pátek 18. listopadu 2011

A Mother's Story

How My Feisty Preemie Came Into the World

It was over four-and-a-half years ago, but it often seems like yesterday that my daughter Aria was born. The way she came into the world, at 32 weeks old, was nothing like the way I’d envisioned. There were no birthing classes, no labor, no excited trip to the hospital.

Several weeks before she was born, I thought I’d gotten food poisoning from some past-its-prime frozen spinach. After what seemed like an obvious bad reaction to the food, I kept feeling intermittently sick and a dull but persistent pain at the top right quadrant of my chest. I went to my OB/GYN and he sent me to my primary care doctor to make sure it wasn’t some kind of tapeworm or parasite. She -- arrogantly -- insisted that it was just food poisoning and didn’t think there was any reason to do bloodwork. In retrospect, I should’ve insisted on it but I trusted her. At 30 weeks pregnant, I’d also gone for a growth scan and it showed that the baby was growth restricted. But I was told that I shouldn’t be too concerned and they’d just keep monitoring me.

The day Aria was born, I had gone for a routine check-up with my husband David. When my doctor took my blood pressure, it was high -- which it hadn’t been before. He said he’d feel better if we went to the hospital nearby for an ultrasound. When we arrived, I got an ultrasound and at the same time they received a call from my doctor that there’d been protein in my urine. They then sent me upstairs to get bloodwork and to be monitored further. We were there several hours doing tests and waiting for the bloodwork results to come back, but nothing seemed urgent. They told me I’d likely go home and do a 24-hour urine test to monitor the protein in my urine.

But things suddenly turned into what felt like an episode of ER. As soon as the blood-test results came back, a nurse bolted into the room and told me that I wouldn’t be going home -- I’d be having an emergency C-section immediately. “How can I be having the baby now -- it’s only 32 weeks old?” I asked, confused and panicked. Suddenly, I was told that I had the HELLP Syndrome, a variant of preeclampsia that involves hemolysis (the breaking down of red blood cells), elevated liver enzymes and low platelet count and that I was at risk for having a stroke or seizures. The baby -- whose sex I didn’t know -- had to be delivered immediately because we were both in danger. I was spiraling into a state of confusion and despair. How could this be?

Because I was considered high-risk, my OB/GYN wouldn’t be able to deliver her. I’d have to be delivered by a maternal-fetal specialist I’d never even met. My husband and I were both reeling from shock. But Dr. Fereshteh Boozarjomehri (it’s no coincidence that her first name means “angel” in Farsi) assured us that I’d be okay. Within minutes of being prepped, I was in the operating room and having a C-section. Aria was born at a tiny 2 lbs. 10 oz., and because of her prematurity and issues with her breathing, she was whisked away to the NICU. In my precarious condition, I wasn’t allowed to leave my bed for 24 hours as they stabilized me. It was horrible and surreal. I’d just had a baby and I saw her for what felt like 1 second. And now she was in the NICU and I had no idea what would happen next.

I couldn’t leave my bed as I recovered, so I asked for a NICU doctor to come to tell me about my new baby’s state. They assured me that though she was tiny, she wasn’t quite as tiny as many of the “peanuts” in the NICU -- she was more like a cashew. Little Cashew soon became her nickname since we hadn’t named her yet. Twenty-four hours later, during which I was convinced that I'd missed the window for bonding with her, I was wheeled up to the NICU to see her. I was shocked. She was tiny and hooked up to tubes. She looked so frail that it broke my heart. I would repeatedly ask if she would survive but no one could tell me anything definitively. I was plunged into fear that I'd lose her.

My feisty little girl -- whom we didn’t name for two weeks -- fought her hardest. There were many scary moments, like when we would do kangaroo care with her, skin-to-skin snuggling that has been proven to have positive health benefits for preemies, and she would suddenly have an apnea episode and stop breathing (which is very common in preemies). The nurse would grab her from me and resuscitate her while I stood by crying. She also had a PDA (patent ductus arteriosus), an open artery in her heart that typically closes in full-term infants but not always with preemies. Luckily, the artery closed with medicine and she was able to avoid getting surgery.

