Becoming a NICU Parent. Pre-term Babies — Feeding Volumes, Breathing and Temperature Basics
Dads need to step up their game for NICU babies
The three basics that your pre-term baby will struggle with include:
- Temperature maintenance
- Respiratory Success (there’s many ways breathing can be compromised with pre term babies)
- Volume of food intake
Even full term babies can face these challenges — especially the respiratory ones. All babies go through shallow breathing the first couple of months, but in pre-term babies, there is a risk of apnea — and low Oxygen saturation levels. Read on to see how to conquer all these….
Food Intake Volume — Learn Feeding Techniques from the Nurses
Respiratory Issues
Most pre-termers will have some form of breathing / respiratory issues.
This is because their brain neurons are still in the process of forming — and the brain is where the breathing signals arise. Sometimes, the signals don’t quite arrive on time, causing the baby to skip breaths.
If this happens for an extended period of time (the exact threshold is set by your doctor and nurse — and is visible on the monitor), your baby may have pre-term apnea.
This is extremely common — and not something to worry about (I lost some sleep over it).
Our Experience with Pre Term Apnea
Breathing issues don’t manifest until after 2–3 days in NICU. Our baby was almost discharged after 3 days because he had no detectable breathing issues.
Fortunately for us, as part of the discharge process, we decided to do a ‘rooming in’ exercise — which allows us to spend a night in the NICU family room along with the baby.
This turned out to be a really fortuitous decision -as the baby developed a low temperature a few hours into the ‘rooming in’. (Low Temperatures, for infants, are as dangerous as a high fever. It means they are not able to maintain their body temperature, and are losing body heat).
This led to him getting some probes put on — and some blood work. The probes then, over a period of hours, detected that he was having breathing ‘events’. And this led to him back in NICU for the next 7-8 days.
Had we taken the baby home, we would not have been able to get the quick diagnosis and fix for the apnea events.
The Apnea Fix
Fortunately, there are several remedies available to resolve apnea. If your baby has just a couple of events a day, they may put it on a tube or CPAP type of apparatus.
If the events are more frequent, your baby may be given a caffeine shot! You read that right. Caffeine citrate has been shown to help breathing in pre-term infants.
Our infant got one such shot — and that helped resolve his frequent incidents.
Some infants may need more than one shot — or regular doses while they are in NICU.
NICU Feeding
Baby doctors are great — and know their stuff. This is not to pick on their skills.
However, they are not the ones attending your baby for a 12 hour shift.
That responsibility falls on a NICU nurse — who typically attends 3–4 NICU babies at once.
Multiply that 12 hour shift by a few years of experience, and you can imagine the sheer acquired knowledge that these nurses have.
What I learnt about proper feeding of pre-term babies was mostly from nurses.
Not just the right positions for feeding, but how to get your baby to re-start after it stops.
Pre-Term babies often take a break from eating, not because they are full, but because eating uses up most of their tiny reserve energy.
This doesn’t mean that their appetite is sated — it means, they just were exhausted just performing the act of eating — and need a small break.
My baby boy would stop for about 5 minutes, pretend that he was all exhausted and done. However, 4 -5 minutes later, with a few tricks I learnt from the nurses, he would pounce on the bottle and eat almost as much as he did first time around!
Each baby has unique feeding patterns — you just need to sit with yours and learn what their pattern is.
If you are a parent, and are not using the NICU time to feed your own baby, you should really not even consider taking your baby home, till you master this skill. It’s as simple as that.
There’s so many intricacies to feeding a pre-term baby, that you can only learn all these by actually working alongside the nurse in charge of your baby.
Nurse 1 — taught me to keep the baby in a side sleeper position
Nurse 2 — taught me the side sleeper — but with an elevated head
Nurse 3 — taught me the same side sleeper position — but with the baby angled outwards from my chest, instead of parallel to it. Not only was this last position super easy for the baby, it was also easy for my own grip and maneuverability.
There’s many , many more tips to feeding your baby. If you don’t get them down, you will end up underfeeding or worse, triggering things like acid reflux, throwing up etc. in your baby.
Just go to the NICU — as often as you can. And learn how to feed from a bottle. The mom should also try and breast feed as often as possible, if she is producing milk (see next section).
