Tuesday, March 17, 2009

Health Care and Preemies

A group that tries to fight premature births and other problems in infants said that the cost of paying for one premature baby for a year is about the same as caring for 12 healthy, full-term babies as reported by Station KSBW in Santa Cruz, California. The March of Dimes, according to the report, said raising a healthy baby costs about $4,551 for the first year, including $3,800 paid for by insurance. A low birth-weight baby costs nearly $50,000, with insurance picking up $46,000. With about one in every eight babies born too soon in the U.S., the 543,000 preemies adds up to about $26 billion in spending each year.

According to the National Institute of Health (NIH), a premature infant is a baby born before 37 weeks gestation. The normal period for delivery is 40 weeks. At birth, a baby is classified as one of the following:
--Premature (less than 37 weeks gestation)
--Full term (37 to 42 weeks gestation)
--Post term (born after 42 weeks gestation)
Additionally:
1.) If a woman goes into labor before 37 weeks, it is called preterm labor. Often, the cause of preterm labor is unknown. Multiple pregnancy (twins, triplets, etc.) makes up about 15% of all premature births. The following health conditions and events in the mother may contribute to preterm labor:
--Diabetes
--Heart disease
--Infection
--Kidney disease
--Lack of prenatal care
--Poor nutrition
--Preeclampsia --the development of high blood pressure and protein in the urine after the 20th week of pregnancy
--Substance abuse
--Young age (a mother age younger than 18)
2.) A woman who has had any of the following is at increase risk of preterm labor:
--Premature rupture of the membranes or placenta previa
--Previous preterm delivery
--Problems with the uterus or cervix
--Unexplained high alpha-fetoprotein level in the second trimester
--Untreated disease or infection (such as urinary tract infection or infection of the amniotic membranes)

When premature labor develops and cannot be stopped medically, the health care team will prepare for a high-risk birth according to the NIH. The mother may be moved to a center that specifically cares for premature infants, for example, a neonatal intensive care unit (NICU). In some cases, medicines called steroids may be given to the mother in help the baby's lungs mature. When born, the baby is moved to a high-risk nursery. The infant is placed under a warmer or in an machine called an isolette, which controls the air temperature. Since infants are usually unable to coordinate sucking and swallowing before 34 weeks gestation, your baby may have a feeding tube placed into the stomach. In very premature infants, nutrition may be given through a vein until the baby is stable enough to receive feedings by mouth. If the infant has breathing problems, a tube may be placed into the windpipe (trachea). A machine called a respirator will help the baby breathe. Oxygen is given. Nursery care is needed until the infant reaches a stable body weight and is able to feed by mouth and maintain body temperature. In very small infants, other problems may complicate treatment and a longer hospital stay may be needed.

According to KidsHealth.org, preemies have basic health needs:
1.) Warmth:
Premature babies lack the body fat necessary to maintain their body temperature, even when swaddled with blankets. Therefore, incubators or radiant warmers are used to keep the babies warm. Incubators are made of transparent plastic, and they completely surround an infant to keep him or her warm, decrease the chance of infection, and limit water loss. Radiant warmers are electrically warmed beds open to the air. These are used when the medical staff needs frequent access to the baby for care.
2.) Nutrition and Growth:
Premature babies have special nutritional needs because they grow at a faster rate than full-term babies and their digestive systems are immature. Neonatologists (pediatricians who specialize in the care of newborns) measure their weight in grams, not pounds and ounces. Full-term babies usually weigh more than 2,500 grams (about 5 pounds, 8 ounces), whereas premature babies weigh anywhere from about 500 to 2,500 grams. So, what are premature babies fed? Breast milk is an excellent source of nutrition, but premature infants are too immature to feed directly from the breast or bottle until they're 32 to 34 weeks gestational age. Most premature infants have to be fed slowly because of the risk of developing necrotizing enterocolitis (NEC), an intestinal infection unique to preemies. Breast milk can be pumped by the mother and fed to the premature baby through a tube that goes from the baby's nose or mouth into the stomach. Breast milk has an advantage over formula because it contains proteins that help fight infection and promote growth. Special fortifiers may be added to breast milk (or to formula if breastfeeding isn't desired), because premature infants have higher vitamin and mineral needs than full-term infants. Nearly all premature babies receive additional calcium and phosphorus either by adding fortifier to breast milk or directly through special formulas for preemies. The baby's blood chemicals and minerals, such as blood glucose (sugar), salt, potassium, calcium, phosphate, and magnesium, are monitored regularly, and the baby's diet is adjusted to keep these substances within a normal range.

