The one constant thing in my career as a neonatal intensive care unit (NICU) nurse is the reaction parents have when their premature infant is born.
A premature infant is a baby that is born before 37 weeks of gestational age. The levels of prematurity are the following:
- Late preterm is defined as 34-36 weeks of gestation.
- Moderate preterm is 32-34 weeks of gestation.
- Very preterm is considered less than 32 weeks of gestation.
Nurses not only care for the premature infant, but we also care for the family. The shock of a preemie infant coupled with the bells and whistles of an intensive care ward can be overwhelming to parents. Most parents are unaware that an intensive care unit for infants even exists. It is over the course of the infant’s stay in the neonatal intensive care unit that the nurse/family relationship is forged. My initial talk with parents of preemies is primarily the same as when I first entered the NICU over 20 years ago.
If I could write an introduction letter to each parent with a preemie, the following would be my personal message to parents:
Congratulations on the birth of your infant. About 11-13 percent of children are premature (AAP, 2012). The human body is a wonderful and sometimes unpredictable thing. You see, most premature births occur due to unknown cause. Sometimes infection, hypertension and substances can lead to a premature birth, but trying to find reason or place blame serves no purpose at this juncture. What is germane is the fact that your child is here and the baby will need special care for the duration of his or her stay. For some reason, the mother’s body decided that the extra-uterine environment was a better place for the infant to develop than the intra-uterine environment.
The good news is that 80 percent of children born after 30 weeks gestation will have minimal long-term health or developmental problems (AAP, 2012). The degree of your child’s prematurity will have a direct effect on their short and long term care and outcome. In short, the younger the preemie, the less time their organs have had to develop. Immature organs do not work as easily or as efficiently as mature organs. Our job is to provide your infant with the specialized care needed to maintain his or her life outside of their mother’s body. This care can be of a respiratory, gastrointestinal or neurological nature, just to name a few types. This care can change on a daily basis depending on your baby’s condition.
Please remember that your child is no longer in a quiet and buoyant environment that his or her mother provided. Your baby’s neurologic system is premature, which adds to their physical stress. For this reason, premature babies are kept in isolettes (incubators); in order to maintain their temperature and decrease the amount of unneeded stimulation. Too much stimulation has a direct negative affect on their breathing and heart rate.
Initially, your child may be too premature to breast or bottle-feed. You may notice intravenous fluids or a feeding tube inserted into their nose, which will provide nutrition until the baby can feed on their own. As your child grows, he or she will be better able to handle normal daily activities such as feeding. The baby will gain weight as he or she matures, which will make it easier for you to provide care to your child. Our job is to bring your child to maturity so you can finally take your child home. It is also to help you bond with your infant by helping you to provide tenderness and care to your baby when possible.
Over the course of the coming weeks, you will experience a broad range of emotions stemming from your infant’s successes and failures. You will have an entire team of health care professionals to lean upon. Call and visit frequently. Ask questions and recognize that this experience will be one of the most stressful times of your life. Remaining positive and realistic is paramount. Stay well.
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