Care of a Premature Infant

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Table of Contents

Introduction
Formulas and donors breast milk
Role of mothers
Conclusion
Reference List

Introduction

The first experience of Neonatal Intensive Care Unit (NICU) is naturally an overpowering desire to flee. Time seem to pass swiftly. People always in hurry and loud; alarms buzzing, doors slamming frequently and intercoms blaring. Clearly, such environment induces a desire to learn to work in such an environment and care for the susceptible preemie. Incubators containing premature infants born at 28 weeks’ gestation and weighing less than 1000g, is common sight. The sight of the infant in an incubator is contritely moving; visible scratches and cuts. Tape cutting across the infant’s face to fasten an endotracheal tube in place. The right arm fixed to the bed to fasten an intravenous tube in place to mention but a few (Kenner & Lott, 2007).

Neonatal medicine has been used for more than four decades to give specialized and intensive care interventions to promote the health and survival of high-risk and critically ill infants. During this period, significant progresses have been made with respect to fast and accurate diagnoses, useful monitoring, and specific treatment (Carter, 2009). Although the present trend of registering premature infants in the neonatal care affords them an increased level of medical treatment which enhances their chances of survival, it deprives the mothers the opportunity to induce an attachment process (Ahn, Lee, & shin, 2010).

Mother’s involvement in premature infant care is very critical because it enhances rapid adoption to the extrauterine conditions and determines long-term development of the child. Hence this paper will compare interventions in care of premature infants.

Formulas and donors breast milk

Maternal breast milk is the upheld form of enteral nutrition for preemie, although adequate maternal breast milk is not always available. In absence of the mother’s own breast milk for feeding her premature infant, the two popular alternatives available are usually formula milk or donor breast milk. Studies of 8 randomized trials indicate that using formulas enhance short-term growth rates; nevertheless, it increases risks of developing the serious gut abnormality known as necrotizing enterocolitis. Their impact on long-term growth or on development has not been proofed (Quigley, Henderson, Anthony, & McGuire, 2007).

Expressed donor’s breast milk from mothers, who have delivered at term, relatively has a decreased energy and protein content than term formula milk. The nutritional value of donor breast milk can be compromised more by Pasteurization. Moreover, donor breast milk variation in fat, protein and calories constituent is determined by the stage of lactation of its collection. Expressed donor’s milk from the donor’s breast contains increased energy and protein content compared to the contralateral breast (Quigley et al., 2007).

Concerns has been raised regarding the nutritional necessity of premature infants or low birth weight infants, who have comparatively depleted nutrients reserves and are susceptible to metabolic disturbances relative to the term infants, cannot be fully satisfied by enteral feeding using donor mother’s milk. Such inadequacies may have adverse implications for growth and development. Nevertheless, a key putative benefit of human donor milk is in its potential to supply growth and immunoprotective factors to the underdeveloped GIT mucosa which may stop severe adverse consequences, such as invasive infections and necrotising enterocolitis (Quigley et al., 2007).

Role of mothers

The present trend of registering premature infants in the neonatal care affords them an increased level of medical treatment which helps increase their chances of survival. However, this division deprives the mothers the opportunity to induce an attachment process. Thus, some programs such as Kangaroo Programs have been designed to bring back together mothers with their infants in the Neonatal Intensive Care Unit (NICU) (Ahn, Lee, & shin, 2010).

Research conducted by Ahn et al. (2010) have revealed that mothers of premature infants experienced challenges in sustaining the parent’s responsibilities due to the infant’s declined chances of survival, escalated incidence of abnormalities and long-term severance.

Affonso, Bosque, and Wahlberg (1993) argue that treatment in the NICUs can hinder the process of nurturing an optimistic baby’s perception and stimulating the attachment process through reduction on the mother-infant contact period. Nevertheless, based on Shin (2003) frequent parental visits should be checked to reduce incidence of nosocomial disease, physical and environmental barriers, and staff loading.

Noteworthy, mothers’ involvement in premature infant care is both beneficial to both the infant and the mothers as revealed by the Ahn et al., (2010) research. The research indicates that mother’s engagement in care stimulated desirable physiological outcomes including; improved infant stature and head circumferences. Also, mothers who initially indicated moderate level of depression depicted no symptoms of depression after a 3-week attachment period.

Breast feeding

When an infant is enrolled into the neonatal intensive care unit (NICU), parent’s opportunity to engage in their child’s care is usually limited by their newborn’s condition and by the range of technological devices used in the support of NICU patient (Lee, 2008).

Driscoll (2005 cited in Lee 2008) argues that “breastfeeding is a relationship and a method of communication. Breastfeeding success or failure is a personally defined experience that is based on woman’s individual perception and self definition.” This means that a mother’s personal objectives affect her viewpoint of her effectiveness (Lee, 2008).

However, since most preterm newborns are not strong or mature to nourish completely from the breast until they are almost attaining their due date, feeding expressed milk to the infant is more logical initial expectation. Instituting and sustaining a mother’s milk provision with breast pump is more challenging compared to instituting and sustaining provision for a full-term infant. When the preemie finally attains the coordination of breathing consistent with sucking and swallowing necessary for oral feeding, adopting to suck from the breast may in addition be difficult and long process (Lee, 2008).

