Ask Dr. Marla: What are the milestones for a premature baby in the first few weeks?

My neighbour’s son was born
early at 30 weeks. What are
the immediate milestones for
this little guy?

Answer:

This is a diffi cult question
because every premature baby will have
needs specifi c to him or her. However there
are some common concerns and hospital
milestones in this degree of prematurity. To
answer your question I turned to Dr. Janine
Flanagan, a developmental pediatrician at
St. Joseph’s Health Centre, and the experts
at SickKids Hospital in Toronto. Babies born
before the typical 40-week term may need a
variety of supports to thrive and be discharged
from hospital. They need to meet three key
milestones, such as being able to breathe well,
feed well and keep their temperatures stable.

Breathing: Because preemies are small in
size, they tire out easily. This is why they so
often need help with breathing. Many will
need oxygen support to keep up their oxygen
levels – called saturations – to supply the
brain and body with healthy oxygenated
blood. While many of us adults kick-start our
days with a cup of caffeine, did you know that
some premature babies may be given caffeine,
too? It helps stimulate them to breathe and
to decrease temporary periods of absence of
breathing called apnea, as well as low heart
rates, called bradycardia. Most babies will
reach this milestone of breathing without the
aid of technology or medication around what
would have been 36 weeks of their previously
predicted full-term due date.

Feeding: Preemies learn to suck around 34
weeks. Those born even earlier may need
special nutrition given intravenously. When
they get a bit older, a feeding tube may be
inserted through the nose to feed them until
they are strong enough to suck and swallow
on their own from the breast or bottle. Often,
because the delivery is unexpected, the
mother’s milk will not be in yet. Although
moms are encouraged to pump breast milk
to stimulate milk production, formula may
be used to supplement if necessary. Nursing
is still encouraged as early as possible to
promote bonding and further stimulate milk
production. Once they are feeding well and
gaining weight steadily, they have reached
this very important milestone that we take for
granted in term newborns.

Temperature: Babies born early also have
diffi culty regulating their temperature so they
are placed in an incubator with a controlled
temperature setting. Once they are able to stay
warm outside an incubator they have reached
this milestone.

The incubator also helps protect them from
infection and too much stimulation. Premature
babies often stay in the NICU – neonatal
intensive care unit – until close to their fullterm
due date. This time is important for them
to feed and grow.

Remember, some babies born early may have
a more diffi cult time and need other special
care and monitoring. Each case is different and
monitored closely by pediatricians specially
trained in neonatal care.

Got a health question? Submit it to Dr. Marla.

Originally published in ParentsCanada magazine, October 2013.

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