The first few weeks at home with a preemie can be especially trying. No matter if your preemie was born at 26 or 36 weeks, here are a few things to keep in mind
1. I Got The Thermoregulation Blues
Your preemie lacks the subcutaneous fat necessary to keep herself warm unless she is sufficiently wrapped. You don’t have to crank up the thermostat to 80F (after all, Eskimos have babies, too), but a wise parent wraps the baby in more than one layer.
For the first day or so, take baby’s temp before feeding or bathing, just as you did in the hospital. Then you will know how she reacts to what is normal environmental temperature for your household. Add or subtract layers accordingly.
Place the thermometer under the arm.
Remember: Normal = 98F-99F
Over 100F = could be a sign of illness; remove one layer and check again in 30 minutes
Over 101 F= call your healthcare provider
Another hint: do NOT use a heating pad to warm the crib. Better to warm blankets by tossing in the dryer on ‘delicate’ for 5 minutes.
Recognize cold stress: cool hands/feet, sleepy, poor feeding.
Recognize heat stress: warm to touch, red, crying, may have ‘prickly heat’ rash.
2. Feeding Frenzy?
Preemies may need to eat every 2-4 hours to consistently gain weight. Do NOT let the baby sleep more than 5 hours the first few weeks, or until your healthcare provider tells you to do so.
Breastfeeding? Avoid fasting during the night to keep your blood sugar from dropping too low. Think about it: the baby is taking nourishment from you; you need replentishment! Those decreased hormones of pregnancy can cause postpartum depression…and hypoglycemia makes it worse.
Set up a Breast Feeding Station for nights. Before turning in, arrange a plate of wholesome snacks, and a pitcher of juice and/or water at your station. (You don’t need to drink milk to make milk.)The idea is to achieve economy of movement, establish a routine and avoid the kitchen at night.
Here‘s how: go potty, wash hands; change diaper, cleanse hands; feed baby and yourself simultaneously! The whole session should take about 30 minutes.
3. Don’t Be The Rabbit
Preemies are by definition immunosuppressed. It may take up to two years to fully gain immunity to the big, wide, world we live in. Meanwhile, what ‘s a preemie parent to do? Go ahead…be the Nazi. You have our permission to blame the NICU Docs and Nurses, who implore you to guard the health of your preemie.
wash hands after every diaper change;
limit visitors, (keep sickies away!)
play the ‘NICU card’ for Doctor’s appointment times (early or latest in the day),
keep up with routine vaccinations (talk to your healthcare provider about seasonal RSV and flu innoculations)
DO NOT ALLOW SMOKING anywhere around the baby (Research shows second-hand smoke can be deadly to infants!)
4. When to call your Healthcare Provider:
fever > 100F(axillary)
Excessive crying with no known cause
Vomiting and/or Diarrhea
Redness, swelling or foul smelling drainage from any body part
Yellowing skin or eyes
No stool for 48 hrs
< 6 wets a day
White patches in mouth
5. When to call 911 :
Baby turns blue or pale
Extreme difficulty breathing
When all else fails, do what parents have been doing for centuries: trust your gut. YOU are the best advocate for your child because YOU know her better than anyone. If something seems wrong, it probably is. Better to seek help than regret you didn’t.
Candace Campbell, MSNc, RN, has practiced as a NICU nurse, and educator for 20 years. Her documentary film, Micropremature Babies: How Low Can You Go? plus her delightful children’s books, My Mom Is A Nurse, and Good Things Come In Small Packages (I Was A Preemie),are available on Amazon.com or at: www.CandyCampbell.com