There are a few things that the NICU staff have to take into account before they can let parents hold their preemie. On the one hand, if a baby isn’t ready, their health could be at risk. On the other hand, preemies benefit from spending some time in a parent’s arms. So, what’s an eager parent to do?

The different ways to hold a preemie 

• Comfort holding: This is where a parent reaches into the incubator with clean hands and arms and cradles parts of their baby’s body with their hand. Sometimes babies like to wrap their hands around the parent’s finger, too. Comfort holding has been shown to calm preemies down, soothe them during certain procedures, and improve their responsiveness.
• Kangaroo care: Also called ‘skin-to-skin contact,’ kangaroo care involves nurses placing a preemie (wearing just a diaper) directly on their parent’s bare chest for a certain amount of time. Sometimes parents are allowed to begin kangaroo care right after their baby is born, but other times babies aren’t quite ready; it really depends on the individual situation. Kangaroo care improves breastfeeding abilities, regulates babies’ heart rate and temperature, decreases rates of infection, and improve sleep patterns, among other things.
• Touching and holding your baby in the ‘classic’ way: Such as holding them in your arms, rocking them, changing their diaper, and breastfeeding them, among others. It might take some time for a baby to be healthy enough to be held in this way.

Signs of readiness

• A baby might be ready when they is in stable condition, has recovered from any recent surgery, and doesn’t need the humidity of an incubator to regulate their temperature.
• A parent might be ready when they are healthy, up to date on vaccines, and emotionally ready to hold their baby. It’s important to remember that many parents in the NICU have mixed feelings about holding their baby at first – and that’s okay. What’s important is that you’re there for them.

Staying in touch with your preemie

The NICU staff knows just how much you want to hold your preemie. Ultimately, they’re the ones who will let you know when it’s safe to for all of this to happen. Don’t be afraid to ask your baby’s nurses and doctors when they think you can hold them, though – it’s totally normal to be eager and anxious to get your preemie in your arms.

More information about premature babies

Ovia won’t deliver more articles about premature babies to your timeline, but if you’re interested in reading more articles about your premature baby, you can find them by tapping the three stacked lines in the upper left corner of your app, selecting “Articles,” and typing “preemie” into the search bar.

Sources

• Mayo Clinic Staff. “Premature baby? Understand your preemie’s special needs.” Mayo Clinic. Mayo Clinic, August 30 2014. Web.
• “Kangaroo care.” Cleveland Clinic Children’s. Cleveland Clinic, 1995-2015. Web.
• “Holding Your Baby Close: Kangaroo Care.” March of Dimes. March of Dimes, 2016. Web.

