Know your newborn (0-1 month)
Know more about sleeping pattern in a newborn
Importance of sleep:
1. Essential for physical growth
2. Brain development
3. Boosts immune system
Sleeping pattern:
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Newborns sleep on and off during the day and night. Babies do not have regular sleep pattern until about 6 months of age
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They sleep for 14-17 hours in every 24 hours.
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They have 2 different kinds of sleep – active sleep and quiet sleep.
In active sleep your baby moves around. You might see jerking, twitching or sucking.
In quiet sleep your baby is still and breathing evenly.
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As babies get older, they need less sleep. However, different babies have different sleep needs.
Clothing
Babies grow very fast, so it’s best to buy the minimum number of clothes in each size.
You’ll need plenty of changes of clothes for a newborn baby.
Here’s a guide to get you started:
3-4 cotton bodysuits
2-3 jumpsuits
3-4 cotton caps
3-4 pairs of mittens
5-6 front open sleeveless tops
7-8 cotton nappies
2 cardigans or jackets (if it’s winter)
3 cotton blankets
3 muslin wraps
1 infant sleeping bag
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Best type of clothings to buy:
Clothes should be comfortable, soft and easy to take care of.
Stretchy jumpsuits that fasten at the front are best, as well as tops with envelope necks, which are easier to get over your baby’s head.
Jumpsuits with zips can make dressing your baby quick and easy too.
Clothes made from cotton are a good choice.
Cotton clothes will keep your baby cooler in hot weather than clothes made from synthetic fibres.
Cotton also washes well and is gentle against your baby’s sensitive skin.
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Washing newborn clothes:
It’s a good idea to wash all baby clothes before your baby wears them for the first time. This can get rid of excess dyes and chemicals, reducing the chance of clothes irritating your baby’s skin or causing an allergic reaction.
You can wash baby clothes with the rest of your laundry, but try to avoid using strong detergents and fabric softeners. Laundry detergents labelled ‘sensitive’ or ‘gentle’ are less likely to irritate your baby’s skin.
Care of premature baby
What is prematurity?
What is Low birth weight?
Survival and development of premature babies
What is a NICU?
What is Kangaroo Mother Care (KMC)?
Corrected age: what is it?
Immunisations in premature baby
Breastmilk, formula milk and supplements in premature baby
Immunisations in premature baby
Preparing for sick or premature babies to go home: tips
What is prematurity?
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Pregnancy lasts an average of 40 weeks (usually between 38 and 42 weeks).
A premature birth is when a baby is born before 37 weeks. So a baby born at 36 weeks and 6 days is officially premature.
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The degree of prematurity is often described by gestational age as:
1. Extremely premature – from 22-28 weeks
2. Very premature – 28-32 weeks
3. Moderately premature – 32-34 weeks
4. Late preterm – 34-37 weeks.
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Term babies are those born from 38 weeks.
What is Low birth weight?
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Babies can be both premature and have low birth weight.
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Any baby with birth weight less than 2500 gms are considered as Low birth weight.
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All low birth weight babies are categorised as below:
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1501 - 2500 gms - Low birth weight
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1001 - 1500 gms - Very low birth weight
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< 1000 gms - Extremely low birth weight
Survival and development of premature babies:
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Survival is affected by how premature a baby is. The more mature a baby is, the more likely they are to survive. Babies are also more likely to survive when they’re given the special care and equipment they need. Most premature babies go on to develop well.
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The longer your baby’s gestation, the less chance there is of any health or developmental concerns.​
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Extremely premature babies (born at 28 weeks or less) can have struggle with survival and also have an increased risk of health and developmental problems in long term. However, this depends on variety of factors that can be discussed with the Neonatologist.
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Premature babies and their parents might have an unexpected and sometimes stressful start to their life together. But with expert care, support and guidance, the early problems often work out and most children develop well.
What is a NICU?
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A neonatal intensive care unit (NICU) is a hospital intensive care unit that specialises in looking after babies who are born sick or premature.