Other than going home to sleep, I lived at the NICU every day and night with Aria. During her six weeks there, I was grateful for the incredible hospital staff (who sometimes had to tough-love me through my fearful moments) and the parents who became my support group -- and who I still count as friends over four years later. We were in it together, celebrating the tiny milestones of our tiny babies as we waited -- during what felt like an eternity -- for them to be able to leave the hospital.

Six weeks after she was born, Aria was finally discharged. Weighing a little over 4 lbs., she came home on an apnea machine to monitor her breathing (which she was constantly connected to for two months other than during bath time). Having her home was surreal: The first night, I honestly didn’t know if I could handle being on my own without the nurses’ guidance. It was overwhelming.

It took us a while, but she learned to nurse, which she hadn’t been strong enough to do until she was five weeks old (before that, I pumped and she was fed through a feeding tube or tiny bottles). And as time went on, we were assured that she didn’t have any developmental delays. Though small in size, which she still is to this day, she was a feisty little fighter. The joy I felt in having her home -- and not having to visit her in the hospital -- was immeasurable. My baby was with finally me.

On World Prematurity Day today, I am grateful that I was given the gift of my teeny-tiny Little Cashew, who is now an incredibly funny, joyful, curious little dancing machine. It doesn’t feel like it’s over four years ago that Aria first came into the world in a way that was anything but ideal. But that experience has made us both stronger.

Serena Kappes is iVillage’s Entertainment Editorial Director.


Prematurity Awareness Month


Does A Bigger Brain Make For A Smarter Child In Babies Born Prematurely?

New research suggests the growth rate of the brain's cerebral cortex in babies born prematurely may predict how well they are able to think, speak, plan and pay attention later in childhood. The research is published in the October 12, 2011, online issue of Neurology®, the medical journal of the American Academy of Neurology. The cerebral cortex is the outer layer of the brain covering the cerebrum, and is responsible for cognitive functions, such as language, memory, attention and thought.

"In babies born preterm, the more the cerebral cortex grows early in life the better children perform complex tasks when they reach six years old," said study author A. David Edwards, DSc, of Imperial College in London. "The period before a full-term birth is critical for brain development. Problems occurring at this time have long-term consequences, and it appears that preterm birth affects brain growth."

The study looked at brain growth rates of 82 infants who were born before 30 weeks gestational age using MRI scans of their brain between 24-44 weeks. Brain scans were collected repeatedly from immediately after the babies were born until their full-term due date. Their cognitive abilities were tested at two years old and again at six years old.

The study found that the faster the rate of cerebral cortex growth in infancy, the higher their scores were on the developmental and intelligence tests as children. A five to 10 percent reduction in the surface area of the cerebral cortex at full-term age predicted approximately one standard deviation lower score on the intelligence tests in later childhood. Motor skills were not correlated with the rate of cerebral cortex growth, and the overall brain size was not related to general cognitive ability.

"These findings show we should focus on the growth of specific regions of the brain like the cortex when trying to understand or diagnose potential problems in babies and fetuses," said Edwards.

The study was supported by the Health Foundation, the Garfield Weston Foundation, Wellbeing of Women and the NIHR Imperial College Healthcare Comprehensive Biomedical Research


pátek 27. května 2011

Necrotizing Enterocolitis (NEC) and Preemies

Necrotizing enterorcolitis is a gastrointestinal illness that mostly affects premature babies. Enterocolitis refers to the small and large intestines and necrotizing means tissue death. Because NEC results in the death of gastrointestinal tissue, it is a very serious concern for a premature baby. It is more common in preemies that weigh 1,500 grams or less, but it can also affect other high risk infants.

What causes necrotizing enterocolitis?

Although it is not entirely clear what causes necrotizing enterocolitis, there are some theories about what could cause NEC. We do know that it generally occurs once milk feeding is started. Since preemies gastrointestinal systems are immature, one theory is that the preemies intestinal tissues are weakened by not having enough oxygen or blood flow. As a result, when the baby’s system is introduced to milk feedings and food is moved through the weakened area of the intestines, bacteria from the food enters into the intestinal tract which damages the intestinal tissues. Even with treatment, NEC is a serious complication for a preemie. If the bacteria continues to spread, the intestinal tissues may become severely damaged and tissue death may occur. In severe cases, tissue death may create a hole in the intestine. When the intestine is perforated, bacteria from the intestines can leak into the abdomen causing a life threatening infection.

