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My Preemie at First Glance What is all this stuff?

Umbilical lines

Seeing my baby the 1st time Feelings * guilt, scared * shock & relief Get a picture * start bonding process

Differences in Preemie Baby Thin skin & reddish-purple tint Body hair- lanugo Fingernails/ toenails- may appear as buds Eyes- may be fused <26wks Ears- very soft, may fold over until 35wk Genitalia- sex organs differentiated but immature. Gestation can be estimated by genitalia.

Differences in Preemie Baby Obscured face- all the tape, cannot tell who baby favors Hands and feet- appear unusually long and graceful Movements Younger babies have less muscle tone 29-32weeks- jittery, jerky movements

EQUIPMENT FOR BABY

Baby’s Bed- Radiant Warmer Easy, free access Overhead heater Saran wrap over bed Humidity to bed to help skin

Isolette/ Incubator Quieter environment Baby more stable Portholes for access Humidity may be added

Cardiorespiratory Monitor Monitors Vital signs Heart rate, respiratory rate, blood pressure, and pulse oximetry Leads- 3 placed on chest, maybe one on leg Alarms for apneas and bradycardias

Leads

Apneas & Bradycardias Apnea of prematurity Apnea is a pause in breathing with one or more of these characteristics Lasts more than 15-20 seconds Associated with color change to pale, purplish, or blue Associated with bradycardia or slowing of heart rate

Bradycardia Slowing of heart rate usually less than 80 beats per minute. Often follows apnea or periods of very shallow breathing. Sometimes due to a reflex ( valsalva)

Why do premature babies have apnea? Immature respiratory centers in brain Infection Low blood sugar High or low body temperature Brain injury

Will apnea of prematurity go away? As baby gets older, breathing will become more regular Usually markedly improves or disappears by time baby is nearing due date.

How is apnea treated? Medications that stimulate breathing CPAP Mechanical Ventilation An apnea bed or periodic stimulation

What happens if my baby has an apnea? The monitor will alarm A nurse will observe baby to see if breathing The nurse may stimulate baby if needs reminder to breathe. The nurse may give extra oxygen, if needed.

Intravenous lines (IV) Babies in the SCN will have IV lines, just like the kind adults get, only with smaller catheters. These IV catheters are secured with tape and taped to a limb board to protect. Some babies may be restrained to keep them from pulling out IV lines. IV lines may be placed on hands, feet, or scalp.

IV line

Umbilical Lines UVC- umbilical venous catheter Painless, no nerves in umbilical stump Used to infuse fluids for baby’s nutrition Taped secure to abdomen Temporary- only used for maximum of 7 days May also have IV

Umbilical Lines UAC- umbilical artery catheter Inserted into artery Blood samples can be drawn painlessly Monitors blood pressure continuously and reflects on monitor. Maintenance fluid infuses at minimal rate. Temporary- usually maximum of 7 days.

UAC & UVC

Peripheral Arterial Line Used after UAC is discontinued. IV catheter inserted into an artery in usually the wrist, foot, or scalp. Looks like an IV, also has a splint. Blood samples can be drawn without puncturing baby. Monitors blood pressure continuously. Maintenance fluid infused.

VENTILATORS

What is a Ventilator? AKA- respirator. A mechanical breathing machine. An ET (endotracheal tube) is inserted through baby’s mouth or nose and into baby’s windpipe to deliver breaths to lungs. ET tube secured with tape to face ET tube makes it impossible to hear crying.

Ventilator tubing ET TUBE

Types of Ventilators Conventional ventilation- gives a set number of breaths per minute with high and low pressures. HFOV- high frequency oscillatory ventilation- gives about 900 breaths per minute. Keeps a constant pressure. See a wiggle when viewing chest. ET tube will be suctioned periodically.

Oxygen administration There is a certain percentage of oxygen baby receives while on vent depending on their needs. Oxygen percentages 21%-100% Personnel adjust oxygen as needed by monitoring pulse oximeter and lab work.

RDS & Ventilation RDS (respiratory distress syndrome) is most common lung disease among preemies. RDS is due to lack of surfactant in the lungs which allows the lungs to stay open and for proper gas exchange to occur.

Signs & Symptoms of RDS Rapid breathing Pulling in of ribs and center of chest with each breath, called retractions. An “ugh” sound with each breath, called grunting. Widening of the nostrils with each breath, called flaring.

