Preterm infant care

Abstract

Each year more than 700,000 infants are delivered in England and Wales. As many as 8 to 10 per cent of these will be admitted to a special care baby unit or a neonatal intensive care unit for care and treatment following their delivery. Some of these infants will be born at term and may be sick from birth. Problems that term infants are admitted with include respiratory difficulties, meconium aspiration (when the infant has opened its bowels in utero and has aspirated some of the contents) and problems caused by a lack of oxygen to the brain, resulting in hypoxic ischaemic encephalopathy. However, the vast majority of infants admitted to Special Care Baby Units (SCBU) and Neonatal Intensive Care Units (NICUs) are preterm, which is any gestation before 37 weeks. They can experience a number of conditions peculiar to preterm infants, including surfactant deficient respiratory distress syndrome (a common lung condition) and necrotising enterocolitis (a serious gut problem), and require varying treatments and therapies. Also, these babies often have developmental problems because of their early arrival. Acute care may last for only a few days; infants might then spend several days or weeks on the unit recovering and preparing to go home. Many infants are well enough to be discharged but continue to have a variety of therapies. Parents are generally the main caregivers, and they need expert guidance and support to help them handle what can often be complex and protracted management strategies. This is when good outreach processes are invaluable. Parents often have ongoing questions about the care of their baby at home and, since preterm infants may develop differently from term infants, such questions cannot always be answered by staff unfamiliar with caring for them. Of course, problems can differ between extremely preterm infants and those born only a few weeks early, but support for parents is always vital, particularly in the first few weeks at home. Parents may feel overwhelmed by the demands of having to care for a preterm infant while at the same time coming to terms with a pregnancy that did not meet their expectations. Two neonatal nurses suggest strategies and practical tips that community nurses can pass on to parents of preterm babies.