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Dealing with premature births

Neonatologist answers questions about problems babies and parents face

By Alicia Fabbre, Special to the Tribune

May 15, 2013

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In recent weeks, the March of Dimes has held its annual March for Babies walks across the Chicago area. The walks benefit community programs and research aimed at helping pregnant moms reach full-term pregnancy. According to the March of Dimes, 1 in 9 babies in the United States is born prematurely. We talked to Dr. Natalia Henner, a neonatologist at Ann & Robert H. Lurie Children's Hospital of Chicago, about premature births. Here is an edited version of the interview.

Q: What is considered premature birth?

A: Premature birth is defined currently as 37 weeks (or fewer) gestation, but that target has been moving over the past couple of decades. We used to say under 36 weeks. The smallest babies fall within less than 26 weeks gestation.

Q: What are some risk factors for having premature babies?

A: Having had a premature (birth) before, that's a definite. Also, lack of consistent prenatal care and lower socioeconomic status, unfortunately, in this country.

Q: Your baby arrives early (32-33 weeks). What are some things parents can expect?

A: You would likely expect that the baby would go to the (neonatal intensive care unit). Babies who are less than 35 weeks gestation definitely go to the NICU; babies who are born close to that mark still have trouble staying warm because they don't have enough body fat.

Some babies also struggle with the fact that their lungs are not fully developed, so they need help breathing or to transition into the way their breathing is going to be. The majority of those babies also need to learn how to eat. The swallow reflex comes into fruition at the gestational age marker of 34-35 weeks. Those babies will need to learn that skill, and they will be fed by feeding tube and slowly learn to eat by mouth and then breast-feed hopefully.

You could expect that all of those things will take several weeks, and those babies tend to go home close to their due dates. But there is no set time. The answer is when he or she learns how to stay warm, does not need any breathing machines and is eating by mouth.

Q: What can parents of a baby born at 28 weeks (or less) expect?

A: Those babies tend to require a lot more care in terms of the technological support. Most babies born within that gestational age will need some help breathing. A lot of those babies will end up on some sort of respiratory support.

All babies born that early will need help not just with feeding but their weight gain and growth. We put central lines in and give them all their proteins and sugars through an IV. Overall, babies born this early have a very long NICU stay. I often tell parents to picture (the baby's) due date, and that's the goal. This little person may surprise you and go (home) a little bit sooner than that, or, more likely than not, you'll be here a little bit past your due date.

Each baby is different, and we can try to prepare (parents) for every scenario, but in the end it's just going to be what it's meant to be. My best advice to the families is to be very patient, ask a lot of questions and really be a part of the medical team.

Q: Any advice for parents on dealing with the roller coaster of emotions of having a preemie and health issues that come up with having a preemie?

A: My best advice is to keep the big picture in mind. There are a lot of people, and there are a lot of different teams and specialists (working with your child). I would suggest picking one, two or three people that you would like to get the information from, and if your baby is in for the long haul, ask to have team meetings (with medical staff) every week or every other week.

The communication piece is the most vital. In a highly medical environment, parents feel that the doctors and nurses must know better what to do. And while this may be true, we haven't done this with you or your baby. So ask us questions that you want answered … ask us the things that worry you the most, because we don't know what that is. The day-to-day life of a NICU is overwhelming. … I suggest to trend look at your baby's care over one week's time.

Q: What are some things you can do during your visits with your child to bond even though your baby is in the hospital and may be hooked up to machines?

A: We can offer skin-to-skin care (where the parent snuggles the infant) even with the sickest baby. There are only one or two types of machines that would prevent you from holding your baby. The smaller your baby is, the more skin-to-skin care we want. Just treating them as babies really helps; that's why you see a lot of NICU nurses dress up the babies. If you put on a little onesie or dress, it helps you bond and see that they're actual human beings. … There's no such thing as too small of a person to care for.

Q: Any words of wisdom for parents once they bring their babies home from the NICU?

A: Be happy about it. You've been waiting to bring this baby home … just enjoy. I think it's very difficult for parents to switch gears (from being) in the NICU. But … at some point you will have to relax about it.

Trying to be overly medicalized with them at home doesn't do anyone any favors. We will never send you home with a fragile baby who we don't think is ready for the outside world. If anything, we're overcautious before we send babies home. They are at the same risk for getting a cold as anyone else, and their risk of dying from a cold is the same as anyone else. They're not any more fragile, though this would not apply to babies who come home with machines, than anyone else.