Babies at risk for necrotizing enterocolitis

Some babies are at higher risk for developing necrotizing enterocolotis. Some risk factors include:

  • Preemies that weigh 1,500 grams
  • High risk babies taking milk by mouth. NEC typically is not seen until babies begin taking milk. Breast milk may be easier on a preemie’s digestive system than formula. Some experts believe the make-up of infant formula may be a factor in the development of NEC. Preemies that are breast fed are at lower risk of developing NEC, but they are not immune from it.
  • Difficult delivery or low oxygen levels at birth
  • Babies with too many red blood cells in circulation
  • Babies with other gastrointestinal issues or infections

Symptoms of necrotizing enterocolitis

  • Abdominal bloating or swelling
  • Baby not tolerating feedings well
  • Decreased bowel sounds
  • Feedings stay in stomach
  • Greenish colored vomit (indicating bile in vomit)
  • Redness of the abdomen
  • Bloody stools
  • Lack of bowel movements
  • Other signs of infection

Diagnosis and treatment of necrotizing enterocolitis

NEC is usually diagnosed by taking an x-ray of the abdomen. NEC may be diagnosed if there is an abnormal bubbly appearance in the intestines. They will also look to see if there are signs of air in the large veins of the liver or in the abdomen. Air is produced by the bacteria found in the bowel. If air is seen outside of the intestines, it may indicate that the bowel is perforated. A needle may be inserted into the abdominal cavity to aspirate fluid from the abdomen. Withdrawing intestinal fluid from the abdomen is another indicator that the intestines have been perforated.

Most of the time NEC can be treated without surgery. Stopping feedings is generally the first step in treatment. A nasogastric tube may be inserted through the nose and into the stomach to keep baby’s stomach empty. IV fluids may be given for nutrition and to keep baby hydrated. Baby may be given antibiotics to treat the infection as well. Baby will then be monitored and x-rayed frequently to make sure the infection isn’t spreading. If the NEC is severe, surgery may be necessary to remove the diseased intestine or bowel.

Feedings may be withheld for a week or longer to treat baby with antibiotics and give the intestines time to recover and mature. When feedings are resumed, baby will be monitored closely.

German baby survives record-equalling premature birth

A German baby born after only 21 weeks and five days in the womb has equalled a world record for surviving premature infants, the hospital said Saturday.

When Frieda was born on November 7 she measured 11 inches (28 centimetres) and weighed only one pound (460 grammes).

"In the specialist literature, other premature babies have been lighter than her at birth, some even less than 300 grammes, but there is no mention of a premature baby even younger than Frieda," the clinic in western Fulda said in a communique.

A baby was born in Ottawa in 1987 at exactly the same stage of its mother's pregnancy, the statement said.

Frieda was discharged on Wednesday weighing 7.7 pounds (3.5 kilos) and measuring 50 centimetres (nearly 20 inches), the clinic said.

Her twin brother Kilian died a few days after being born.

Professor Reinald Repp, director of the paediatric clinic, could not be reached on Saturday, but a doctor on duty told AFP that "there is no foreseeable risk of after-effects for the moment" and that the little girl "should develop normally like any other child."

Generally babies born before 22 weeks have no chance of surviving because their lungs, heart and brain are not sufficiently developed.

"Frieda was kept in a completely sterile environment, with her breathing assisted and fed through her navel," Repp told the mass circulation Bild newspaper.

Any baby born before eight months of pregnancy is considered premature.

Very premature babies (less than 32 weeks) are considered at high risk of suffering developmental problems.

Click here to find out more!

A baby at a maternity ward. A German baby born after only 21 weeks and five days in the womb has equalled a world record for surviving premature infants, the hospital said Saturday.
A baby at a maternity ward. A German baby born after only 21 weeks and five days in the womb has equalled a world record for surviving premature infants, the hospital said Saturday.


pátek 20. srpna 2010

Breastfeeding and Preemies – What Mothers Should Know

While it is well documented that breastfeeding is the healthiest option for babies, the benefits ring true in an especially critical way for premature infants.