Swaddle versus No Swaddle while feeding
Taking off the swaddle will make your baby hungrier. This is because, he or she is now able to move around, feels a little colder — and needs more energy.
A good strategy is to start the feeding with the swaddle on. If the baby has fed enough, then no other action needed. If you feel he/she has underfed, you can remove the swaddle, try burping them, give a 2 minute break, and see if they want more!
Producing Enough Milk
The mom should be drawing milk breasts every three-four hours. At most, with a 4 hour gap, no more.
For pre-term babies especially, mother’s milk has a distinct advantage over formula. However, not to sweat. There isn’t any downside to formula — if you are not producing enough, for whatever reason.
You do need to try your best though — and keep at it with the frequency of 3–4 hours. In our case, little to no milk the first two days after delivery. And then, just by sticking to the 3–4 hour routine, my wife started producing a sizeable amount.
Should you power pump?
Some lactation experts will ask you to ‘turn it up’ on the lactation machine — to get more milk produced. While this is somewhat acceptable once in a while, it can be dangerous if done too often (more than once a day).
In fact, once your body starts regularly producing breast milk, you should not need to rely on powering up.
Small quantities of breast milk?
If you are only producing small quantities — consolidate those into a larger bottle.
If you have some leftover breast milk from the last feeding, mix it into formula, in the very same bottle — so the breast milk is not wasted.
Not all nurses are created equal
Nurse shifts change every 12 hours. Which means, in a week long period, your baby could see as many as 14 different nurses! And with touch events every 3 hours — that’s 56 times nurses will look after your baby.
There are nurses that will care for your baby as their own.
And there are nurses that are just checking all the boxes (diaper change, fed from bottle..). We had a few nurses with slip-ups that included — not using mom’s milk kept in the refrigerator, not bundling the baby well — which leads to heat loss (which is scary for pre-term babies), and other such issues.
I tried to make as many of the touch events as possible (I would personally feed the baby as often as I could and also do the temperature and diaper events).
Each time I felt the nurse was rushing through things or just pre-occupied elsewhere, I stayed longer with the baby. And I always told the nurse I would return for the next event. I wanted the nurse to know that the parent was not far away ever — and could re-appear at a moment’s notice.
Some nurses though, were truly spectacular. Not only would they keep the baby warmly bundled, but managed to go out of their way to feed the volume required and do all the touch events to perfection!
Don’t be that Dad
Whatever your day job may be, this particular job is completely hands on. It requires manual dexterity as well as mental presence.
If all you know is how to manage people and get work done on your behalf, you will not succeed at being a NICU dad.
I wrote this blog post because I encountered one such dad.
He talked a good game — ‘all right..let’s see what we got here…doesn’t sound too bad…let’s get this thing rolling….’ He chit chatted with the nurse for a good 20–30 minutes. She provided him with a detailed, hands-on tutorial on feeding the child.
He still failed at it — he only got the baby to take in a fraction of it’s requirement. And then left, in semi frustration.
This is not to make fun of such dads. Just realize that you are there not to entertain or be entertained. Your baby is in an ICU. You need to wrap your head around that, before you come in there to perform any service.
Summary
If you are a first time NICU parent, there are skills you need to acquire. ASAP!
You may think that you’ve raised other children (non NICU babies), so you know what you are doing. Incorrect!
A NICU baby has very very different and specific needs, that only his NICU nurses pick up on. You need to get a full download from those nurses — and sit alongside them to get as much on-the-job practice as you can.
Skip the balloon decorations and baby showers (we made this mistake) and the fancy strollers.
If you know your wife may be delivering early (due to potential health history or just that you’ve been told ahead of time), get ready to become a full time nurse. Especially you Dad, since Mom will most likely be struggling to recover herself!
Your baby will need your (Dad’s) nursing skills more than anything else. Take off from your job if you need to (I would almost wager that you need to). Get a healthy baby home first, then you can celebrate all you want.
Thoughts? Comments?
A note on pacifiers
Pacifiers have been shown to be great for infant pain management and brain development. Infants who have procedures performed on them, benefit from the pacifier, as it relieves their pain somewhat.