Treatment of RDS Extra oxygen Surfactant administration Given through the ET tube directly into the lungs. Usually given shortly after birth. May need more than one dose. Improvement after administration seen almost immediately.

How can I tell my baby is getting better from RDS? Baby will breathe easier- rate will decrease. Baby will need less oxygen Vent settings will be gradually decreased and baby will be doing more of breathing on their own.

CPAP Continuous positive airway pressure Baby is now breathing all on their own. Large prongs will be inserted into the nose and a hat will be applied on the head to keep system in place. Pressure will be continually keeping baby’s lungs expanded.

CPAP

Other kinds of oxygen administration Nasal cannula Oxyhood Blowby

Nasal Cannula

Phototherapy Treatment of jaundice in newborns Baby is placed under special lights. These lights help break down the excess bilirubin in the skin. The baby’s eyes will be covered with eye patches to protect them from the bright lights.

What is Jaundice? Jaundice is a high level of bilirubin in the baby’s system which causes the “yellowing” of the skin. Bilirubin is produced when red blood cells are broken down in the body. The preemie baby’s liver is immature and unable to process the bilirubin rapidly. 90-95% of all preemies develop jaundice.

Scalp IV Phototherapy shields

Feeding Tube AKA- OG or NG tube OG (orogastric tube) NG (nasogastric tube) Placed through the mouth or nose and advanced down the esophagus into the stomach. Kept open to air to keep stomach decompressed when not feeding. Used for feedings until baby ready for bottle.

Feeding tube Feeding tube

Procedures needed first few days X-rays Ultrasounds Echocardiograms PICC-line insertion Blood transfusions

Why does my baby need blood transfusions? To replace blood that has been taken for lab samples, baby’s immature system cannot replace RBC fast enough. Baby may have a low circulating volume of blood at birth resulting in low blood pressure or poor oxygenation.

Are blood transfusions safe? None is 100% guaranteed safe, but chances of obtaining infection are very low. Blood is screened very thoroughly prior to administration. Baby will get a small volume 2-4 times in the day from the same donor.

Can I be a donor for my baby? Mothers cannot donate due to the fact they just gave birth and lost blood themselves. Yes, others in your family may try to be direct donors. The donor’s blood has to be CMV negative and be compatible with baby. Ask baby’s nurse if interested.

The people caring for my baby

Neonatologist Physicians with special training at least 5 years beyond medical school. The neonatologist makes daily rounds on your baby. He/She will order the medical treatment your baby needs and monitor their progress. He/She is available for your baby 24 hours.

Bedside Nurse There is a nurse assigned to your baby 24 hours a day. Duties include: Weighing and feeding baby Drawing labs and starting IV Administer meds as ordered Monitor status Inform neonatologist of changes in status.

Respiratory Therapist The respiratory therapist is responsible for the ventilator and oxygen equipment. They administer treatments as ordered. They assist nurses with suctioning as needed. They work with the nursing staff and help with position changes.

Social Worker The social worker is concerned about you, the parents, and how you are coping. She can counsel you or just be an ear to listen. She can help if you need financial assistance or have questions regarding home care.

Other members of the SCN team Cardiologist X-ray technician Ultrasound technologist Speech-language pathologist Physical therapist

Does my baby feel pain? Preemies do have signals to let you know they are in pain or irritated. Breathing rate and heart rate changes Increase in blood pressure Oxygen level in blood may decrease. May move jerkily, stiffen their body, arch back,and become flushed

Can medications help with pain control? Yes, meds can help to alleviate pain. Pain relief drugs and relaxing drugs are given to most preemies. Morphine and Ativan are drugs of choice in our SCN. EMLA cream is also used for circumcisions.

Non-medical pain relief Decreasing stimulation Repetitive movements/ actions (rocking,singing) Applying firm touch and gentle pressure. Containing baby by swaddling tightly.

Requirements for discharge Weight- at least 1800gm and gaining weight consistently. Body temperature maintained without use of warmer. No significant apneas or bradycardias. Taking all feeds from a bottle or breast.

In closing Concentrate on now, don’t dwell on “what ifs” Don’t miss many happy moments and memories with your baby right now. Take pictures and keep a journal. Be an optimist- your baby needs you to be positive and strong.

References Linden,D.,Paroli,E., & Wechsler,D.(2000). Preemies: The essential guide for Parents of Preemies.Pocket Books, NY. Website www2.medsch.wisc.edu/childrenshosp/parents_of_preemies