Frequently Asked Questions
Why was my baby born prematurely?
There are many reasons that a pregnancy might
end early. Some of the causes of premature
birth include:
- Infections
- Preeclampsia
- Multiple gestation
- Uterine fibroids or anomalies
- Premature cervical dilatation
- Fetal or placental anomalies
Some premature deliveries follow early spontaneous
labor of unknown cause. In other circumstances,
labor must be induced or a cesarean section performed
due to fetal or maternal difficulties. Talk to
your obstetrician if you have questions concerning
your baby's early birth.
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Why does my premature baby
look different from a full term baby?
A full term infant has completed nine months
of development and dramatic change, starting as
a single fertilized egg. The fetus changes in
appearance rapidly during gestation, so newborn
premature infants will have an appearance corresponding
to the point in pregnancy when delivery occurs.
Infants at 23 to 24 weeks gestation
(the earliest age compatible with survival) have
no body fat, thin skin with a shiny red appearance,
a head which is rather large in proportion to
the body, and eyes which may not yet be open.
As pregnancy progresses, body fat accumulates,
the skin becomes thicker, the head appears less
large relative to the body, and all features look
more mature. Therefore, an infant born at a later
gestation will reflect these changes and appear
more mature.
A baby born prematurely will undergo these developmental
changes in the ICN (NICU), so that by the time
of discharge, the infant will appear similar to
one born at term. Development in the ICN versus
intrauterine development may sometimes result
in some differences in appearance which are due
to environment. These resolve over time.
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How can I help my baby when
he's so small or sick?
Parents of a small premature or sick infant
may have feelings of helplessness, since their
baby's needs are complex and the technology used
in the ICN (NICU) can seem intimidating. Parents
naturally want to be the primary care providers,
so it can be frustrating when infants in the ICN
need the specialized care of the medical and nursing
staff.
The ICN staff understands the feelings that parents
may have, and knows that it is essential to involve
parents as much as possible. Parents should realize
that their infant's stay in the ICN is temporary,
and that they will eventually assume full care
for their infant at home.
ICN medical staff and nurses will explain issues
as they arise, and will help parents understand
the decisions made for their infant's care, as
well as the technical aspects involved in caring
for the baby. In many situations, the staff finds
it helpful to understand parents' feelings and
concerns, and parental input is valuable for making
important decisions.
A very sick or premature infant may not be ready
to be held, but he/she can be touched and be made
aware of parents' presence and warmth. When a
baby can be held, a nurse will help parents to
do this. Parents can participate directly in aspects
of care such as feeding, changing diapers, and
bathing.
Breastfeeding is encouraged, as it provides important
nutrients for the infant and protection against
infection. In also involves the mother in a very
meaningful way in the care of her baby. Breast
milk can be pumped and stored in a freezer in
the ICN. This milk can be used for feedings when
a mother is not available for breastfeeding, or
for those babies not yet ready to breastfeed directly.
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Can I breastfeed if my baby
is small or on a ventilator?
We encourage breastfeeding for all babies, and
feel that it is especially beneficial for those
who are premature
or sick. You may pump your milk, which can then
be stored in a freezer in the ICN (NICU). Even
if your baby cannot breastfeed directly, breast
milk can be used for bottle or tube feedings.
Frequently, premature babies need more calories
and minerals than are provided by breast milk,
so fortification of the milk and/or supplemental
formula feedings may be necessary. The ICN nurses
and lactation specialists can help mothers with
breast pumping and feeding issues. An electric
pump can be rented for home pumping, and insurance
often covers the cost.
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Why does my baby have a birth
defect?
Most birth defects, or congenital anomalies,
occur for unknown reasons. Some are genetic in
origin, which means that it is related to the
chromosomes or genes; this does not necessarily
mean that the problem is inherited from the parents.
Other anomalies occur randomly during the very
complex process of embryonic and fetal development.
Some anomalies are discovered prior to delivery
through ultrasound
or amniocentesis, whereas others are not known
before birth. You may discuss with your obstetrician
and your baby's neonatologist how the problem
may have occurred. Certain tests may be done to
establish the nature and extent of the problem,
and determine whether it is genetic. Geneticists
from the Children's
Hospital of Philadelphia (CHOP) come to see
patients when needed. Families can meet with geneticists
to determine the risks, if any, for future pregnancies.
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How could my baby be born
with an infection?
The fetus in utero can develop either viral
or bacterial infections. This is possible even
if the membranes are intact, but the likelihood
of a bacterial infection rises if a prolonged
period elapses between rupture of membranes and
delivery. Speak with your obstetrician or your
baby's physician if you have questions about how
the infection developed.
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How did my baby develop an
infection in the nursery?
Newborns, particularly those who are premature,
have immune systems that are not fully developed.
As such, babies are at increased risk for contracting
infections. Great care is used in handling infants
in the ICN (NICU), and sterile technique is used
when working with intravenous
lines, central
lines, endotracheal
tubes, and intravenous fluids and medications.
However, infants may still develop infections
from bacteria or viruses in the environment. The
ICN staff is alert for signs of infection and
will begin antibiotic therapy if an infection
is suspected.
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Why does my baby need a blood
transfusion? Is it dangerous?
A baby will need a blood
transfusion if the number of red
blood cells declines to a level that is too
low. Red cells carry oxygen from the lungs to
the body tissues. If the red blood cell count
is too low, then the body may not receive enough
oxygen. Most infants have a decline in their red
cell count following delivery. In premature infants
born prior to 34 weeks gestation, this is more
pronounced, because the bone marrow (where blood
cells are made) stops making adequate numbers
of blood cells until the baby reaches approximately
34 to 36 weeks corrected age.
