for Your Premature Baby after Discharge
By Ricki Goldstein, M.D., and Dennis Clements, MD, PhD, MPH
your premature baby home after several weeks or months in the hospital
is very exciting -- but often overwhelming.
infants (24-32 weeks gestation) are very different from full-term
infants in their growth, nutritional requirements, medical needs,
and behavior and development.
they are recovering from serious illness, and they can play catch
up in growth and development for several months or years after discharge.
infants develop for two to four months outside the womb. During
this time, they are exposed to different types of stimuli such as
light, noise, touch, and pain.
stimuli make them very sensitive to similar types of stimulation
after they go home. They benefit from being swaddled in a blanket
in the early weeks and often prefer a quiet environment with dim
lights to achieve a quiet alert state that is needed for feeding
and staying calm.
Problems: Chronic Lung Disease and Acid Reflux
Premature infants can have continued medical problems after discharge.
The most common problem is chronic lung disease -- sometimes called
bronchopulmonary dysplasia (BPD).
can occur because the infants still have some inflammation in their
lungs and may require extra oxygen or medications to help them breathe
medications to treat this may be diuretics or water-elimination
medicine to help keep fluid out of their lungs (Diuril, Aldactone,
or Lasix), or medicines that they breathe which help keep their
tiny airways open and decrease inflammation (Albuterol, Zopenex,
common problem in premature babies is excessive spitting or gastroesophageal
reflux, more commonly called acid reflux.
up usually doesnt bother full-term babies. But in premature
babies, it may cause them to stop breathing or make their heart
slow down. This can begin or get worse after discharge as the acid
production in your babys stomach increases.
is often treated by thickening formula or breast milk, and with
medicines that decrease acid in the stomach (Zantac or Prilosec)
or that help prevent milk from coming back up (Reglan).
your baby goes home on medicines for chronic lung disease or acid
reflux, it is very important to give these medicines as directed,
make sure you refill them when they are close to running out and
have your pediatrician adjust the doses as your baby grows every
couple of weeks for at least the first two to three months.
your baby is sent home on a heart or breathing monitor, it is important
to use it as directed.
just because the symptoms are gone that doesnt mean the problem
is better. It means the medicines are working.
problems will resolve over time and the medicines can be stopped
when your baby gets bigger and stronger.
Formula Helps Weight
Premature babies are always smaller than they should be for their
age when they go home. To increase weight, they often need special
transitional formulas (with higher calories) or added powdered formula
if they are taking breast milk.
most common transitional formulas are Enfacare or Neosure. If they
had problems with tolerating milk protein or had a serious infection
in their intestines (called necrotizing enterocolitis or NEC), they
may drink a formula that is easier to digest such as Pregestimil,
Neocate, or Elecare.
is very important to mix the formula as instructed and to continue
using it until your doctor says you should change.
premature infant should stay on infant formula until he is a year
old from his expected birth date -- in other words, his age corrected
for being premature. For example, if your baby was born at 28 weeks
(three months early), he should continue formula until 15 months
of age. This helps his bones develop properly.
premature baby may develop slower than a full-term baby. This is
to be expected -- it may take up to two years to catch up with children
who were born on their expected birth date.
delay can be more serious if your baby had bleeding in his brain
or a stroke. Those born before 28 weeks gestation may not catch
up until three years of age particularly with language development.
babies may benefit from intervention services such as physical,
occupational, speech therapy, or developmental therapy during the
first couple of years.
is important to have your childs development followed in your
hospitals neonatal follow-up clinic.
F. Goldstein, MD, is director of Duke Special Infant Care Clinic
(SICC), where they follow the medical and developmental progress
of premature and other sick babies for the first two to three years.
The SICC teaches parents what to do to help their babies develop
as normally as possible and arrange for intervention services if
needed. For more information call 919-681-6024. Dennis Clements,
MD. PhD, MPH, is the chief medical officer of Duke Children's Hospital.
information presented on this site is intended solely as a general
educational aid, and is neither medical nor healthcare advice for
any individual problem, nor a substitute for medical or other professional
advice and services from a qualified healthcare provider familiar
with your unique circumstances. Always seek the advice of your physician
or other qualified healthcare professional regarding any medical
condition and before starting any new treatment.