Caring for a preterm baby: What parents must know

Monday December 3 2018

Caring preterm baby What parents must know

Mary Angiro with her 11-month-old baby who is now hitting all the normal milestones. She commends the doctors and nurses who looked after her and her baby. PHOTO BY BEATRICE NAKIBUUKA 

By Beatrice Nakibuuka

Having a preterm is one of the most traumatising experiences to mothers. Mary Agiro was a first time mother whose baby had to be delivered at 30 weeks because she suffered severe pre-eclampsia and her amniotic fluid kept reducing.
“My doctor had said I would give birth in May 2018 but one day I woke up in the middle of the night and I was cramping. I went to Lifelink Hospital in Ntinda in the morning but the doctor referred me to a hospital with a gynaecologist I was familiar with,” she recalls.

Since she knew a gynaecologist at International Hospital Kampala (IHK), Angiro met the doctor and she was diagnosed with severe pre-eclampsia and was warned that the baby needed to be removed immediately or her life was at risk.

Preparing for delivery
“I was given a steroid injection which the doctor said would help my baby’s lungs mature, says Angiro. I gave birth on December 6, 2017 but my baby was too small. She weighed only 500g but fortunately did not have any defects or complications except for her size. By the end of January, we were still in the hospital. I got worried because the bill kept increasing and there was no hope for my child to be discharged.”

All expectant mothers according to Dr Victoria Nakibuuka, a neonatologist at IHK and Nsambya hospitals, need adequate antenatal care. If a baby is at risk of being born too early, giving the mother steroids before the delivery can help her unborn baby’s lungs to develop faster.

This reduces the risk of serious complications or death of the newborn. She recommends that the mother gets the steroid injections at least two days before the baby is born.

“Antenatal steroids are a series of injections given to pregnant women who are at risk of delivering preterm. These steroids have been shown to speed up the development of a premature baby’s lungs, brain, and digestive system, which helps to decrease the risk of some common complications of being born preterm,” Dr Nakibuuka says.

The mothers also need essential care at birth so that the preterm is safe. When a child is born before term and weighs below 1,000g, they need to be put in an incubator to protect them from infection, excessive noise or light levels that can cause harm.

The incubator can regulate air humidity for respiratory support. The incubator can be equipped with special lights to treat neonatal jaundice which is common in newborns. Dr Elizabeth Katumba, a consultant paediatrician at Norvik Hospital Kampala and the secretary Uganda Paediatric Association, says preterm babies usually need warmth because they do not have enough fat to make them warm.

She recommends kangaroo mother care which helps to maintain normal temperature and the mother is more likely to get breastmilk for the baby because of the bond she shares with the child and reduces the risk of death for the babies by 30 per cent.

Angiro recalls having stayed for the longest time at the nursery but the nurses took very good care of her baby. “When the baby got out of the nursery, the nurses taught me how to take care of her. These lessons were very useful even when we took the baby home,” she says.

Medication
Dr Nakibuuka says if the preterm baby has no breathing problem and can feed well, then they are safe to be handled out of the ICU. They, however, need to be taken good care of because they are very delicate.

Timely medication for both the mother and child is very important in order to save them as well as good feeding. The mother needs to feed well so that she can have quality and enough breast milk. Breastmilk is the best food for preterm babies because it has the right amount of protein, carbohydrates and is easy to digest.

“I became fond of the nurses and by the time I left the hospital, I was a junior nurse. I had to learn all the terms they used. There were times when I got impatient with the nurses, especially when the baby vomited but they knew what they were doing,” says Angiro.

Proper feeding
Breastmilk is important for better brain development, prevents infection and encourages the development of the intestines.
“These babies usually need supplements because the breast milk from the mothers may not contain enough nutrients that would enhance their growth. Omega3 and 6 fatty acids enhance the development of the brain and the eyes. The fortifiers add caloric value and contain calcium and phosphorus for bone growth since preterm babies are usually prone to rickets,” Dr Nakibuuka says.

By the time Angiro was delivered of her baby, she recalls having plenty of breast milk to feed her baby but when stress kicked in, the breast milk reduced. She, however, got a breast milk donor who was also a breastfeeding mother and offered to give the milk freely.

Other essentials
Apnea is a term for the absence of breathing for more than 20 seconds. It can occur in full-term babies, but is more common in premature babies. The more premature the baby, the greater the chances that apnea will occur so it will forget to breath thereby increasing their risk for respiratory failure and death.

The problem is prevented by using aminophylline that is cheaper and readily available in most pharmacies but also caffeine can help with the problem but is more expensive and hard to get.
“When I finally got home with the baby, it was very challenging. We were not in hospital anymore. I now had to take full responsibility. Ensuring that she is breathing and feeding after every three hours was hectic. I would set an alarm that would ring every three hours and would wake up in turns to feed the baby with my husband. Sometimes we would both over sleep because of fatigue but she thankfully, she did not get any complications,” Angiro recalls.

“During one of the reviews, the doctor advised that we stop giving her caffeine. I got panicked, fearing that what if she got the apnea. I was not sure I was going to be a good mother,” she adds.

According to Dr Nakibuuka, preterm babies should be protected from infections because they are more susceptible than the normal babies. Prevention of these infections is through proper hygiene, breastfeeding them and using antibiotics where necessary.

Angiro says that her child is now healthy achieving milestones every healthy child does. She adds that although she would take her for review on a weekly basis, she now only needs to go once a month.

MALE INVOLVEMENT
Mary Angiro recalls the day she had to leave her child at hospital because she feared the cost would accumulate.
“The day I got discharged is the worst day of my life. I felt worthless leaving my child in the hospital. I kept asking myself, what kind of mother leaves her baby behind? I cried,” She recalls adding: “The nurses counselled and had told me that even when I remained in hospital, I was not going to sleep with the baby because she was going to be in the nursery. I was assured my baby would be safe and in good hands.”

Dr Victoria Nakibuuka, a neonatologist at IHK and Nsambya Hospitals, encourages men to support their wives during such a time because they usually become traumatised. “Men should not only provide financial support but also support them emotionally, she says.

Financial constraints
Most parents that have premature babies have a challenge with financing since insurance companies do not cover premature births.
Agiro cries out to insurance companies to have premature births catered for in the insurance policies.

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