Here on the mom unit, they typically send the neonatologist in to consult with the parents, so in case the baby does come, the parents will be prepared for what they can expect to see with a premature child at his/her gestational age.
Tonight Dr. Schrager came in and laid it all out for me. Which was helpful. Much of this I have hear about or seen with Donna’s little Wesley and Stephanie’s Kate and Tyler, so there weren’t too many surprises. However, I feel like things are much clearer in my mind now, and I feel mentally ready, now that I know the possibilities. Honestly, things look pretty good at this point! and in the back of my mind, I’m still convinced I’ll be laying here on bedrest until June 26, and this whole conversation with the neonatologist will be a distant memory of what could have been, but wasn’t.
I’m still in week 31. First off, he told me that at week 31, babies have a 95% survival rate. That’s super encouraging! However, the baby usually still needs to develop three critical abilities: 1) suck 2) swallow and 3) breathe.
The typical NICU stay lasts between (what would have been) week 35 and full-term.
Before going home, the baby needs to be:
1) Stable
2) Able to bottle/breast feed without supplemental tube feedings
3) Over 4 pounds
4) Able to maintain body temperature in an open crib.
They categorize issues preemies face in two ways: early development and long-term.
At 31 weeks, the largest issue is lung development. I have been given steroid shots to help the little guy’s lungs develop more quickly, so that’s all they can do at this point to prepare him for the possibility of premature birth. Dr. Schrager emphasized that when the mothers have had those shots, the babies often do very well; in some cases, not even requiring oxygen. However, boys typically develop slower than girls (and I’m having a boy). Preterm babies lungs are deficient in surfactin. So there are 3 possible ways of handling this: oxygen supplement, CPAP (tube in the nose), or a tube in the throat to the lungs actually giving the baby surfactin.
He talked about minor issues that are pretty universal with preemies:
- Apnea: they forget to breathe while sleeping. Usually by week 31, the babies will not go home on a monitor. Occasionally they will.
- Jaundice: the big concern here is staining of the brain with bilirubin. Phototherapy will start early for a preemie.
- Head ultrasounds: are routine procedures for preemies. Due to the fragile blood vessels, the purpose is to rule out bleeding blood vessels in the brain. He said some parents freak out when the nurse says ‘your baby had its head ultrasound today.’ But this is very routine, precautionary, and in itself not necessarily an indication of any abnormality or disability.
- IVs: Initially all the baby’s nutrition will come through IVs. However, they encourage breastfeeding and want the moms to start pumping within the first week of giving birth, starting about 2 mls/day and working up.
- Weight loss: Expect a large initial weight loss of 10 – 15% of the birth weight. This often surprises parents, since the baby is already so small, a 10-15% loss seems huge.
Occasionally umbilical catheters are used in the vein for nutrition and in the artery to monitor blood work & for meds. The need for blood transfusions is hard to predict. Basically it depends on the health of the child; the more sick they are, the more blood they typically need. They have very little blood, and when they are sick, their blood is being drawn frequently, and they need more.
Long-term, babies born at 31 weeks do not usually have major neural development issues. However, there seems to be some risk of learning issues, such of dyslexia, which usually 15% of preemies face, contrasted with 5% in the general population.
As the baby grows, during the first year, development should be gauged according to the “corrected age”–the baby’s age adjusted to its due date. In the 2nd year, the differences become even less, and after 2 years, there is no need to adjust the age any more.
If the baby should come at week 32, the issues are basically all the same. At week 35, there is a 50/50 chance the baby will need to be in the NICU. Between weeks 34-36, babies are called “late pre-term infants,” and often go home as full-term infants. However, there is a higher risk of re-admission for jaundice or dehydration, in that scenario.
Overall, the prognosis is good for Little Q, even if he came today.
But like I said, there’s all this hype and bedrest, and watch me go full-term!!!
