (long-term disabilities).
We were so blessed. My tiny boy needed a little help with breathing for the first two days so they put him onto something called CPAP (Continuous Positive Airway Pressure). This is a non-invasive form of respiratory assistance using a small mask. Thereafter he was on oxygen for a further two days and then nothing!
“The complications one expects with a prem baby are largely dependent on their level of prematurity.”
He also had an episode of jaundice and had to lie under lights to help reduce his bilirubin levels. Jaundice can happen even with full-term babies, so we weren’t too alarmed. Thankfully there were no infections, no brain bleeds, no bowel issues, no cardiac abnormalities … the list of potential problems is long and frightening.
Our biggest challenge was getting my little man to feed and grow. Premature babies often don’t have a developed sucking reflex, which usually develops at 35 to 36 weeks. It is critical that they get good quality nutrition, so a tube is passed via the nose or mouth into the stomach and milk is fed, initially in very small quantities, directly into the stomach.
There is some very good evidence for the use of breast milk in prem babies in terms of gut health. Colostrum, just a few precious drops of the first milk, is essential. In fact, breast milk is deemed so important in the management of prem babies that there is an organisation called the South African Breast Milk Reserve who strives to get breast milk donated to those babies whose mothers can’t produce.
Obviously, as the mother of a tiny new preemie, many hours are spent hooked up to a breast pump. Mom needs to get a milk supply established so she lands up pumping as often as she’d be feeding – so much for getting a little rest while your baby is in the neonatal unit.
It’s also harder to produce great volumes of milk when you’re not physically bonded to your baby. Oxytocin levels are lower and that has an effect on lactation. I found it easier to take my pump with me to the neonatal unit and then pump just after I’d had a snuggle with my precious bundle. All that skin-to-skin contact is great for oxytocin release and a better let-down reflex.
And that brings us to Kangaroo care. Kangaroo care is a method of holding a baby that involves skin-to-skin contact. The baby, who is naked except for a diaper and a piece of cloth covering their back (either a receiving blanket or the parent’s clothing), is placed in an upright position against a parent’s bare chest.
This snuggling of the infant inside the pouch of their parent’s shirt, much like a kangaroo’s pouch, led to the creation of the term “kangaroo care”.
Kangaroo care has shown to have multiple benefits for a baby:
- Stabilisation of the baby’s heart rate
- Improved (more regular) breathing pattern
- Improved oxygen saturation levels (an indicator of how well oxygen is being delivered to all the infant’s organs and tissues)
- Gain in sleep time
- More rapid weight gain
- Decreased crying
- More successful breastfeeding episodes
- Earlier hospital discharge
The benefits of kangaroo care to the parents include:
- Improved bonding, feelings of closeness with their babies
- Increased breast milk supply
- Increased confidence in ability to care for their babies
- Increased confidence that their babies are well cared for
- Increased sense of control
Initially, trying to move my little D with all his wires and tubes out of the incubator and onto my chest seemed quite daunting. Even as a doctor, it felt overwhelming. And yet the bliss of feeling his tiny little body against my chest is indescribable.
After eight long weeks, my sweet boy was weighing in at a hefty 2.5kg and was finally drinking his bottles to the satisfaction of the paediatrician. It would be another three weeks before I could get him to successfully latch but we were reassured by the fact that we could bottle feed expressed milk. We brought our little Miracle Baby home on Mother’s Day.
Today he is a solid five-year-old. He is super bright, exceptionally strong and has ambitions of being the next Ronaldo. Yes, it is a daunting rollercoaster ride being the mommy of a tiny new prem baby. Just take it day by day, gram by gram, milestone by milestone.