Praveen, let us discuss today what a premature baby goes through when it is admitted into our neonatal unit?
Most newborns are healthy. However, some newborns do need intensive care which is called as neonatal intensive care unit, or in short, NICU. Getting admitted to the NICU is a very stressful event for the newborn and for the parents. The newborns which are tiny infants in the cradle or under the warmer, will be there. They might be attached to lot of equipment through wires and stuff.
A newborn needs a support, depending on their gestational age, or level of prematurity. Either breathing support giving oxygen through the nose or through a tube called endotracheal tube, where they are connected to a machine called ventilator. They may have lines which are inserted in the veins or through the belly button, where the nutrients are given.
Some babies are fed through a tube which is placed through the mouth into the stomach or some babies might be receiving medications through the injection IV lines.
Would you want to tell more about the initial days and how subsequently things change?
The journey of a premature infant is very prolonged and depending on the gestation age, they may stay for anywhere between one week to ten days or up to 3 months of age. Now, the problems come at different ages of these infants and it can be rollercoaster of emotions. As soon as they are born, they need a lot of breathing support and machine support. But as the day’s progress, one by one support could be withdrawn depending on the infant’s response. Parents will be updated regularly about the progress however, the main is the outcome, which cannot be predicted.
What is the cost involved since the journey can last from anywhere between a week to 3 months?
Once you are in a hospital for that long, the cost involved in managing the infant could be very high. This includes the stay, the equipment being used, the medications, the investigations and of course, the health professional charges. Now, this depends on the place where the newborn is getting admitted, ranging from to very minimal to very high. And also in the initial days, the cost will be very high and as and when the support to the infants reduces, the cost could also be reduced.
If the baby is staying in the unit for a month or two, what happens to the parents? Where do they stay? How do you support them?
As I mentioned, in the case of extremely premature infants, the attachment to the newborn itself takes time because the premature infants do not look like full term infants. They might have a very purplish or red appearance and the bonding may not immediately take place. After delivery, while the mother is still in the hospital, they can visit any number of times without restrictions. However, once the mother gets discharged, it might be difficult for her to come to the unit. In the first few weeks, they are not required to stay in the hospital. However, once the infant is more stable and not on any breathing support, then they might be able to hold the infant and also have a skin-to-skin contact, that’s something called KMC that is Kangaroo mother care. Once they are ready to be discharged to the ward, we would require the parents to come to the hospital for training on how to look after the infant.
Is there any role for the parents, even before the discharge? Parents can come and participate in the nursing care of the newborn?
That’s true. Now, the care of the premature infants in the beginning is mostly done by nurses. However, prior to the discharge, we need to prepare the parents to take care of their newborn, as they were absent during the first few weeks after the delivery. So, we train them in the simplest of the things like changing the diapers, administering medications, feeding, and precautions to take during feeding. This preparation starts much before discharge and continues in the ward till they can go home. That could be reviewed during the out-patient visits.
Once the baby gets discharged, how often should they visit? Which other specialists do they need to visit?
Once a premature baby is discharged, a regular follow-up is necessary. This is to identify any problems and start treatment early. The number of visits changes depending on the underlying problems. For example, in case of eye problems, a specialist dealing with retinopathy of prematurity would want to see the infant every week. If there are neurological problems or in all extremely premature infants, they would need developmental follow-up. This could be during regular visits, during vaccinations, and developmental visits, which can start from around 3 months of age. Until the child has attained all milestones, developmental follow-up will be needed. Also, the nutrition plays a major role in the development of the child. Hence, during the regular visits, the nutrition will be addressed. Looking at the weight length gain is very important as well.
Team Ovum Hospitals