This drop in red cell count in prematures
is called "anemia
of prematurity." If an infant is sick and
requires frequent blood tests, this can cause
the blood count to drop faster. Sicker infants
need higher blood counts, so they will be more
likely to receive blood transfusions.
All blood from the blood bank is tested very
carefully for hepatitis viruses and HIV, and it
is now extremely rare to contract these diseases
from blood transfusions. The benefit from the
transfusion is far greater than the risk of contracting
a disease.
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Can I, or someone else, donate
blood for my baby?
A person donating blood for a specific patient
is called a "directed donor." Mothers
usually cannot donate blood since they are often
anemic following delivery. Fathers, other relatives
and friends may donate blood. All donors must
have a blood type that matches that of the baby.
Since the baby's blood type is generally not known
prior to delivery, and since a baby may need a
transfusion in the first couple of days, there
may not be time to donate blood before the baby
requires it. Also, blood that is donated requires
a few days to be tested before it can be used
for the baby.
Blood from directed donors is subjected to full
rigorous testing for the viruses that cause AIDS
and hepatitis. It is of great importance that
anyone donating blood be in perfect health to
avoid transmitting illnesses to the baby. Ask
the ICN (NICU) staff about blood donation if you
are interested in the directed donor option.
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Are my baby's medications
safe?
Most medications used carry very little risk.
For some drugs, blood levels are checked periodically
to ensure that the baby is receiving a safe dose.
Infants are given medications only when the possible
benefits of the medications outweigh their risks.
In other words, an infant is at lower risk receiving
a medication, than if that medication were not
given. Efforts are made to use the minimum number
of drugs possible, and to stop them when they
are no longer needed.
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Can my baby have her hearing
checked?
All infants at Pennsylvania Hospital, including
those in the ICN (NICU), have their hearing checked
prior to being discharged home.
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What are the monitors for?
Management of infants in the ICN (NICU) requires
careful following of many details. Electronic
monitors allow the ICN staff to see information
such as heart rate and heart beat pattern, breathing
rate, blood pressure, and blood oxygen level.
Alarms will sound if any of these values are too
high or too low. Monitors safeguard the infants,
by letting the staff know when something may be
wrong.
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Why does my premature baby
need her eyes checked?
Premature babies have periodic eye examinations
to evaluate for the presence of retinopathy of
prematurity (ROP), a disorder in retinal blood
vessel development. The retina is the light sensitive
layer in the back of the interior of the eye.
During gestation,
the retina matures slowly, and its blood vessels
grow from the very back of the eye toward the
outer edge of the retina. By term, the retina
is mature, and the blood vessels are in their
fully developed positions. When a baby is born
very prematurely, the retina has not yet finished
developing, and it is possible that the blood
vessels can develop abnormally. Because ROP can
result in visual impairment, all premature infants
receive regular eye examinations. The examinations
are performed by ophthalmologists from the Children's
Hospital of Philadelphia (CHOP), who come
to the ICN (NICU).
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When can my baby go home?
In order for a baby to go home from the ICN
(NICU), he or she should be able to be cared for
at home with a minimum of risk. For many babies,
this means that they are as well as if they had
never had any difficulties. For others, there
may be minor issues that can be managed at home.
Premature
infants often are discharged a little before
their due date (as early as 35 weeks corrected
age), and somewhat smaller than if they had been
born at term.
By the time of discharge, a premature infant
should be fully breast or bottle feeding, show
steady weight gain, be able to maintain body temperature
wrapped in a blanket in a crib (no longer needing
an incubator) and, usually, not needing supplemental
oxygen. Infants are discharged only when the ICN
staff is confident that they no longer need the
inpatient services of the ICN, and can be cared
for safely at home. Following discharge, the ICN
staff remains available to parents on a 24-hour
basis to answer questions and provide advice as
needed.
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How will I know how to care
for my baby at home?
The ICN staff is experienced at helping parents
prepare for the transition to caring for their
baby at home. Many infants will be fine at discharge
and can be cared for as normal newborns. Other
babies may have medical or developmental issues
that need special continuing care.
Parents will be taught how to give any medications
that their baby will need at home, and will be
taught any special feeding techniques. If a baby
needs a home apnea
monitor or oxygen, parents will learn to manage
these. A visiting nurse can be arranged to help
with care at home if needed. Babies are discharged
home only when parents feel sufficiently comfortable
making the transition to home care.
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What if my baby has problems
at home?
We are committed to ensuring that the transition
to the home environment be as smooth as possible.
After discharge, you will have questions, and
there may be occasions when you may feel that
your baby is having difficulties. Parents should
feel free to call the ICN staff with questions
following discharge home. Once a relationship
is established with a pediatrician, it may be
appropriate to consult him/her initially, but
parents can always call the ICN with questions.
We encourage parents to identify the emergency
room closest to home that can provide specialized
pediatric and infant care. This is important for
all children, but particularly so for those infants
with a history of complex issues. Going to an
emergency room that does not specialize in children
can delay proper care.
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Discharge Planning
Bringing your baby home from the ICN is a time
of great happiness, but there may be issues with
which you feel unsure or which may make you apprehensive.
We want to ensure that all parents are as comfortable
as possible with the transition to the home environment.
To achieve this, we will work with you to help
you understand all aspects of your infant's care,
and teach you any special skills you may need
to care for your baby at home.
The discharge planning process involves the neonatologists,
nurse practitioners, residents, nurses, social
workers, and any family members who will be caring
for the baby at home. If your baby will be going
home with an apnea monitor, you will be provided
with apnea monitor and CPR training. If you and
your baby will need the assistance of a visiting
nurse at home, this will be arranged. If your
infant will need medications at home, we will
help you to learn to give them. Following discharge,
we are available to answer questions that arise,
and you can call us at any time in the ICN.
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