Getting ready to be a mother

by Carolyn Conant Van Blarcom

THE PREMATURE BABY

All of the precautions and gentleness which are necessary in the care of the normal baby, born at term, must be greatly increased in caring for the baby who is born prematurely. The premature baby is not only small, but in general is imperfectly developed, having slenderer powers than the full term baby, and at the same time much greater needs. His respiratory and digestive organs are less ready to act than those of the normal baby; his muscles and nerves are feeble; his heat-producing machinery is unstable and yet he loses an excessive amount of body heat.

Accordingly, the baby who has been deprived of those valuable last weeks of growth and development within the uterus, is small and limp; lies quietly most of the time; moves very feebly, if at all, and needs special care. To help him in maintaining a normal body temperature it is usually necessary for him to be oiled with warm olive oil and entirely wrapped in cotton batting or flannel or enveloped in a quilted garment, with hood attached, made of cheesecloth or flannel and cotton batting, such as is shown in Fig. [65]. Diapers are often omitted in caring for very feeble babies, a pad of cotton, instead, being slipped under the buttocks, as this may be changed with less disturbance to the baby than a diaper.

A satisfactory bed may be devised from a basket or box with the bottom well padded with several inches of cotton, a small pillow or a soft blanket folded to the proper size, covered with rubber or oiled muslin and a cotton sheet. The sides of the basket may be lined with heavy quilted material, to shut out drafts and help to preserve an even temperature of the air immediately around the baby, or such a basket as is shown in Fig. [66] may be used. A flannel covered hot water bag at 110° F. may be placed beside the baby, or two, three or four glass bottles, each holding about a pint, containing water at 100° F. and securely stoppered, may be hung in the corners of the basket. A thermometer, also, should hang in the basket and the temperature kept between 80° F. and 90° F. The temperature varies less if the bottles are filled in rotation than if all are reheated at the same time.

Fig. 65.—Quilted robe, with hood, for the premature baby. It may be made of flannel or cheesecloth with cotton batting for the padding.

The amount of heat needed around the baby is decided by taking his temperature (by rectum) at regular intervals; supplying more heat if the temperature is low and less if it is at or above normal. Some doctors have the temperature taken every four hours; others twice daily. As the baby grows able to maintain a temperature of 98° F. to 100° F., unassisted, the surrounding heat is gradually reduced and finally removed, and flannel clothing replaces the quilted robe.

Fig. 66.—An improvised bed for the premature baby, consisting of a closely woven clothes basket with padded bottom and four flannel covered bottles of hot water, attached to the sides. The necessary thermometer and special feeder are shown in the basket. (By courtesy of Dr. Alan Brown, Hospital for Sick Children, Toronto.)

The basket in which the baby lies should be placed in a darkened, well ventilated room and should be carefully screened from drafts. As the baby needs moist air there should be a large, open vessel of water in the room.

Since the premature baby’s lungs are not fully expanded, respirations are likely to be shallow and irregular, thus failing to supply the amount of oxygen which he needs. And as crying always causes deep breathing, it is a common practice to make the baby cry at regular intervals during the day.

In feeding the premature baby, breast milk is the most desirable food. In fact, many doctors feel that his life virtually depends upon it. If the baby is too feeble to nurse, the milk may be expressed from the mother’s breast, being immediately covered and placed in the refrigerator unless used at once. Breast milk is sometimes used whole and sometimes diluted with sterile water and is often given from a medicine dropper or through a special feeder. Such a feeder consists of a glass tube with a small nipple on one end and a rubber bulb on the other, by means of which the milk may be gently expressed into the baby’s mouth. (See Fig. [66].)

The premature baby’s bath is of considerable importance. It almost always consists of sponging him with warm olive oil as he lies in his bed and with the least possible exposure and turning. It is given every day or every second or third day, according to his condition. The eyes are wiped with boric pledgets and the nostrils with spirals of cotton dipped in oil. The buttocks are wiped with an oil sponge each time the diaper is changed.

It must be borne in mind constantly that the premature baby is particularly susceptible to infection. He should be safeguarded by having everything that comes in contact with him scrupulously clean; being protected from drafts, chilling and dust, and allowing no one with a trace of a cold to come near him. The person who cares for him should wear a freshly laundered gown and protect her nose and mouth with a gauze mask while attending him.