• Try to schedule your NICU visits: This means waking up, getting ready, leaving your house, and then leaving the NICU around the same time every day. Many parents find that creating a schedule helps them feel more in control of the situation. On the off-hours of your visits, consider scheduling some time to exercise and express your feelings in some way, perhaps  in a journal, or by talking to a friend or family member on the phone, or even seeing a therapist. Feeling refreshed can improve your time in the NICU, and when you’re with your baby, you’ll want to be able to focus on them emotionally.
• It’s okay to be intimidated by the NICU: Babies in the NICU are growing bigger and stronger by the minute. That said, the unit can feel overwhelming for a new parent. It’s filled with unfamiliar sounds and sights, and it can be hard for people to adjust to the environment. Don’t be embarrassed if you or your partner feel disoriented and uneasy in the NICU. In time, you’ll get more comfortable.
• Breastfeed if you’re able: Breast milk has health benefits that can be helpful for preemies. Pumping and sharing breast milk with a preemie can help parents feel like they’re able to do something concrete for their babies, too. Consider renting a hospital-grade breast pump, which can stimulate your breasts and help produce milk.
• Know that you might not be able to pump – and that’s okay: Not all new moms can pump breast milk. If your body is struggling to produce enough breast milk, remind yourself that this is nothing to feel shame or guilt about. Your presence at the NICU alone is helping your baby, and the hospital staff will make sure your child is getting all of the nutrition they needs.
• Get involved with the nurses and doctors: Learn the rules of the NICU, especially the visiting hours, how many people you can bring to the NICU, and what you can bring into the room with you. Get to know the staff in the NICU, especially the primary nurse assigned to your preemie, because he or she will be learning your baby’s specific habits and preferences. Don’t be afraid to ask questions; they’ll be happy to help you out.
• Get involved with your preemie: Kangaroo care, or skin-to-skin contact between parents and their preemie, is a way to encourage bonding with preemies. Many hospitals encourage kangaroo care between parents and their babies, so don’t be afraid to ask when and how that can happen. You may also be able to take on some of the aspects of your baby’s care, like helping to change their diaper, take their temperature, or breastfeed them skin-to-skin.
• Don’t be afraid to advocate for your baby: You are your baby’s voice in the NICU, so it’s up to you to let the hospital staff know concerns or preferences you have for your preemie. If you have a request, just ask; the worst that happens is your baby’s doctor or nurse says they can’t do it.
• Bring hand lotion: Parents wash and sanitize their hands repeatedly while they’re in the NICU. Your hands might get uncomfortably dry, so consider bringing some moisturizing lotion along.
• Take pictures: Many new parents feel that they shouldn’t or don’t want to take pictures of their preemie while they is growing in the NICU. This makes sense, but a lot of parents also say that they later regret not taking pictures during this time. If this seems like something you’re interested in doing, know that many parents eventually do appreciate having these pictures.
• Know that leaving the NICU will be hard: For some women, leaving the hospital without their newborn baby can trigger intense feelings of depression and emotional pain. However, at some point, your team will probably advise you to leave the hospital to sleep and get some time away. It might not be easy to leave at first, so if you have a hard time leaving, remind yourself that most new parents of preemies struggle with this, and that you’re not alone.

As the parent of a preemie, you’re going to find that deep inside, you have an incredible amount of strength, resilience, and hope. Some days will be harder than others, but try to find the positives about the NICU. Remember that the NICU is the safest place for a preemie to be, and that every day that a preemie spends in the NICU is one day closer to coming home with their parents.

Sources

• “7 ways to stay involved in your baby’s care in the NICU.” NICU Awareness. Project Sweet Peas, July 17 2014. Web.
• “Becoming a parent in the NICU.” March of Dimes. March of Dimes Foundation, 2016. Web.
• “How to bond with your baby in the NICU.” Penn Medicine. The University of Pennsylvania Health System, Oct 1 2015. Web.
• “How you can participate in the care of your baby in the NICU.” Healthy Children.  American Academy of Pediatrics, Nov 21 2015. Web.
• Anne Smith. “Breastfeeding the premature baby: breastfeeding in the NICU.” Breastfeeding Basics. Breastfeeding Basics, 2016. Web.
• Melinda Caskey, Bonnie Stephens, Richard Tucker, Betty Vohr. “Adult Talk in the NICU With Preterm Infants and Developmental Outcomes.” American Academy of Pediatrics,  Vol 133 Issue 3. Web. 2014.

Chronological vs. adjusted age

Preemies and birthdays 

Talking to other people about your baby’s age

Usually around the two year-mark, premature babies’ development catches up with that of full-term babies, and parents stop relying on the baby’s adjusted age to notice developmental milestones. But like most things regarding preemies, this depends on things like the baby’s development and what the caregivers prefer.

Sources

• “Corrected Age for Preemies.” Healthy Children. American Academy of Pediatrics, Nov 21 2015. Web.
• “The premature infant: How old is my baby?” March of Dimes. March of Dimes, August 2014. Web.