According to the March of Dimes, preterm babies spend more time in the hospital than healthy babies do. Average length of hospital stays for a term infant for the first year of life in 2005: 2.3 days. Average length of hospital stays for a preterm infant in 2005: 14.2 days. Preemies also need more outpatient visits and prescriptions. Additionally, the emotional toll can be severe for the parents and all family members. When an infant arrives prematurely, the family faces a stressful new world. Often, the parents see the baby only for a moment before he or she is whisked away to the neonatal intensive care unit (NICU). Instead of taking home a healthy newborn, parents spend hours in the hospital, talking to all kinds of specialists. The medical equipment that is helping the baby is frightening. The doctors and nurses use clinical words that parents don't understand. And the busy, hectic atmosphere in the NICU is stressful. Often the mother, feeling lonely and sad, leaves the hospital before the baby does.Many preterm infants face life-threatening complications. Things can change very quickly. One day the baby appears to be doing well; the next, hope seems to be lost. Families with premature infants often refer to the NICU as a roller-coaster experience. Day-to-day life is completely disrupted. Parents spend hours in the NICU, away from their other children and their jobs. Sometimes the NICU stay can last for months, and often the facility is located miles from home. Families face financial stress as they struggle to pay the high NICU costs. Facing important decisions about their baby, families find that marriages and relationships are tested as never before. How do we share the time in the NICU? How do we manage the household? How do we find time for our other children and for ourselves? What do we tell others about the new baby? The baby's siblings may feel worried—and left out. How do we pay for all the expenses, and what about our insurance coverage? What about time off from work?

It's important to take your baby to your doctor's office soon after your preemie leaves the hospital, according to the American Association of Family Physicians (AAFP). Your doctor will check your baby's weight gain and find out how your baby is doing at home.Talk with your doctor about feeding your baby. Your doctor may recommend vitamins, iron and a special formula if the baby is bottle-fed. Vitamins are often given to premature babies to help them grow and stay healthy. Your baby also may need extra iron because premature babies often do not have as much iron stored in their bodies as full-term infants. After about 4 months of taking iron drops, your baby will have about the same amount of iron as a full-term baby. Your doctor may want your baby to take iron drops for a year or longer.Your baby may not grow at the same rate as a full-term baby for the first 2 years. Premature babies are usually smaller during this time. Sometimes they grow in bursts. They usually catch up with full-term babies in time. To keep a record of your baby's growth, your doctor can use special growth charts for premature babies. Your doctor will also want to know things like how active your baby is, when your baby sits up for the first time and when your baby crawls for the first time. These are things doctors want to know about all babies, not just premature babies.

The AAFP also recommends the following ways to care for your new preemie:
1.) Feeding schedule:
At first, most premature babies need 8 to 10 feedings a day. Don't wait longer than 4 hours between feedings, because if you do, your baby may get dehydrated (dehydrated means lacking fluids). Six to 8 wet diapers a day show that your baby is getting enough breast milk or formula. Premature babies often spit up after a feeding. This is normal, but you want to make sure that your baby is still gaining weight. Talk to your doctor if you think your baby has stopped gaining or is losing weight.
2.) Solid food:
Most doctors advise giving a premature baby solid food at 4 to 6 months after the baby's original due date (not the birth date). Premature babies are not as developed at birth as full-term babies are, so it may take them longer to develop their swallowing ability. If your baby has medical problems, a special diet may be helpful.
3.) Sleep Habits:
Although premature babies sleep more hours each day than full-term babies, they sleep for shorter periods of time. They wake up more often (and they wake you up more often!). All babies, including premature babies, should be put to bed on their backs, not on their stomachs. Use a firm mattress and no pillow. Sleeping on the stomach and sleeping on soft mattresses may increase your baby's risk of sudden infant death syndrome (SIDS), which is the sudden and unexplained death of an baby who is younger than 1 year old (usually while the infant is asleep, which is why it is also called "crib death").
4.) Vision and Hearing:
Crossed eyes are more common in premature babies than in full-term babies. The medical term for this condition is strabismus (say this: "straw-biz-mas"). Often, this problem goes away on its own as your baby grows and develops. Your doctor may want you to take your baby to an eye doctor if your baby has this problem. Some premature babies have an eye disease called retinopathy of prematurity (ROP), which is a condition in which the small blood vessels in the eye grow abnormally. ROP usually only occurs in babies who are born very early, at 32 weeks of pregnancy or earlier. If there's a chance your baby has ROP, your doctor will advise you to take the baby for regular check-ups by an eye doctor. ROP can be treated to help prevent vision loss.Premature babies are also more likely than full-term babies to have hearing problems. If you notice that your baby doesn't seem to hear you, tell your doctor so your baby can be checked for hearing problems. You can check your baby's hearing by making noises behind or to the side of the baby. If your baby doesn't turn his or her head, or jump at a loud noise, you should tell your doctor.
5.) Immunizations:
Immunizations (also called vaccines or shots) are given to premature babies at the same ages they are given to full-term babies. Your baby might be helped by getting a flu shot when she or he reaches 6 months of age. Premature babies might get sicker with the flu than full-term babies. Talk with your doctor about flu shots for your entire family. This can help protect your baby from catching the flu from someone in the family.

Premature babies require a huge commitment in time, care, expense, and love. They are very fragile in the first few hours and days and must be monitored around the clock for any health issues. Preemies need more attention than babies or children who have had a normal delivery. The premature baby is special and must be cared for with extra special devotion to their needs.

Until next time. Let me know what you think.

1 comment:

Neo said...

Very nice and informative entry. I'd like to invite anyone interested to visit my neonatology blog at
http://neo-lifeinthenicu.blogspot.com
It's intended as a lightheated and informative read for those interested in neonatology. Please feel free to leave comments/suggestions. Thanks!