Premature babies: the care provided to newborns in neonatology

In the neonatology department of the Femme Mère-Enfant hospital in Bron, in the Rhône, the medical team, led by specialist Olivier Claris until 2020, makes it a point of honor to adapt to the rhythm of the child. She avoids constantly disturbing him and only intervenes to provide him with care when he is awake. The light is dimmed as much as possible and the noise limited. The baby is comfortably installed in his incubator: cocoons can even be used to restore fetal position.

The medical team agreed to host the drafting of Parents in order to present and explain all the care that a premature baby needs.

A neonatology department only accommodates not just infants born prematurely, but also babies who are too small or sick at birth, or in the days following. Several sectors therefore make up this service: one for neonatal resuscitation, one for neonatal medicine and one for pre-discharge. Depending on the services, it may be possible for your loved ones to see your baby. In all neonatology departments, the parents’ reception, at least, is preserved.

A baby is considered premature if it is born before the 37th week of amenorrhea. We speak of great prematurity if the delivery occurs between the 28th and 32nd week, and of very great prematurity if it occurs before, that is to say at less than 6 months of pregnancy. All premature infants under 35 weeks spend at least a few days in an incubator or brooder.

There are no specific recommendations as to when the baby can be discharged from the incubator and the neonatology department. It is estimated thatit must weigh at least 2 kg and be able to withstand temperature transitions. It is quite possible that a premature infant will need to stay in the hospital for several weeks or even months.

In addition to toilet care (neck, armpits and groin), measuring their weight and height and changing them, many devices surround infants hospitalized in a neonatology department. They help him maintain his body temperature, allow him to breathe, feed him and control his heart rate. In addition, blood samples, X-rays, ultrasounds, electro-encephalograms… may be necessary.

Indeed, premature babies run considerable pathological risks, including:

• respiratory distress syndrome
• bronchopulmonary dysplasia (an abnormality in the development of the lungs)
• apnea
• bradycardia (irregular heartbeat) or a heart defect
• jaundice
• anemia
• infections
• cerebral hemorrhage
• inflammation of the bowel (necrotizing enterocolitis)
• deafness
• retinopathy (retinal detachment)

For all of these reasons, premature infants need comprehensive medical care, 24 hours a day.

In large and very large premature babies, the skin does not yet have an epidermis, which prevents the newborn from being able to maintain its body temperature. The incubator is therefore used to maintain a temperature between 36.7°C and 37.5°C. She also creates a humid environment in order to avoid losses by evaporation which would lead to weight loss of the newborn. Sometimes a plastic covering is added to the child’s skin to limit other types of heat loss.

The premature newborn can breathe very well independently. In this case, no assistance is put in place. If this is not the case, several solutions exist: you can use medications that stimulate respiratory drive (caffeine, doxapram…). If the respiratory immaturity is more important or if the newborn presents a respiratory pathology due to prematurity, respiratory assistance will be provided. Either a ventilation mask or a tube passing through the trachea will be used.

The premature newborn has a immature digestive tract. It is therefore necessary to start feeding it gradually. He is given small amounts of breast milk, through a tube going directly into his stomach and, in addition, he receives nutrients by blood infusion. As the child’s digestive tolerance improves, the gastric supply is increased until the blood supply is suppressed.

The ideal food for premature infants is breast milk. As much as possible, direct donation is preferred: the mother draws her milk at the maternity ward and it is given to the child. Otherwise, female milk stored in milk banks is used. When the infant has passed a stage of 32 weeks or weighs more than 1.5 kg, it is possible to wean it and feed it with special milk for premature babies.

Let’s not forget, later on, that our infant’s diet will depend on his corrected age. This is, quite simply, the age the baby should have been had he been born at term. A baby born, for example, 8 weeks early, would only be 4 months old according to the corrected age when we turn 6 months old.

Apart from the vaccination schedule, the corrected age must be taken into account to assess the evolution of the child and his psychomotor progress. This is also particularly relevant for his diet: the switch to growing-up milk, food diversification…

The immune system of premature infants is immature. In addition, before 34 weeks, the skin is not fully formed and cannot play its role as an immune barrier. So the baby is particularly susceptible to infectionespecially those transmitted by the hands.

It is for this reason that the hygiene rules concerning staff and parents in a neonatology unit are so strict: do not wear jewellery, watches or bracelets and always wash your hands before and after touching a baby.

Advances in neonatal medicine are daily and an infant has more and more chances of surviving and being in good health if he is born prematurely. However, it is possible that you will hear about the concept of viability during your stay in the maternity ward, if your child is premature. It is currently considered that the viability threshold of a premature baby is around 22 weeks of amenorrhea. In France, 85% of premature infants are born between the 32nd and 36th week of amenorrhea, 10% between the 28th and 32nd and 5% before the 28th.