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The incubator The staff may lay your baby on his tummy to encourage better breathing and sleeping, and to discourage movement to save energy. The UK'S Back to Sleep campaign recommends reducing the risk of sudden infant death syndrome (SIDS) by putting babies on their backs to sleep. You needn't be concerned about your baby being on his tummy because the staff will observe him, and breathing and heart monitors give added peace of mind.
Your baby may need his position changed frequently, and the mattress may be tilted to raise his head and to aid digestion and breathing. Babies feel calmer and grow better when semi-cocooned. Possibilities include a specially shaped fabric or foam roll, wedge, bolster, pillow or nest. Some NICUs cushion a baby's head with a beanbag to prevent it being flattened.
Many small babies stay in an incubator until around 34 weeks post-conception age or until they weigh 1350 to 1800g (3 to 4lb).
A premature baby's temperature-regulating mechanisms aren't mature and he can't shiver or sweat. He hasn't enough fat to keep him warm, because fat appears beneath the skin only in the last few weeks of full-term pregnancy. And he lacks 'brown fat' -- a type of fat which is a ready source of heat energy and found in full-terms between the shoulder blades and around the kidneys.
An incubator provides a constant temperature and a radiant heater can supply extra heat. Small babies also stay warm if nursed kangaroo-style. (Kangaroo care, as it's known, is when you hold your baby next to your skin, inside your clothes -- ask the SCBU staff for more details.)
Preventing dry skin An extremely premature baby's skin is very thin so it easily dries and cracks. An incubator's high humidity helps prevent water loss, as does covering the skin. Some units use a liquid paraffin derivative to retain moisture.
Sleep Deep sleep helps your baby grow and develop. Quiet times with minimal noise, light and touching help him sleep. Once your baby is able to leave the incubator, you'll find he sleeps better in your arms than in the incubator.
Protection from infection A mother's antibodies don't cross the placenta until 32 weeks, so the immune system of a baby born earlier doesn't protect him very well. You can help by:
• Providing breastmilk
• Avoiding close contact with outsiders
• Washing your hands before touching your baby
• Wearing a mask if you have a cough or cold
• Not touching a cold sore or active genital herpes infection.
Protection from bright light The NICU lighting may be extremely bright so that the staff can see clearly. This can be bad news for premature babies because their eyes are particularly vulnerable to bright light, and it prevents very low-birthweight babies getting enough deep sleep. It can also make them restless, decrease weight gain and reduce their 'islands of wakefulness' (the short periods of time when they are awake and alert). At worst, it may harm their eyes.
You and the staff can help by:
• Keeping background lighting low
• Using dimmer switches to prevent the sudden changes of brightness which make some babies short of oxygen
• Drawing curtains on bright days
• Covering the incubator unless a very ill or small baby needs observation for skin colour changes, difficult breathing, restlessness and other problems
• Covering a head box
• Draping a cover over his head if he's on a ventilator
• Putting goggles on him until a post-conception age of 31 weeks
• Shielding his eyes under a radiant heater
• Screening a phototherapy unit shining on a nearby baby
• Directing extra lighting away from his eyes
• Dimming the light regularly when he reaches a post-conception age of 30 to 32 weeks
• Having separate lighting controls for each incubator.
Protection from noise Loud or sudden sounds stress an immature baby, impair sleep and can reduce his oxygen level. Loud noises may also prevent him from beginning to learn to distinguish speech patterns.
These things help protect your baby:
• Talking quietly
• Having quiet times
• Putting a 'Quiet -- baby sleeping' notice on the incubator
• Preventing unnecessary sound, such as from a radio
• Reducing the ringing volume of telephones or replacing a ring with a flashing light
• Not banging doors, drawers and rubbish bins
• Moving equipment quietly
• Tending to crying babies promptly
• Using a padded incubator cover
• Attending to alarms quickly
• Replacing noisy alarms with flashing lights
• Replacing staff bleeps with vibrating radio pagers
• Frequently removing water from ventilator tubing.
Your voice, heartbeat and other body sounds Hearing your voice and listening to your heartbeat, tummy rumbles and other body sounds is comforting and soothing to your baby. If you or your husband can't be there, you could make a tape of your voices.
Your smell Recognising your natural scent may relax your baby and is particularly important when he's learning to breastfeed. Just putting one of your used breast pads by him in the incubator may help him relax.
Touch Small babies who are stroked and cuddled grow and develop quicker. A study of healthy pre-terms of less than 36 weeks post-conception age showed that stroking and other touching increased their weight gain by 47 per cent a day! A similar study found extra touching enabled prems to go home sooner. Stroking can interrupt 'stop-breathing' (apnoea) attacks, and letting your baby hold your finger may calm him and help him breathe. However, if your baby is very premature or ill, the nurses may suggest touching him as little as possible to prevent bruising him or disturbing his sleep.
When something has to be done, he'll have less of a shock if you rouse him first by:
• Stroking him gently
• Giving him a finger to hold
• Letting him suck a (clean) fingertip or pacifier
• Wrapping him in a blanket
• Slowly raising the light level
• Talking or singing softly.
Some babies are less stressed if essential procedures are grouped together, though the most unwell and immature may do better if they recover after each one. Gently cupping the top of his head with one hand and laying the other on his back may comfort him.
As your baby grows and develops or becomes healthier, you'll be able to touch him more. Indeed, a baby of 28 weeks post-conception age will probably manage an hour of actual cuddling. He'll probably love being massaged, and may sleep well and need less oxygen afterwards. Keep him warm, turn the lighting down and wash and warm your hands, then use a little warm oil (such as almond oil) and let your hands express your love by moving over his body.
Nappy changing You may have to supply nappies, creams, cotton wool and other toiletries. Change your baby's nappy as soon as it's wet or soiled, as a damp nappy quickly cools a small baby. The nurses will show you how to avoid dislodging any tubes and wires.
Cleaning Small wet babies rapidly become chilled when washed, so the nurses may recommend extra heat from a radiant heater. Being washed can be stressful and increase your baby's need for oxygen.
Swaddling Many babies like being wrapped firmly -- perhaps because they feel more secure. This swaddling encourages them to cry less, sleep more and save energy by moving less. It may also increase their oxygen level.
Movement A baby mature and well enough to be out of an incubator is comforted by being rocked, perhaps because it triggers memories of being in the womb. Rocking encourages rhythmic breathing and deep sleep. If you use a sling or carry your baby kangaroo-style, you'll provide motion and warmth.
Clothes A baby may wear only a nappy and a knitted bonnet or other hat in an incubator. A hat is important because a bare head loses so much heat.
Most clothes and nappies are much too big for low-birthweight babies, and only when they are about 3000g (6lb 10oz) will standard nappies and stretch-suits fit. However, small ones are available.
Nappies You could try the following:
• Double-fold standard muslin nappies
• Make small nappies from terry towelling
• Cut standard terry-towelling nappies diagonally and hem the long edge
• Cut down disposables and tape their raw edges
• Take a first-size pair of waterproof pants and sew extra seams to make the leg and waist holes smaller.
Toys A premature baby of over 30 weeks post-conception age may enjoy a bright mobile -- especially if it is black, white, red or orange. A musical toy might appeal, too. Easily cleaned plastic toys are best as soft toys harbour germs.
Written by Dr Penny Stanway, author of Coping with Your Premature Baby. Dr Stanway is an experienced doctor, medical author, journalist and broadcaster. She is author of several other books, including Breast is Best and The New Guide to Pregnancy and Babycare.