While some expectant mothers know ahead of time that they may deliver prematurely, many others have no indication. In the midst of National Prematurity Awareness Month all mothers can arm themselves with some basic knowledge about the importance of mothers’ milk should they deliver prematurely.

Critical Importance for Preemies

Acting as a medicine for premature babies, mothers’ milk is more than just a source of food and nutrition - it offers protection in fighting the complications of prematurity through three main functions:

• The antibodies in mothers’ milk paint the inside of the baby’s intestines sealing off tiny open parts so germs cannot enter and make their way to the bloodstream.

• Some components of mothers’ milk directly kill germs while other parts make it difficult for them to grow.

• Mothers’ milk helps a premature baby develop the ability to fight infections on his or her own, by turning on certain genes and processes that control the immune system’s defenses against infection.

Getting Your Milk Supply Started

Colostrum, the milk a mother produces right after delivery, has the highest concentration of the antibodies necessary to fight complications of prematurity. Due to its high concentration of protective substances, colostrum is often referred to as “liquid gold”. Pre-term mothers make colostrum for a longer time period than do full-term mothers, and it is important to capture all of this ‘liquid gold’. There is a critical window shortly after delivery where preemies are more susceptible to illnesses. As a result it is recommended that mothers get off to an early start pumping, usually six hours after delivery. Mothers should pump roughly eight times a day to start, as often as if they were breastfeeding a full-term infant. Mothers can also take care to monitor their milk volumes by keeping a pumping log that tracks the frequency of pumping and the volume of milk pumped in a 24-hour period.

Bonding With Your Baby in the NICU

Mothers must realize that while they may not be able to directly breastfeed their infant while in the NICU, pumping provides a way to establish a relationship with their baby. By providing milk, mothers create an emotional connection through actively becoming engaged in caring for their baby. Mothers can use a breast pump at the baby’s bedside in the NICU where they can see and touch their baby. In addition, if a premature baby is healthy enough to be held, mothers can hold them in ‘Kangaroo Care’ (skin-to-skin), which helps boost the baby’s body functions including breathing, heart rate, oxygen levels, temperature and deep-sleep.

Remember Yourself

Finally, it is critical for mothers to take care of themselves and recognize that caring for a preemie is hard work.

Irene Zoppi

pondělí 19. dubna 2010

Breastfeeding a Premature Baby

Breastfeeding a Premature Baby

Breastfeeding, although it may be more challenging with a preemie, is one great thing you can do to help your little guy or gal get off to the best start. Breastfeeding provides the perfect nutrition for a premature infant because your breast milk automatically adapts to your baby’s needs; something formula just can’t do. This is so important for a premature baby because your breast milk not only provides just the right amount of calories, fatty acids, vitamins, and protein for your premature baby, but it also helps your baby in other ways. Your breast milk is perfectly suited for your baby. It is more easily digested than formula which is particularly important for preemies as their digestive systems are not as mature as full term babies. Scientists have yet to figure out how to replicate all the ingredients that are found in breast milk. Breast milk contains nutritive components as well as components that help fight infection. In fact, about 80% of the cells in breast milk are macrophages. Macrophages are cells that help fight off viruses and infections. Because preemies face a higher risk of infection, feeding your baby breast milk is even more important. By breastfeeding your premature baby, you will help protect her delicate and immature immune system and give her the best nutrition possible.

Before you start breastfeeding

If your baby arrives early you may not be able to breastfeed her right away. Premature babies are often fed through a nasogastric tube to start off with, especially if your baby is born before 33 weeks. Babies do not develop the suck-swallow-breathe reflex that is needed for breastfeeding until they are about 32-33 weeks gestation. To help your baby get ready to breastfeed there are some things you can do. You should talk to your hospital caregivers to help you and your baby prepare for breastfeeding.

Get lots of skin to skin contact with your baby. Many hospitals encourage “kangaroo care” for premature babies. Before your baby can start kangaroo care, she needs to be stable enough that she can breathe on her own, or have minimal breathing support, and she also needs to be able to maintain a normal heart rate, oxygen level, and body temperature while she is being held. Kangaroo care is a type of skin to skin contact that gives moms and preemies a way to bond. It also helps preemies prepare for breastfeeding and has provides other health benefits for preemies.