Benefits of mother’s milk

Premature infants require the immunologic and metabolic advantage of maternal milk. In spite of the limited data from randomized controlled studies, breast milk seems to confer increased protection to preterm infants from morbidity including late-onset sepsis and necrotizing enterocolitis. In addition, they benefit by getting less frequent and/or reduced severity of diseases, lesser incidence of numerous chronic conditions, and perhaps better developmental results (Lee, 2008).

Milk secreted by mothers to premature infant distinguishes in constituent from that of mothers of full term newborns. Preterm milk has more protein and fat and lower lactose, hence more caloric content, than full term milk for no less than the first month following perturbation (Lee, 2008).

Kangaroo Mother Care

Kangaroo Mother Care comprise of three segments. First, it involves the kangaroo position in which premature infants who have acclimatized to the extrauterine conditions and able to breastfeed, are discharged and placed in an upright position against the mother’s chest, with bare skin-to-skin contact. Noteworthy, the kangaroo position has a resemblance property of temperature-regulating function to the incubator.

The mother and the preemie can then be discharged without consideration of the infant’s gestational age or weight. Preemies are sustained consistently in this position the entire day even at night until they express through their behaviors their readiness to leave hospital care; normally at 37 or 38 gestational weeks old. Moreover, other caregivers such as the father and grandparents may switch with the mother as the kangaroo position giver (Tessier et al., 2011).

The second segment involves kangaroo nutrition. In spite of breastfeeding being the core source of nutrition, newborn may also get preterm formula and vitamin additives appropriately. The third segment is clinical management which involves monitoring infants routinely until a weight increase of a minimum of 20 g daily is evident. Subsequently, weekly visits are programmed until term that is 40 weeks’ gestational age, which makes up the ambulatory least neonatal care, (Tessier et al., 2011).

On the other hand, the Traditional Care (TC) intervention involves keeping infants in incubators until they achieve control of their temperature and have the necessary weight gain. They are released based on the recent hospital practice, which is normally until they weigh 1700g. This stage is when intensive care is not necessary any longer, and retention in hospital distinguishes them from their counterparts in the KMC intervention (Tessier et al., 2011).

Challenges of breastfeeding

A previous study indicated that women, who continued to smoke during breastfeeding, depicted a decrease incidence of respiratory infections among their preemies relative to the infants of their smoking counterparts who adopted bottle feeding. The speculation is that smoking and breastfeeding is less harmful to the infant (Kenner & Lott, 2007).

The American Academy of Pediatrics (AAP) has permitted breastfeeding for women using methadone. While there is transfer of methadone into breast milk, studies have estimated that the amount receive by the infant is about 2.8% of the amount consumed by the mother. Certain studies speculate that milk from methadone-treated mothers improve symptoms of neonatal abstinence in preterm infants. Nevertheless, further studies have not substantiated these outcomes (Kenner & Lott, 2007).

When a lactating mother uses alcohol, below 2% of the dose gets into her breast milk. Although alcohol is not reserved in the breast milk, its levels correlate with that in the maternal circulation. Hence, the breast milk will contain alcohol as long as the maternal breast milk carries a considerable amount of alcohol. Siphoning the breasts and disposing the breast milk directly following alcohol consumption does not accelerate the clearance of alcohol. Alcohol will still sustain in the freshly produced breast milk depending on its levels in the circulation. Because no threshold for alcohol’s adverse impact on the developing preterm brain has been determined, the AAP and the American College of Obstetricians and Gynecologist (ACOG) encourages total abstinence through pregnancy (Kenner & Lott, 2007).

Conclusion

Breastfeeding sustenance for premature infants differs across entity NICUs and broader geographic regions. In the United States, maternal attendance in the NICU mainly is limited by the requirements of employment. In either way, it is obvious that premature infants gain approximately as much from breast feeding as full term infants, and that their mothers also benefit. Thus with appropriate support and supervision, it is achievable for care practitioners to support families in addressing the unique challenges of accomplishing such benefits (Lee, 2008).

Reference List

Affonso DD, Bosque E, Wahlberg V, et al., (1993). Reconciliation and healing for Mothers through skin-to-skin contact provided in an American tertiary level intensive care nursery. Neonatal Network, 12:25-32.

Ahn, H. Y., Lee, J. & Shin, H. J. (2010). Kangaroo Care on Premature Infant Growth and Maternal Attachment and Post-partum Depression in South Korea. Journal of tropical pediatrics, 56 (5). 342-344.

Carter, B. S. (2009). Ethical issues in neonatal care. Medscape. Web.

Kenner, C. & Lott, W. (2007). Comprehensive neonatal care an interdisciplinary approach.Westline industrial drive, st Louis; Missouri: Saunders Elsevier Inc.

Lee, K. G. (2008). Breastfeeding and the premature infant. In Brodsky, D., & Ouellette, A. (Eds) Primary care of the premature infant. (pp. 61-69). John F. Kennedy Boulevard Suite, Philadelphia; Saunders Elsevier Inc.

Quigley, M. A, Henderson, G., Anthony, M. Y., & McGuire W. (2007). Formula milk versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Library.

Shin, Y. H. (2003). Current status of Korean premature infant care and its perspective. J Korean Acad of Child Health Nur, 9, 96-106.

Tessier, R., Cristo, M., Velez, S., Giron, M., Ruiz-Palaez, J. G., Charpak, Y., & Charpak, N. (2011). Kangaroo mother care and the bonding hypothesis. Pediatrics. 102(2). Web.

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