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NICUs have specialist doctors, nurses, other professionals and equipment to care for sick or premature babies.​
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The first time you go into a NICU, it can feel overwhelming. But the staff at the NICU will be there to support you as you get to know the place.At the entrance, you’ll see a series of taps or hand sanitiser dispensers. You need to wash your hands with sterilising soap for several minutes or apply hand sanitiser before you go in. Babies in NICUs can very easily catch infections, and proper hand-cleaning reduces the risk of this happening.​
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Most babies will have either a heated open cot or a covered incubator. These keep their bodies at the right temperature. Depending on what medical support babies need in the NICU, there might be: machines to help with breathing machines to give measured amounts of fluids and medicines to babies through tubes going into their veins, monitors attached to babies with cords to measure heart rate, breathing, blood pressure and the amount of oxygen in their blood a soft small tube that feeds babies through their nose and directly into their stomach special cooling beds to help reduce brain injury in babies who have had a difficult birth staff wearing special gowns to reduce the risk of infection.
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All these things keep babies safe and comfortable, with as little extra handling as possible. Other large machines are brought into the NICU when they’re needed. These might include machines to: take X-rays and ultrasounds monitor brain function give babies treatment under lights, or phototherapy, for jaundice.
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The NICU is usually a calm place, with nurses and doctors quietly looking after the babies and other specialists coming in and out.
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Monitors will sound to alert the staff if a baby’s breathing or heart rate is out of the normal range. Sometimes monitors will sound even when babies are fine. If an alert sounds on a monitor attached to your baby, you can ask your baby’s nurse what the alert means.
What is Kangaroo Mother Care (KMC) and how is it beneficial?
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Kangaroo care generally refers to skin-to-skin contact with your baby.
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Researchers agree that skin-to-skin contact is beneficial for all infants and helps you bond with your new baby. Most research defines and explores kangaroo care as a practice that helps babies born early or with low birth weight. But if your baby doesn’t fall into these categories, they can still benefit from skin-to-skin contact.​
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Here are a few basic tips for getting started:​
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Dress comfortably:
There are no strict guidelines for what to wear. But you should wear something that you can easily open in front because your baby will rest against your bare chest. You’ll also need to remove your bra if you wear one. You can use a hospital gown that opens in front.​
2. Place your baby on your chest:
Your baby should be in an upright position with their head resting to one side against your chest. Your baby will typically wear only a diaper, hat and socks. The hat and socks help keep your baby warm.​
3. Cover your baby:
Once you’re settled skin-to-skin, drape a blanket over your baby’s back. Keep your baby warm and comfortable while snuggled against your chest. Your care provider may suggest using a wrap to secure your baby against your chest.​
4. Relax together:
During your session, try and relax as you hold your baby. Remember to breathe normally. This is a great time to let your baby rest and relax, too. Allow your baby to snuggle in and fall asleep. Avoid playing with your baby or rousing their attention.​
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What to avoid during kangaroo care:
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Put away phones or other electronic devices. These can distract your focus away from your baby. Focusing on your baby is important for bonding and also for keeping your baby safe as you hold them.​
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Make sure your skin is clean and healthy. Don’t do kangaroo care if you have a rash, open cuts or cold sores.
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Clean your skin beforehand and don’t apply any perfumes or lotions.​​
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Avoid doing kangaroo care if you’re sick. Your baby’s immune system doesn’t fully mature until they’re two to three months old. So, in these early weeks, it’s crucial to limit your baby’s exposure to germs. If you’re sick, see if another caregiver can take your place until you’re feeling better. Or ask your healthcare provider if it’s safe for you to do kangaroo care while wearing a facemask.
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What are the benefits of kangaroo care?
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Kangaroo care has many benefits, particularly for babies born preterm or at low birth weight.
Research shows that kangaroo care can help:
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Stabilize your baby’s heart rate.
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Improve your baby’s breathing pattern and make their breathing more regular.
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Support healthy sleep, including more quiet sleep and longer cycles.
