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.
In many hospitals there are special rooms for premature babies, which are divided by glass partitions into cubicles so that each baby is in a three-sided enclosure. The rooms are usually darkened to save the baby from the needless irritation of light, and are supplied with constantly changing fresh, moist, filtered air, the temperature being kept at from 80° F. to 90° F.
In a patient’s home or in a hospital where there is no special room for premature babies, a cubicle may be improvised by placing the basket in which the baby lies, in the corner of a room and placing a screen parallel with one of the walls. Such a room should be darkened, well ventilated and have in it a large open vessel of water.
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 sorely needs. As crying inevitably involves deep breathing, it is a common practice to make the premature baby cry at regular intervals during the day in order to promote the respiratory function. Dr. Griffith further recommends plunging the baby into a mustard bath at 100° F. or 105° F. if necessary to make him cry vigorously. It is also important to turn the premature baby from side to side, several times a day to prevent fluid from collecting in the lowermost part of the lung, a condition favorable to the development of pneumonia.
In feeding premature babies, breast milk is ordinarily the most desirable food. If the baby is too feeble to nurse, as frequently occurs, the milk may be expressed from the breast of his mother or a wet nurse, by stripping or pumping, into a sterile receptacle, and if not used immediately it should be covered and placed in the refrigerator. Breast milk is sometimes used whole and sometimes diluted with water, and is given by gavage if the baby is very feeble; from a medicine dropper or 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, thus minimizing his effort to obtain it. (See Fig. [175].)
The amount and intervals for feeding the premature baby have to be adjusted to the individual with even greater care than for a normal baby, for he needs more fuel and building material, because of his imperfect development and yet because of that same imperfect development his digestive powers are feebler than those of the full-term baby. During the first day or two, he is sometimes given nothing but water or sugar solution, the milk being started gradually when the baby is from thirty-six to forty-eight hours old. He may be given a very small quantity every two hours, or he may be fed at three- or four-hour intervals, depending entirely upon his condition and progress. It is usually considered very important for the premature baby to have sterile water or sugar solution to drink between feedings, and this is given in the same manner as his milk.
Unlike the normal baby he is not taken from his bed to be fed, unless he nurses at the breast.
The premature baby is weighed as often as is safe for him, since the suitability of his food is largely indicated by changes in his weight. But sometimes very young and feeble babies are weighed only once or twice a week because of the inadvisability of disturbing them more frequently.
Avoidance of fatigue and the conservation of the premature baby’s limited strength and energy are accomplished through reducing his muscular activity to the minimum, by very little and very gentle handling; and by minimizing his loss of energy in the form of heat by keeping the little body warm and quiet.
In this connection the daily bath is of considerable importance. It almost always consists of sponging the baby 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.