• Difficulty breathing: Premature babies can develop breathing problems like apnea, which is an extended pause in breathing. They can also experience respiratory distress syndrome (RDS), which occurs when a baby’s lungs can’t stay expanded, or bronchopulmonary dysplasia (BPD), which is a chronic lung condition that premature babies usually outgrow as their lungs develop. These conditions require different treatment, but they also tend to go away as babies grow.
• Trouble with their immune systems: Premature babies are at higher risk of infection because their immune systems may not be strong enough yet to fully protect them.
• Blood and blood vessel problems: A baby born too early could have complications like jaundice, a chemical build-up in their blood, or anemia, in which there aren’t enough red blood cells in the body. Premature babies are also at risk of developing heart murmurs, low blood pressure, blood vessel defects, and bleeding in the brain, which can cause a dangerous buildup of fluid in the brain and sometimes require surgery.
• Difficulty regulating body temperature: This usually depends on how early a preemie is, but many preemies have a hard time staying warm and might need to stay in an incubator for some time, until they’re ready to take on temperature regulation on their own.
• Digestion and metabolism complications: Premature babies sometimes develop problems with their blood sugar, since their body may not have enough glycogen stored away and their livers aren’t developed enough to start doing their job yet. If their gastrointestinal systems aren’t developed yet, they can also have problems with the cells that line their bowels.
• Problems with their eyes: It’s not uncommon for preemies to be born with retinopathy of prematurity (ROP), which is an eye disease that indicates the baby’s retinas aren’t fully developed. This condition usually goes away in time.
• Long term health challenges: Premature babies can also face health challenges that start or last after their stay in the hospital is over. Preemies may experience long-term vision, hearing, digestion, respiratory, and learning problems, among others. According to Mayo Clinic experts, premature babies have higher rates of chronic illness, dental problems, and behavioral issues.

Considering all of the health challenges that preemies face, it makes sense why professional care is so important in their first weeks of life and beyond. While caring for a premature baby certainly isn’t easy, medical advancements have made the world a much safer place for preemies.

Sources

• “Health Issues of Premature Babies.” Healthy Children. American Academy of Pediatrics, Feb 26, 2016. Web.
• “Long-term health effects of premature birth.” March of Dimes. March of Dimes Foundation, Oct 2013. Web.
• Mayo Clinic Staff. “Premature Birth: Complications.” Mayo Clinic. Mayo Foundation for Medical Education and Research, Nov 27 2014. Web.

According to a 2008 guide from the American Academy of Pediatrics, the National Association of Neonatal Nurses, and March of Dimes, the following are some milestones to look for when monitoring a baby’s development (remember, all of these milestones apply to a preemie’s adjusted age, and they certainly don’t apply to all babies, because every baby is different!).

• 2 months: By this age, many babies can move their hands and legs, lift their head and chest during tummy time, hold objects in their hands, cry if they need something, respond to sounds, make eye contact, look and watch people and things, and recognize their primary caregivers.
• 4 months: At 4 months, many babies can bring their hands to their mouth, reach for and grasp objects, startle when they hear a sound, laugh, squeal, bring objects to their mouth, show an interest in mirrors, and comfort themselves.
• 6 months: Many 6 month old babies can sit without any help, hold one object in each hand at the same time, respond to their name, babble ‘nonsense’ sounds and make cooing noises, shake objects and hit them against other things, follow things with their eyes, look in the direction of things that have left their sight, and show emotions like happiness, unhappiness, and excitement.
• 9 months: A 9 month old baby may be able to pick up small objects with their pointer finger and thumb (pincer grasp), crawl, roll over, transfer objects between their hands, recognize certain words, copy your words or movements, try to help feed themselves, can play peek-a-boo, and might seem scared when they see a stranger.
• 12 months: By 12 months, many babies can stand without assistance, take a few steps alone, put objects in a container, point at things, associate simple words with objects or people, hand over objects over when asked, help with getting dressed, appear to be more comfortable when they’re around their caregivers, and can play with other children.