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Encourage your baby’s growth and brain development.
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Lower your baby’s risk of hypothermia, serious infections.Kangaroo care also helps you:Bond with your baby.
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Establish breastfeeding and increase your milk supply.
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Feel confident in your ability to care for your baby and respond to their needs.​
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What is the history of kangaroo care?
Resting your baby against your chest is a natural practice that’s gone on throughout history. But kangaroo care as a named, clinically defined process began in Bogota, Columbia, in the late 1970s.
Preterm babies there at this time had a high mortality rate.Two doctors in Bogota — Edgar Rey, MD, and Hector Martinez, MD — went in search of a solution to help the babies they cared for.
They found one through a conversation with a village wet nurse. She explained how she bundled newborns up against her chest, and this supported the babies’ health and growth.
Drs. Rey and Martinez tried such skin-to-skin positioning with mothers and babies at their hospital. They termed this practice “kangaroo mother care” to describe how bundling your baby against your chest resembles preterm kangaroos crawling inside their mother’s pouch and latching on to a nipple for feeding. The baby kangaroos stay in the pouch for many months until they’re old enough to search for food on their own.
The doctors’ efforts in Bogota were very successful, leading to a 70% drop in deaths among preterm babies within the first year.​​In the decades that followed, researchers have continued to uncover benefits of kangaroo care and its hallmark feature of skin-to-skin contact.
For example, they learned that kangaroo care helps babies sleep better and breathe more regularly. It also helps support breastfeeding and healthy parent-infant attachment.
Researchers today are looking further into the benefits of kangaroo care and how it can help babies thrive in different settings.
In nations with limited access to medical technologies, kangaroo care can be lifesaving.
In resource-rich nations, kangaroo care can still play a valuable role in supporting your baby’s health and well-being while also helping the two of you bond.
Corrected age: what is it?
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Corrected age, or adjusted age, calculates your premature baby’s age by taking their prematurity into account.​
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Corrected age is your baby’s age now (their chronological age) in weeks or months minus the number of weeks or months early they were born.
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For example, a 1-year-old who was born 3 months early would have a corrected age of 9 months – that is, 9 months post their due date.​
Why corrected age is important?
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Corrected age helps if you or your doctor are trying to work out whether your premature baby’s growth and development is tracking in a typical way, especially in the early years.
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For example, if someone notices that your baby is 6 months old but not sitting up yet, you could explain that your baby was born 3 months early. This means your baby’s corrected age is only 3 months and you wouldn’t expect them to be able to sit up at 3 months. But your baby is probably doing everything a 3-month-old usually does.
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Extra point
If you’re giving your child a first birthday party, you should celebrate their birthday one year from when they were born, regardless of corrected age.​
Correcting a child’s age for prematurity can be done until your child is at least 2 years old.
​​​​​​​​​​When to have immunisations?
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Premature babies generally get the same immunisations at the same chronological age as babies born at term.
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Premature babies need the protection of immunisation because they’re more likely to get some infections.​
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If your baby was very premature, they might get their first immunisations while they’re still in hospital. They might also need an extra dose of some vaccines when they’re older.​
Breastmilk for premature babies
Your breastmilk is usually best for your premature baby.
It meets most of their nutritional needs. It’s important for their development and growth. And it protects them from infection and illnesses.
If you give birth prematurely, your milk will be slightly different from milk at term. This is because your baby’s needs are different from those of a baby born at term. Because premature babies need more proteins for growth than term babies, your colostrum will have more protein than the colostrum of mothers who give birth at term.Your breastmilk will also have more of an enzyme called lysozyme. Lysozyme attacks certain bacteria and helps protect your baby from infections. And your breastmilk will have more fat and less lactose, because premature babies find lactose hard to digest.
Expressing breastmilk for premature babies
If your baby is born younger than 34 weeks, it might be weeks before they can try breastfeeding.
But your baby can still have breastmilk. They might even be able to have small amounts of breastmilk from birth. Your baby will probably be given the breastmilk through a tube that runs from their nose or mouth down their throat into their stomach.
