Preterm Concerns

Preterm babies are born before 37 weeks. This was the time when the baby should have been in the mother’s womb.

So the baby gets exposed here to a new environment.

Hence the baby is kept in the neonatal intensive care unit unit, to provide an environment as close as possible to the mother’s womb.

Since the baby’s brain, intestine, lungs and other organs are still growing they will need help at the NICU.

Read NICU Family guide by Connecticut Children’s Medical Center to know more.

It takes time for your milk to be introduced .

Initially fluids are given through the drips. Later your milk through the feeding tube. Where the baby’s sucking coordination develops typically around 32-34 weeks, milk is given a spoon/Pallada then allowed to suck.

Tubes, monitors and alarms look scary, but they help in taking care of the baby. These monitors helps us to monitor baby’s parameters.

At times it feels like you are not doing enough. Everything is mostly done by the staff, but here are things actually you can do-

• Speak to your baby- they have heard your voice right from the time he/she was in your womb. They know your voice so speaking to them calms them.
• Provide a gentle touch on the back and head instead of tapping.
• When you provide kangaroo mother care, it helps you and baby to bond, they can smell you and even see you. It also helps in weight gain and even early discharge.

If you feel you need more help, have queries ask the NICU team.

After 40 weeks, your Baby need to be stimulated gradually as your baby's brain is developing and the stimulation helps in brain connections and healthy development.

• Tactile Stimulation- Give the baby a massage. This helps Click on this link to learn more.
• Visual Stimulation- They are seeing the world for the first time abuzz with all kinds of information. Pre-term babies initially can only see black and white. Use black and white contrast pictures. After 40 weeks can see bright coloured toys. They can also only focus till 8-10 inches from their face so keep their toy within this range. Click on this link to learn more.
• Audio Stimulation- Parent's voices are the best stimulation as they are familiar to the child. For Preterm, speak and sing to the baby in a low voice. Post 40 weeks, introduce different sounds like rattle, squeaky toys, bells etc. Soft and pleasant sounds should be used. Click on this link to learn more.
• Tummy time- is important for muscle development. It should be done under supervision and started when baby comes home. If you have any medical concerns for tummy time- do consult your neonatologist or developmental paediatrician.This is a very nice video about tummy time by pathways. Please visit pathways website for more information.

Developmental Checks- Child's brain grows 90% under 2 years and completes by 5 years. So this period of early brain growth is utilised to enable optimal development. Anticipatory guidance will be given to parents to maximise the child's potential. Any deviations or delays, abnormalities of muscle strength, posture when picked up early can be managed more effectively. Appropriate therapies will be suggested when required.

Also observed will be the various domains of development, language, play skills, social skills and cognition. Formal development assessment will be suggested when required.

Hence checks are recommended with a Developmental Paediatrician at-

• Post Discharge at term age.
• 3 months
• 6 month.
• 10 months
• 14 months
• 18 months
• 2 years and there after annually till 5 years of age.

Know what to expect by clicking on milestones to learn more.

Neonatal Checks-

General movements assessment- till 3-4 months of age, videos will be requested. Parents have to share a video when baby is alert and active (not when sleepy, tired, hungry or crying ). Preferably against a light background, minimal dressing (as feet and hands have to be observed). Do not stimulate or talk to your baby for that 1 minute when the video is being shot. Most importantly the camera should be above the baby and focussed well.

Vision Check- As the blood vessels in the eyes are still developing, it is important to monitor how well these vessels are growing. Else It can affect learning as good eye sight is crucial for normal development. With early monitoring, any deviation in preterm babies can be picked up early and treated early.

Hearing Check- Hearing is one of the earliest senses to develop.It is needed for good speech and language development.

Hearing test is done for all babies at birth, it is called Oto Acoustic Emission (OAE). It is a screening test. If abnormal another confirmatory test will be requested.

For babies in the NICU, another hearing test called Brain Evoked Response Audiometry (BERA) will be requested. BERA test is a confirmatory test for hearing (test both brain and nerve, whereas OAE test only the outer hearing pathway).

It is important to screen by 1 month, confirm the hearing issue by 3 months and start rehabilitation (therapy ) by 6 months. Starting early has better outcomes.

Red flags

Visual- Baby not looking at you by 2 months, follow you by 3 months, squint, abnormal movements of eyes to name a few.

Hearing- Not turning to sound by 3-4 months.

Doesn’t startle to loud noise by 3-4 months.

Myths and Facts

• Important to monitor milestones -preterms are corrected for gestational age (date they they should have been born), till two years and milestones are checked. Click on link to learn more.
• Preterm and low birth weight babies have a higher chance of Neuro developmental concerns (delay in motor and speech ,learning etc). Monitoring is quintessential.
• Please don’t ignore speech delay saying he is a boy will catch up late and saying baby was born preterm.
• Be open to discuss with neonatal team on any concerns.
• Preterm and low birth weight will need iron, calcium and vitamin D supplementation till 2 years .Check with neonatal team regarding diet and supplements.

Read more about sleep. Screen time, feeding, play and language stimulation in our blogs.

Resources For Professionals

Developmental Supportive Care at NICU by WHO