Before you leave the NICU 

After the NICU

Every preemie has a unique set of needs, but one thing they all need is consistent check-ups starting soon after they leave the NICU. Your preemie may need an appointment anywhere from 2 days to 2 weeks after they come home, depending on what’s in their care plan. A preemie may also need to visit specialists for specific health concerns. Some specialists who work with preemies include neurologists, ophthalmologists, and physical therapists.

What happens at a first appointment?

• Assess your baby’s health
• Ask how your baby’s been doing
• Make sure that your baby has been feeding well
• Record your baby’s weight and take measurements (if your hospital didn’t already take these)

Once your baby is set up with appointments with all of the providers that they needs, it’s a good idea to set aside some time to post the phone numbers of all your baby’s providers around your house for quick reference. Doctor’s visits are really important for keeping your preemie up to date on their health care, and they’ll make the transition from the hospital to your home that much smoother.

Sources

• “Going home: a parent’s checklist.” PreemieCare. Raising Multiples, 2009. Web.
• “Taking your preemie home.” Kids Health.  The Nemours Foundation, 2016. Web.
• “Your newborn: Bringing baby home from the hospital.” Caring for Kids. Canadian Pediatric Society, Jan 2014. Web.
• Caitlin Berens. “What to expect at baby’s first doctor appointment.” Parents. Meredith Corporation, 2016. Web. 

What makes a preemie a micro preemie? 

• When a baby is born at 33 to 36 weeks of their mother’s pregnancy, he or she is considered late preterm.
• At weeks 29 to 32, babies are very preterm.
• At 26 to 28 weeks, babies are moderately preterm.
• If a baby is born between 23 to 25 weeks, they’re considered a micro preemie.

Do micro preemies have different needs in the NICU? 

• Breathing: Because their lungs haven’t developed yet.
• Feeding: Micro preemies usually get their nutrients through an IV until they’re about 34-35 weeks old, when most preemies can successfully bottle- or breast-feed.
• Hearts: Nurses and doctors work hard to prevent heart murmurs, which preemies are at a higher risk for.

Leaving the NICU with a micro preemie 

Micro preemies: Tiny gifts

When micro preemies are born, they still have a lot of growing left to do, and the NICU can help them grow to full-term. Because they’re born so early, micro preemies need extra attention during their hospital stay, and many are at a higher risk of long-term health problems that, in many cases, can be treated with surgery or physical therapy. Despite their size, though, micro preemies have an amazing amount of strength and resilience.

Sources

• James G. Anderson, Rebecca J. Baer, J. Colin Partridge, Miriam Kuppermann, Linda S. Franck, Larry Rand, Laura L. Jelliffe-Pawlowski, Elizabeth E. Rogers. “Survival and Major Morbidity of Extremely Preterm Infants: A Population-Based Study.” American Academy of Pediatrics. American Academy of Pediatrics, Jun 14 2016. Web.
• Lex W. Doyle, Saroj Saigal. “Long-term outcomes of Very Preterm or Tiny Infants.” American Academy of Pediatrics. 10(3)e130-e137. Mar 2 2009. Web.
• Mayo Clinic Staff. “Complications.” Mayo Clinic. Mayo Clinic Foundation, Nov 27 2014. Web.
• Sandra Juul. “Birth at 26 Weeks Gestation.” Penut-trial. Sandra Juul, MD. 2013. Web.

In general, a preemie can leave the NICU when they can keep themselves warm, can breastfeed or bottle-feed, and is growing at a healthy rate. Having standard signs of readiness doesn’t mean that all preemies need the same kind of care once they’re home, though. Some need a lot of care, some need just a little bit more than any other newborn, and others are somewhere in the middle. But no matter what, there are some things to know about taking care of a preemie once their time in the NICU is finished.