They might be able to have breastmilk by bottle or cup, but this isn’t common.If your baby is having your breastmilk through a tube, you’ll need to express either by hand or with a manual or electric pump. The hospital might have a pump for you while your baby is in the neonatal intensive care unit (NICU).
It’s helpful to start expressing breastmilk soon after your baby’s birth – within an hour if you can. Then it’s good to express every 2-4 hours to establish and keep up your supply. Expressing at least once overnight also helps to keep up your supply.
If expressing breastmilk works for you, it’s one of the things you can do to feel close to and care for your baby.
Premature babies starting to breastfeed
Before your premature baby can feed directly from your breast, kangaroo care can be a great way to help them get comfortable with skin-to-skin contact. It can also help you to produce more milk.
When your baby is ready to start breastfeeding, you might find that progress can be quite slow, especially if your baby was born very early or has been very sick. Feeding is a complicated skill, and premature babies get tired very quickly. They might have only enough energy for breastfeeding once or twice a day.
During this learning time, your baby might get only a very small amount of milk from your breast, with the rest by tube. It can take some premature babies many weeks to learn how to breastfeed.
Supplements
If your premature baby was born very early, they’ll need extra nutrients for good growth. This means extra powdered protein and calories will be added to your breastmilk. If your baby’s bone minerals are low, your baby will also get calcium and phosphate supplements to boost their bone growth.
Donor milk
If you can’t breastfeed or express your breastmilk, your baby might be able to have donated breastmilk.
Donated breastmilk is pasteurised before it’s given to babies. Pasteurisation reduces the risk of infection, but it also reduces some of the nutrients and other properties of the breastmilk. But donor milk still has enough nutrients to help your baby grow and develop well. Extra protein and calories are usually added to it.
Formula milk
If your baby can’t have breastmilk or donor milk, they can have preterm infant formula.
If your baby can have breastmilk, there might be times when your baby’s doctor suggests that your baby needs feeds of infant formula as well as breastmilk to get extra nutrition. This is called mixed feeding.
If you need to do mixed feeding with your baby, it’s still important to breastfeed or express breastmilk for as long as you can. Many babies have a combination of breastmilk and formula, and any amount of breastmilk has benefits.
No matter how you’re feeding your premature baby, you’re also being there for your baby and providing comfort. A warm and loving relationship with you is an important influence on your baby’s development too.​​​
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Preparing for sick or premature babies to go home: tips
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Your sick or premature baby’s homecoming is more likely to go smoothly if you’re prepared.
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Here are tips for getting ready from parents of premature babies.
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Preparing your home:
You’ll want to focus on caring for and getting to know your baby better, not putting equipment together.
Give your house a thorough clean.
2. Accept help:
If friends and family offer to help with cooking, looking after older children, gardening, shopping or cleaning, say, ‘Yes, please!’
3. Gathering information
Ask the hospital staff any last-minute questions. Make sure you know how to use any medical equipment you’re taking with you.
Find out what you should do if your baby becomes unwell or there’s an emergency.
Make sure you’ve got contact details for follow-up appointments.
4. Make a safe sleep environment for your baby.
Sleep positions and bedding for home might be different from those that your baby needed in hospital.
5. Preparing others
Warn family and friends that your baby might need to be protected from too much handling and too many new people at first. This helps to prevent infections and overstimulation.
Ask anyone who’s unwell to stay away.
ROUTINE CHECKUP
When should babies be following up with Pediatrician after birth?
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1. First follow up should be at 3-5 days of birth
Evaluation needed in first follow up:
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Thorough physical examination
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Jaundice
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Adequacy of feeding
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Birth vaccination if not already given
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Weight and length and the head circumference
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Common newborn screening tests
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2. Subsequent follow up should be at 4-6 weeks of age for:
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Monitoring of growth
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Vaccination
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Follow up schedules can be planned by your Pediatrician depending on your babys need.
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