1. Newbies Material taken from IHC Health Services, Inc., www.musckids.com &www.musckids.com The Preemie Parents’ Companion by Susan Madden

2. 1.What is prematurity? 2.Common problems: -Breathing -Gastrointestinal -Brain -Heart -Vision -Nutrition & Feeding 3. Unexpected Journey (VHS) 4. Home Visit Strategies

3. Baby born before 37 weeks of pregnancy

4.  Chronological age is the age of the baby from the day of birth -- the number of days, weeks, or years old the baby is.  Adjusted age is the age of the baby based on his due date. If a baby is 6 months old, but was born two months early, his adjusted age is 4 months.

5. Here's one example: Chronological age: 20 weeks The number of weeks your baby was premature: 6 weeks Subtract the number of weeks premature from the chronological age: 20 weeks minus 6 weeks equal 14 weeks. 14 weeks is your baby's adjusted age. Divide your baby's adjusted age in weeks by 4 to determine your baby's adjusted age in months: 14 divided by 4 equals 3 1/2 months.

6.  When will a baby catch up developmentally? Most premature babies "catch up" to their peers, developmentally, in two years. After that, any differences in size or development are most likely due to individual differences, rather than to premature birth. Some very small babies take longer to catch up.  KOTM Policy: Do not adjust after 24 months

7.  small baby, often weighing less than 2,500 grams (5 pounds 8 ounces)  thin, shiny, pink or red skin, able to see veins  little body fat  little scalp hair, but may have lots of lanugo (soft body hair)  weak cry and body tone  genitals may be small and underdeveloped

8. 1. Breathing Problems  Respiratory distress syndrome (RDS): caused by infants inability to produce surfactant, a fatty substance that coats the sacs in the lungs to keep them from collapsing. Other causes can be infection or breathing meconium or fluid into the lungs

9.  Apnea and Bradycardia: Sometimes, a premature baby stops breathing for Short periods of time (apnea) accompanied by a Slower –than-normal heart rate (bradycardia).  Meconium aspiration: Caused by inhaling meconium during labor and Delivery.

10.  Nasal cannula: flexible hollow tube with two prongs that fit just bellow baby’s nose  Oxygen mask: oxygen flows through a tube into the mask at a constant rate.  CPAP: Continuous Positive Airway Pressure

12. 2. Gastrointestinal Problems:  Reflux: the muscle at the entrance the baby’s stomach is not mature, allowing food to move back up into the esophagus.

13. Symptoms  belching  refusal to eat  stomach ache  fussiness around mealtime  hiccups  gagging  choking  frequent coughing  coughing fits at night  wheezing  frequent upper respiratory infections  rattling in the chest

14. Treatment  After feedings, elevate the upper body at least 30 degrees for 30 minutes  If bottle feeding, keep the nipple filled with milk so infant does not swallow too much air.  Adding rice cereal to feeding may be beneficial for some older babies  Burp the baby several times during feeding.  Make sure diaper is loose  Medications: can help decrease the amount of acid the stomach makes. Another medication will help empty the stomach faster.

15.  Necrotizing enterocolitis (NEC): an inflammatory bowel disease. The lining of the intestinal wall dies and the tissue sloughs off.

16. 3. Brain Problems: “The brain of a premature baby is still growing and developing, so many of the blood vessels are quite fragile. Babies born 6 weeks or more early are prone to have bleeding in the brain during labor delivery, or first few days after birth. The bleeding is referred as interaventricular hemorrhage.”

17.  Why is interaventricular hemorrhage a concern? Severe damage to cells can lead to brain damage. The amount of bleeding varies and is described in 4 grades. Grade 1 - bleeding occurs just in a small area of the ventricles Grade 2 - bleeding also occurs inside the ventricles Grade 3 – ventricles are enlarged by the blood Grade 4 – bleeding into the brain tissues around the ventricles Grade 1 & 2 are common, Grade 3 & 4 are the most serious and may result in long-term brain injury to the baby (example: cerebral palsy)

19. 4. Heart (PDA): “A blood vessel located just outside of the heart, called the ductus arteriosus, allows blood to bypass the lungs while your baby is still being carried in the womb. After birth, the ductus arteriosus should close, redirecting your baby’s blood flow through the lungs. If the ductus arteriosus does not close, we say it is a patent, or open. A patent ductus arteriosus (PDA) can place stress on the babies heart and lungs, and may need to be closed with medication and/or surgery.”

20. 5. Eye Problems:  Retinopathy of Prematurity (ROP): When immature blood vessels to retina develop abnormally. Four Stages of ROP : Mild Stage 1 to severe Stage 4 when the retina detaches in the eye. Treatment  Stage 1 & 2 resolve without treatment  Half with Stage 3 and most with Stage 4 need treatment: cryopexy (freezing to stop damage) or laser photocoagulation (create small burns creating scars to seal the borders of the retina helping to prevent detachment)

22.  Alignment problems: Premature babies are more prone to Alignment problems of the eye, called lazy eye or amblyopia

23.  NPO: Baby can’t take in any foods by mouth. This can be due to too small or too sick.  Gavage Feedings: Infant is placed on a feeding tube. This occurs when infant can take food orally but may not have enough sucking strength for bottle or breast.

24. 1. Commonly called NG – tube placed through the nose into the stomach 1.2. 2. Commonly called NJ – tube placed through the nose into the jejunum (mid section of the small intestine) 3. 3. Commonly called G tube - tube is placed directly into the stomach The other 2 types are vary rare.

25. Unexpected Journey The Earliest Days

26. Six States of Alertness: “Premature babies have a difficult time transitioning from one state to the next. They may make sudden leaps from one state to the next, or get stuck in one state.” The Preemie Parents’ Companion

27. Calming Techniques for Self-Regulation:  Visually  Auditory  Vestibular  Tactile  Gustatory/Oral  Propioceptive See Handouts for strategies

28.  Muscle Tone (high/low/mixed tones)  Sensory Integration  Delayed Speech  Distractibility  Quiet Observer

29. QUESTIONS?