• You might need to bring medical equipment home with you: It’s not uncommon for preemies to be sent home with certain kinds of equipment to support them until they’re developed enough to safely breathe or feed on their own. Equipment you might need could be oxygen, breathing monitors, or feeding tubes. Your baby’s caregivers will talk to you about this equipment before your baby is officially discharged from the NICU.
• You might not get out too much: In their first weeks of life outside the NICU, preemies are at higher risk of developing infections, so it’s best to keep them away from lots of people at first. You may not want to take your preemie to public places, although this depends on your doctor’s advice. With check-ups, if you get the first doctor’s appointment of the day, and try to not sit in the main waiting room, your baby will be exposed to fewer germs.
• Be careful with visitors: Before you have anyone visit your baby, it’s important to make sure your baby’s doctor approves visitors. Once your doctor says visitors are okay, it’s still important
  make sure that anyone who visits is healthy, up to date on shots, and that they thoroughly wash their hands with hot water and soap before touching your baby. This goes without saying, but no one should smoke when they’re near your preemie.
• Don’t be surprised if your baby has a hard time falling asleep: Babies are adaptable – it’s one of their many talents! But this can make it hard for them when they’re in a new environment. Many parents of preemies report that their baby had a hard time falling asleep in the quiet darkness of their room, after getting used to the sounds and lights of the NICU. If this happens with your preemie, try putting a white noise machine in their room and keeping a dim light on at night to help their adjust.
• Don’t feel bad if discussing your preemie with other people is tough: In the weeks following your baby’s discharge, you could hear a lot of the same questions over and over again. It’s possible that people will make comments that come across as rude or inconsiderate. Unfortunately, many people don’t understand what it’s like to have a preemie, and while they’re trying to be kind and understanding, it might add more to your plate. How you deal with this is really up to you, but don’t be afraid to decrease your amounts of social time if you find yourself not wanting to deal with the comments right now.
• Take care of yourself: Unfortunately, this one’s a little too easy to put on the back burner, but it’s just as important as the advice above! In the days following your baby’s discharge, you’ll likely be a little on edge and scared of being in charge, especially if your preemie needs a lot of extra care at home. All of these feelings are completely normal, but an important part of coping with these huge changes in your life is to try to make time to relax, and appreciate all the hard work that you’ve done so far (and so well!). As time goes on, your perception of what’s normal will change, and soon enough this will all be second-nature.

Sources

• “Home after the NICU.” March of Dimes. March of Dimes, 2016. Web.
• “Taking Your Preemie Home.” KidsHealth. Nemours, 2016. Web.

Music plays a central role in so many people’s lives, and for quite some time researchers have been studying whether or not it can be practically helpful as well as emotionally.

One example involves premature babies in the NICU. As the theory goes, music just might be powerful enough to help preemies breathe, sleep, and self-soothe more effectively while in the NICU. But just how much of this theory is true?

The benefits

The American Academy of Pediatrics says that three sounds are particularly helpful for premature babies and their parents during their stay in the NICU.

• The sounds of an ocean disk, which is an instrument that has metal balls inside it that move and make a ‘whoosh’ sound
• Sound from a gato box, a wooden instrument which, when plucked, mimics the soft sounds of the mother’s heartbeat
• A lullaby sung out loud by one or both of the baby’s parents

Normally, the ocean disk and gato box are played live in the NICU by trained music therapists, who can match the instrument’s rhythms to the baby’s heartbeat. Researchers found that on days when babies were exposed to these sounds, babies had better success with feeding, longer and deeper sleep patterns, fewer and shorter crying episodes throughout the day, and better oxygen intake than on days that they weren’t exposed to music. There definitely seem to be some positive health benefits from exposing babies to any of these three sounds in the NICU.

The limits

Even with those benefits, not all sound in the NICU is created equal! Too much sound can damage a baby’s hearing, and it’s very important to protect a baby’s hearing at this age. It’s possible that other kinds of musical intervention, especially loud ones, would be bad for a preemie’s hearing.

There also isn’t enough evidence to support the idea that music can help all babies in the NICU. Some sick babies in the NICU haven’t been shown to benefit directly from music.

