Premature babies, especially those who were born very early or who had complications in the Neonatal Intensive Care Unit (NICU),
may have both short-term and long-term effects from their experience. The range and severity of these effects is large, from
nearly undetectable to severely debilitating. As these babies prepare to leave the NICU, parents gradually become more responsible
for their complete care so that transition to home or a less intensive care environment is easier.
This section addresses some of the medical and developmental issues that some premature babies may face as they leave the
NICU or another ward of the hospital, and head to the family home.
The chances that a baby will have ongoing medical and developmental concerns are usually related to how premature the baby
was at birth and the complications which occurred. Just one week extra in the womb can make a significant difference.
A premature baby’s two ages
For the purposes of developmental benchmarks and the follow-up process, you will need to start thinking about your baby’s
age in two ways:
-
the baby’s actual or chronological age, which is the age measured from the day the baby was actually born
-
the baby’s corrected age, which is the age measured from the day the baby was expected to be born
Suppose a baby was born two months premature. If that baby’s actual age is now six months, his corrected age is four months.
This can make a big difference in terms of how you and health care providers think of your baby’s progress. For example, most
full-term babies can sit up when they are about seven months old. However, if your baby was born three months early, although
his actual age is seven months, his corrected age is only four months. This child will have to wait a few more months before
he can sit up on his own.
Though the corrected age is used as benchmark for a baby’s behaviour and development, the actual age is used for vaccinations.
This distinction between the actual and corrected age is very important because all assessments of development must be based
on the biological age of the brain.
What is normal for a baby?
Part of the anxiety of returning home with a premature baby, is wondering whether some event or behaviour is “normal.” For
example, all babies spit up and vomit to some degree during or immediately following feedings. If a premature baby who had
gastrointestinal issues in the NICU goes home and vomits after a feeding, how do you know whether this is a concern or whether
this is just normal? Do you take the child to the hospital or let the event pass?
It is not always easy to determine what behaviour is normal for a baby and what is a concern. Even for full-term babies without
any medical issues, the range of what is normal in terms of child behaviour and development is vast. For example, it is not
all that unusual for a child to begin walking as early as nine months. It is also not all that unusual for a child to begin
walking at 15 months. Both these dates are considered within the normal range. Parents of premature children, especially those
who were born extremely premature or who had some sort of complication in the NICU, may have an even more difficult time knowing
when to be concerned about their baby’s behaviour.
Thankfully, parents can learn and get to know their baby’s individual behaviour and can get help from professionals. The staff
in the follow-up programs, as well as your primary care paediatrician, will be very helpful in this regard.
In addition to learning as much as you can about typical full-term and premature baby development, parents can help by observing
and recording their child’s behaviour. That way, when attending follow-up clinic visits and visits to the paediatrician, they
can more fully explain in detail what the child is up to. With this new information combined with the baby’s history, health
care providers and parents will be in a better position to assess whether a baby’s development and behaviour are normal or
a cause for concern.
Other skills worth learning
It is recommended that parents, especially those of premature babies who are deemed at risk for future complications, learn
some specific skills. If medication is prescribed, parents should know exactly how and when to administer it at home. If medical
equipment, such as supplemental oxygen, is to be used at home, parents will need to know how to use this equipment. Infant
cardiopulmonary resuscitation training, or CPR training, is recommended for all parents, especially if their baby is at risk
for complications. It should also be noted that severe cardiac events in babies and young children, such as a cardiac arrest,
are preceded by breathing troubles.
Protecting and overprotecting your premature baby
All parents want to protect their babies and children from injury. At the same time, all parents want their babies to thrive
and do well. For parents, these two goals can often seem at odds with each other. Children fall down many times before they
get steady on their feet. Developing to full potential involves some degree of risk.
For parents of premature babies, especially those who were born extremely premature or who endured complications in the NICU,
the urge to unnecessarily overprotect their baby may be strong. This urge often exists in parents of normal, healthy full-term
babies too. Also, knowing what is not risky for a baby will help parents find the right medium between bringing up baby in
a safe “bubble,” which is not particularly good for development, and putting their child at undue risk by over stimulating
them.
The trick is to treat your baby, as much as you can, like a normal baby within specific confines recommended by the involved
health care professionals.