Pump breast milk for your baby. Your preemie probably won’t be able to breastfeed right away, but you can still provide her the best nutrition by pumping breast milk for her. Pumping is very important when you have a preemie because your baby will not be sucking at the breast and stimulating your body to produce milk. The first few weeks after a baby is born are critical for establishing a good milk supply. If your baby isn’t nursing at the breast you will need to stimulate your breasts to produce milk by pumping. Your hospital will probably provide you a hospital grade pump while you are in the hospital, but after that you may need to rent a hospital grade pump. You can also purchase a double electric pump like Medela’s Pump in Style; however, a hospital grade pump is preferable when pumping for a preemie.

Pumping for a Preemie

Keep everything you pump, no matter how small the amount. When you first start pumping for your preemie you may only produce very small amounts of a yellowish substance called colostrum. It may seem like a minute amount and you may even wonder if it is enough to bother saving. Colostrum is very important for your preemie because it is very rich in carbohydrates, protein and protective antibodies. You should keep whatever you pump even if it just a few drops. Your baby will not eat very much during his first feedings so every little bit you can pump is important and should be kept.

Pump frequently. Since your preemie is so little, you may find it very easy to pump enough milk to meet his needs. Because of this, you may be tempted to pump less frequently. You should pump about every three to four hours, even if you are producing more milk than your baby is taking at the hospital. You can always freeze the extra milk to save for later. Plan to pump every three hours for about 10-15 minutes using a double electric pump. At night you can go a little longer between pumping sessions, but you should not go longer than five hours without pumping. Ideally, your pumping routine should mimic your baby’s eating routine so that once your baby starts nursing at the breast, your body is already in a similar routine as your baby. It is important to pump frequently because pumping frequently helps establish a good milk supply. Preemies often have a weaker suck and may not nurse as efficiently as full term babies. Pumping will help you to develop a good milk supply and hopefully once your baby gets stronger she will be able to nurse well enough to maintain this supply.

Drink plenty of water. Drink a large glass of water about an hour before you plan to sit down to pump. You may also want to keep a glass of water nearby while you are pumping because pumping can sometimes make you thirsty.

Massage your breasts before you pump. Massaging your breasts may help you to pump more. Try massaging your breasts before you pump. You can also try massaging your breasts after you have pumped for a while and notice that you are no longer pumping any milk. Watch for when your breasts stop producing milk. When you notice this take a break from pumping for a few minutes, massage your breasts and pump again. By using this technique, you may be able to pump as much as an ounce of extra milk or more for your baby.

Storing pumped milk

When you pump your breast milk, you should store it in small bags or containers. You can purchase special storage bags to keep your breast milk in. Ask your hospital caregivers how much you should store per bag and if it is okay for you to bring in frozen breast milk. Some hospitals do not allow the use frozen breast milk. Label your breast milk with your baby’s name and what date the milk was collected. The hospital will use the milk in order of when it is dated.

Breastfeeding your preemie

Once your baby is strong enough to breastfeed, your hospital caregivers will help you get started. Your baby may start out by just licking at your breast. She may suck at the breast for a while before she actually starts to swallow any milk. Preemies take a lot longer than full term babies to nurse. It may take her as long as 40 minutes to an hour for just one feeding. If she refuses to suck or keeps falling asleep, you should stop nursing and try again later. If you find the process is frustrating, you may want to work with a lactation consultant to help you. Your preemie may not suck well enough to empty your breasts when she nurses. For this reason, it is a good idea to pump after she nurses to make sure that your breast is emptied. Preemies may only nurse on one breast per feeding. This is not uncommon or something to worry about. To keep your supply up, you may want to pump the other breast after your baby nurses.

Breastfed preemies may need a supplement

Your doctor may advise you to give your baby a special supplement. Supplements can be added to your breast milk. You can even give your baby a supplement while you breastfeed by using a special tube feeding devise that allows your baby to nurse and take the supplement at the same time. This may seem discouraging to a breastfeeding mom, but supplementing will help your baby to thrive. Once your baby gains weight and starts breastfeeding better, you can work with your doctor on weaning from the supplement.