So while certain sounds have been proven to be beneficial for babies in the NICU, there are limitations to the kind of sounds that should be played for preemies. More research is needed before researchers can safely use music as therapy for all preemies in the NICU.

The bottom line 

Certain types of sound and music have been shown to have positive effects on many preemies in the NICU. Lullabies sung by parents are especially helpful and encourage bonding between babies and their caregivers. Sounds from instruments like the ocean disk and the gato box can help soothe some babies and improve their sleep and feeding patterns.

More research is needed to determine whether or not music soothes all preemies, and unfortunately, you won’t be able to get your preemie hooked on your favorite artist directly while they is in the NICU. Only certain music and sounds are safe! But overall, it looks like there are some solid benefits to exposing a preemie to certain sounds and music in the NICU.

Sources

• “Music therapy can comfort and soothe premature infants and parents.” American Academy of Pediatrics. American Academy of Pediatrics, April 15 2013. Web.
• Ashley L Hodges, PhD, WHNP-BC, Lynda Law Wilson, RN, PhD, FAAN. “Preterm infants’ responses to music: An integrative literature review.” Southern Nursing Research Society. Southern Online Journal of Nursing Research, Sep 2010. Web.
• Joanne Loewy, Kristen Stewart, Ann-Marie Dassler, Aimee Telsey, Peter Homel. “The effects of music therapy on vital signs, feeding, and sleep in premature infants.” American Academy of Pediatrics. (5): 902-918. Web. May 2013.
• Kathi J. Kemper, M.D., M.P.H. and Craig Hamilton, Ph.D. “Live Harp Music Reduces Activity and Increases Weight Gain in Stable Premature Infants.” Journal of Alternative and Contemporary Medicine. 14(10): 1185–1186. Web. Dec 2008.
• S. Amon, A. Shapsa, L. Forman, R. Regev, S. Bauer, I. Litmanoviz, T. Dolfin. “Live music is beneficial to preterm infants in the neonatal intensive care unit environment.” Birth. 33(2): 131-136. Web. May 2006.
• Susan Hatters Friedman, MD1, Ronna S. Kaplan, MA, MT-BC, NMT2, Miriam B. Rosenthal, MD1,2, and Patty Console, MT-BC2. “Music Therapy in Perinatal Psychiatry: Use of Lullabies for Pregnant and Postpartum Women with Mental Illness.” Music and Medicine. 2(4) 219-225. Web. Sep 2010.
• Suzanna A. Peczeniuk-Hoffman. “Music Therapy in the NICU: Interventions and Techniques in Current Practice and a Survey of Experience and Designation Implications.” ScholarWorks at WMU. Western Michigan University, Dec 2012. Web.

One of the joys of parenthood is watching your baby reach different developmental milestones. It’s normal for parents to worry about whether or not their baby is hitting the right milestones at the right times, and as the parent of a preemie, you might find yourself thinking about milestones more often than other parents do. Even if milestones haven’t been on your mind just yet, there are a few things it’s good to keep in mind when you use milestones to track your preemie’s development.

Calculate your baby’s adjusted age to measure their development

Milestones are markers, not the finish line 

Don’t compare your preemie to other babies

A premature baby is still a happy baby!

Your baby has amazing things ahead of them, and keeping an eye on developmental milestones can certainly help the two of you get where you both need to be. Celebrate the milestones as they come, but keep in mind the fact that an absence of certain milestones doesn’t mean your baby isn’t perfectly happy and healthy.

Sources

• “Growth and development after prematurity.” Tommy’s. Tommy’s, 2016. Web.
• “Supporting you and your preemie.” American Academy of Pediatrics. American Academy of Pediatrics’ Preemie Health Coalition, 2008. Web.
• Maureen Mulligan LaRossa, R.N. “Developmental Milestones.” Emory University School of Medicine. Emory University, 2016. Web.