Preemie Primer

From A to Z: Premature infant information at your fingertips

Welcoming a little one into your family is always a cause for joy, but when he is far littler than anyone expected, it can also bring fear, sadness and confusion. Babies born before 37 weeks are considered premature. Most weigh less than five pounds; some only one or two. About 475,000 preemies are born annually-and that number is rising. Since 1981, there has been a 27 percent increase in premature births. For parents, having a preemie is tough. So this primer may be just what the doctor ordered.

-By Tamra B. Orr

Breastfeeding basics
Breastmilk is the best food for preemies. The milk of a mother with a premature baby is rich in proteins and fats, helping preemies fight infection and gain weight. If your baby has an immature suck and swallow reflex, he might have to be fed through a tube at first.

Coping with car seats
Choose a car seat without a shield or tray to prevent your baby's head from striking it in a sudden stop. Put rolled blankets on both sides of his head and place another between the front of the diaper and crotch strap to prevent slipping. Some babies may need a car bed if they have trouble breathing in a semi-reclined position.

Dealing with diaper rash
With preemies, less is better. Their fragile skin is easily irritated by chemicals and quickly absorbs them. Use only water and a washcloth-no lotions or wipes. Don't bathe too often; it depletes natural body oils. Use a chemical-free cream for rashes and let your baby go diaperless.

Examining the eyes
About 60 percent of preemies under 1,200 grams have varying levels of a condition called retinopathy of prematurity, which can lead to blindness. The exam for ROP is usually done immediately. Feelings, whoa-oh-oh, feelings. This is an emotional time. You may feel angry, guilty, scared or sad. Accept your feelings as normal. Share with people you love, ask questions, start a journal, cry when you need to.

Grappling with jaundice
Many babies deal with jaundice when breaking down unneeded red blood cells. In a preemie, the condition is worse because the liver is immature. Make sure your baby is eating and having frequent bowel movements. Find some indirect sunlight for a sunbath.

Home, sweet home
When you bring your preemie home, you may feel overwhelmed. Know what medication is needed, and how to work any equipment and do infant CPR. Keep a list of important numbers by the phone. Mostly, relish the joy of this moment.

Introduction to infections
Preemies have trouble fighting off germs due to their immature immune systems. Limit the number of visitors and wash your hands frequently. Don't go overboard: The world isn't sterile.

Just another breath
Apnea in preemies is common. They can stop breathing for 20 seconds or more. Most preemies grow out of this condition; some wear monitors and/or are given medication to stimulate them to breathe.

Kangaroo care
Hold your baby skin-to-skin on your chest, either in the NICU or at home, and then rock, talk, sing or nap with her. It will help you to bond, decrease crying and possibly decrease the risk of apnea and enhance growth.

Looking at the long term
Preemies carry a risk of future complications including learning, behavioral, vision, hearing and dental problems. Your physician can tell you what to watch for with your child.

Managing monitors
If your baby comes home with a monitor (usually due to apnea and/or bradycardia, a slowing of the heart rate), make sure you ask the hospital for instruction and training.

NICU knowledge
The NICU can be frightening with its high-tech equipment, blinking lights and bustling staff. Take time to become friends with a few of the nurses; learn how you can help and what puts you in the way.

Operating oxygen
About 5 percent of babies who use a ventilator in the hospital will be sent home with oxygen temporarily. The hospital will teach you about how and when to use it.

Perception of pain
In spite of what was once thought, preemies do feel pain. If your baby is distinctly uncomfortable, try dimming the lights, nursing, rocking, singing or swaddling.

Questions and more questions
All of the questions you have about your preemie are appropriate. A general rule of thumb: Ask doctors about procedures and tests; ask nurses about updates, routines and understanding what the doctor just told you.

Risk of RDS
Respiratory distress syndrome is when the lungs are developed but lack a chemical to help them open and close regularly. RDS was once a serious condition, but now the chemical can be administered directly into a preemie's lungs.

Seeking support
If you need help with laundry, picking up the kids or just sharing your feelings, ask. Others are waiting to help you, and it will give you the energy to take better care of the one who needs you most.

Temperament tuning
Preemies have a lot to handle in those beginning weeks, too, and that can cause extra fussiness. Sleeping and eating patterns may be erratic, and crying may be often. Comfort her as best you can; she will soon settle into calmer and more predictable patterns.

Unexpected appearance
Preemies look different than full-term babies. The head appears too large for his body; his skin is thin enough to see the veins and facial features are sharp without the usual baby fat to soften them.

Valuing your needs
It's easy to focus so much on your baby's needs that you forget your own. Take care of yourself. It's the only way you will be able to take care of your baby when he or she comes home.

Watching the weight
Every ounce your baby gains brings you all closer to a more normal life. Keep a chart of how much he gains weekly; it will make you feel like you are making progress.

X-rays or not?
If you worry about how much radiation your preemie is getting from all of the X-rays he has had, don't. The amount used is so small that it takes 20 chest X-rays to equal the amount people get naturally.

You and your family
Take time to connect emotionally and physically with the rest of your family. You and your spouse may both be reacting to the birth of your premature baby differently, so grab a moment to bond and communicate. Spend time with your other children. You don't want them to get lost in the shuffle, especially younger children who can't understand what is going on.

Zzzzzs
Preemies sleep a lot; that is when they do most of their growing. Use this time to recharge, too. Take a nap, write in a journal, spend time with your spouse or call a friend.