h2. Shelov, Steven P., M.D., M.S., F.A.A.P. Your Baby’s First Year.

h3. Bantam Books. New York, New York 2005 ed. 2 pp 55-58

If your baby is born prematurely, she may neither look nor behave like a full-term infant. While the average full-term baby weighs about 7 pounds (3.17 kg) at birth, a premature newborn might weigh 5 pounds (2.26 kg) or even considerably less. But thanks to medical advances, children born after twenty-eight weeks of pregnancy, and weighing more than 2 pounds 3 ounces (1 kg), have almost a full chance of survival; eight of ten of those born after the thirtieth week have no long-term health or developmental problems.

The earlier your baby arrives, the smaller she will be, the larger her head will seem in relation to the rest of her body, and the less fat she will have. With so little fat, her skin will seem thinner and more transparent, allowing you to actually see the blood vessels beneath it. She also may have fine hair, called lanugo, on her back and shoulders. Her features will appear sharper and less rounded than they would at term, and she probably won’t have any of the white, cheesy vernix protecting her at birth, because it isn’t produced until late in the pregnancy. Don’t worry, however; in time, she’ll begin to look like a typical newborn.

Because she has no protective fat, your premature baby will get cold at normal room temperatures. For that reason she’ll be placed immediately after birth in an incubator (an enclosed bed) in which the temperature can be adjusted to keep her warm. After a quick examination in the delivery room, she’ll probably be moved to a special-care nursery (often called a neonatal intensive care unit [NICU]).

You also may notice that your premature baby will only cry softly, if at all, and may have trouble breathing. This is because her respiratory system is still immature. If she’s more than two months early, her breathing difficulties can cause serious health problems, because the other organs in her body may not get enough oxygen. To make sure this doesn’t happen, doctors will keep her under close observation, watching her breathing and heart rate with equipment called a cardiorespiratory monitor. If she needs help breathing, she may be given extra oxygen, or special equipment such as a ventilator, or another breathing-assistance technique called CPAP (continued positive airway pressure) may be used temporarily to do some of her breathing for her.

As important as this care is for your baby’s survival, her move to the special-care nursery probably will be wrenching for you. On top of all the worry about her health, you may miss the experience of holding, breastfeeding, and bonding with her right after delivery. You won’t be able to hold or touch her whenever you want, and you can’t have her with you in your room.

What’s your and her father’s best defense against the stress of an experience like this? Ask to see your baby as soon as possible after delivery, and become as active as you can in caring for her. Spend as much time with her in the special-care nursery as your condition, and hers, permit. Even if you can’t hold her, touch her through the portholes of the enclosed bed. Feed her as soon as advised by her doctor. The nurses will instruct on either breast- or bottle-feeding techniques, whichever is appropriate for the baby’s needs and your desires. Because premature babies have a great need for food in order to become stronger and increase their resistance to disease, they may require fluids given intravenously or through a feeding tube. But breastmilk is the best possible nutrition, and once you start breastfeeding, your baby should nurse frequently to increase your milk supply.

You may be ready to return home before your newborn is, which can be very difficult, but remember that your baby is in good hands, and you can visit her as often as you’d like. You can use your time away from the hospital to get some needed rest and prepare you home and family for your baby’s homecoming.

The more you participate in her process of recover and the more contact you have with her during this time, the better you’ll feel about the situation and the easier it will be for you to care for her when she leaves the special-care nursery. As soon as your doctor says it’s OK, gently touch, hold, and cradle your newborn. If you have any questions, be sure to ask them of the doctors and nurses. Also, don’t forget that your own pediatrician will be participating in, or at least will be informed about, your infant’s immediate care. Because of this, he will be able to answer most of your questions. *Your baby will be ready to come home once she’s breathing on her own, able to maintain her body temperature, able to be fed by breast or bottle, and is gaining weight steadily.*