If your baby was born prematurely, you may greet your D-Day, or day of discharge, with an uncomfortable mixture of joy and trepidation. You’re finally able to take your baby home, but you’re also leaving the safety and security of 24-hour medical care. Remember first and foremost that your baby will not be discharged unless your doctors and nurses believe that your baby is absolutely ready for this step.
Health challenges facing premature babies
Any baby born before 37 weeks gestation is considered to be premature, and they can often have serious health challenges, including issues with temperature regulation, feeding, apnoea (irregular breathing) and the need for oxygen supplementation, or jaundice. For these reasons, your “preemie” may spend weeks or even months in the Neonatal Intensive Care Unit (NICU). Thankfully, with medical support and growth, immature organs can eventually recover and function independently in most cases.
Many premature babies who are discharged no longer need specialised medical care, but they will need supportive care once they’re home. For some, medical needs will continue even once they have been allowed to go home. Your discharge will most likely coincide with a meeting to discuss a follow-up medical care plan that includes visits to a paediatrician and any specialists that may be involved. Take charge, ask questions, make notes and diarise your appointments so that you feel as though you are in full control once again of this little life.
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Basic requirements for discharge for premature babies
Before being discharged, your baby must meet at least the following basic requirements:
- Maintain their body temperature in an open crib for 24 to 48 hours, depending on how premature your baby was at birth.
- Take all feeds by bottle or breast, without supplemental feedings.
- Be gaining weight steadily.
Some babies reach this point two to four weeks before their original due date. However, babies who have had surgery, those who have needed long-term assistance with breathing, or those who are born with special needs may stay in NICU way beyond their scheduled due date.
“Many preemies may need to see early intervention specialists to ensure that they are meeting their milestones.”
Medical needs of premature babies after discharge
Your baby probably won’t need specialised medical care after discharge, but will require regular medical care and evaluation to see that they are growing and developing well. However, there are some common medical challenges that many premature babies face in the long term.
- Apnoea: Many premature babies have episodes of apnoea, or pauses in breathing, that improve as the baby gets older. Your baby will not be discharged from hospital if this apnoea causes a slow heart rate or a change in colour. However, they may be sent home with a breathing monitor because the apnoea is minor and only requires stimulation to help your baby breathe again. If this is the case, it would be a good idea to invest in a breathing monitor and also to take a course in infant CPR, to ensure you’re well prepared.
- Other breathing problems: Premature babies often have breathing difficulties and may need supplemental oxygen. Sometimes this need persists even after discharge and your baby may then be sent home with equipment to administer oxygen.
- Infections: Your baby’s immune system may not develop fully for a longer-than-average period of time. Be vigilant when it comes to keeping them safe from possible infections, for example, from other people or by going out in public places.
- Developmental needs: Many preemies may need to see early intervention specialists to ensure that they are meeting their milestones. Remember, if a delay is picked up early, with some help, your baby can catch up quickly.
At home with your premature baby
- It is best if you plan for a few quiet weeks at home. Your baby’s immune system is still developing, so you need to ensure that visits outside the home are limited for the first few weeks to doctors’ appointments only, especially if you are discharged in the winter months.
- There are often viruses floating around doctors’ offices, so organise to wait in an examination room instead of the main waiting room when you go for your appointments. Most doctors will recommend that you don’t visit public places during the first few weeks and that you limit your home visitors. Anyone who is ill should not visit; there should be no smoking inside your home, and visitors should wash their hands before holding your baby.
- Feeding and sleeping are especially important to your baby’s health and they might sleep more often than a full-term baby, but for shorter periods at a time. Your preemie will need 8 to 10 feeds per day, with no more than four hours between feeds. Six to eight wet nappies a day are a good indication that your baby is getting enough breast milk or formula.
What is kangaroo care?
Kangaroo care is a way of holding a baby that maximises skin-to-skin contact between parent and child. Medical professionals strongly advise parents to incorporate as much skin-to-skin time with your baby, and this is particularly beneficial for preemies. Studies have shown that the benefits of kangaroo care include:
- increases bonding between the parent and child;
- it can help stabilise your baby’s heart rate and regulate their breathing;
- improves your baby’s oxygen saturation levels and regulates their body temperature;
- boosts your breast milk supply;
- improving a premature baby’s overall health;
- may have a positive impact on your baby’s brain development.
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Ensure that you have warmed the room well. Remove all of your baby’s clothing, except for the nappy, and lay them on your bare chest with their head to the side so you’re able to stimulate all of their senses. Don’t be surprised if your little one nods off – this is incredibly soothing for them! Remember to take care of yourself also so that you can take care of your tiny baby!
The Chris Hani Baragwanath hospital has started a Kangaroo Mother Care Unit in ward 40. The unit aims to also start a self-help group for mothers of these premature babies. Nursing staff, allied medical disciplines and mothers who have had premature babies, will be involved.
You can find out more about this initiative here.