Disease prevention in premature infants includes a set of different measures. Many people are involved and responsible for their implementation, improvement and modernization: the state, the healthcare institutions, physicians, nursing staff, medical professionals, NGOs.
Prevention of the most common diseases of the premature infants and the possible late consequences are the basis of the treatment and care for these children. Today we witness the survival and growth of children under 1000 g. This is due to the contemporary and modern neonatal therapy. Recent years are characterized by extremely rapid development and introduction of new methods of intensive care therapy, prevention and follow-up of premature infants.
Some of them are: a routine application of surfactant treatment in hyaline membrane disease (HMB) in premature infants. This led to significant reduction of mortality from HMB and improved survival. Introduction of new methods for artificial ventilation, dosed and strictly controlled oxygen treatment, improved housing conditions, timely diagnosis and treatment of early neonatal and nosocomial infections, and of the complications, etc.
Examinations that are performed at the NICU
- “Eye screening of premature infants” for the early detection and treatment of retinopathy of the premature baby.
- Ultrasound examination of the central nervous system in premature for the early diagnosis of intraventricular hemorrhage, the periventricular leukomalacia, etc.. This allows for rapid focusing the parents of these children to the need for early motor rehabilitation.
- Screening for hearing examination, allowing early detection of abnormal hearing and timely treatment.
Further to these facts and priorities, we should also mention the improved equipment in most NICUs in the country. It includes modern incubators for growing premature infants, newer generations ventilation equipment, with improved capabilities and gentle to the immature child, personal continuous monitoring for each baby, and rapid diagnosis equipment (transfontanelle ultrasound equipment in the department, and mobile X-ray machines, etc.).
The medical staff with their skills, experience and attitude towards the child and his parents plays an important role in the whole process.
After being discharged from the department, the care for the baby is taken on by the parents along with doctors from different specialties. These children are grown, checked up and monitored more often and with more caution. The care for them post discharge contains many components.
Frequently asked questions and concerns after discharge
1. How and what to feed the baby with?
Upon discharge from the department, your neonatologist will inform you on how to continue feeding at home. The common practice in most NICUs is that the mother to be next to the baby before discharge. She takes part in caring for it - bathing, breastfeeding techniques, how to hold it during breastfeeding and then, the technique of bottle-feeding and others. Breast milk is the ideal food for your baby. In the beginning, the baby may get tired quickly when breastfeeding. In such cases, squeeze and supplement with this breast milk. When difficulties or doubts whether the deal with breastfeeding, breastfeeding consultants in your city may be useful for you when in difficulty or in doubt whether you do well with breastfeeding. Look for them. If you feed the baby with infant formula, the neonatologist will help you with the choice of milk (a special type for premature babies), the optimum amount for the age and condition, the number of feedings, and medication supplements: vitamin E, iron formulations and others, targeted at prevention or treatment.
2. If your child is diagnosed with bronchopulmonary dysplasia (BPD)
Your neonatologist will inform you about the disease, both during hospitalization as well as the state of the baby at discharge. He will direct your attention to the feeding peculiarities, what to watch on the baby, what is normal and when to seek medical attention. The GP will refer you in the first month after discharge to a consultation with a pediatric pulmonologist. He will follow up the pulmonary disease of your baby, the appointed tests, treatment and checkups.
3. When to seek medical help?
If the child refuses to eat (in three or more consecutive refusal of food), if breathing is difficult, fast or slow, the color of the skin becomes pale, and the area around the lips and the hands appear of bluish color. You should seek for a doctor immediately regardless of the time of day.
4. If your child is diagnosed with intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL)
Diagnosis and monitoring of the evolution of the IVH / PVL start at the department. At discharge, the child will receive information about his condition at the time and the need for check-ups, exams, and consultation. Your GP or neonatologist will refer you for a consultation with a pediatric neurologist.
Your pediatric neurologist will inform you for any further examinations, testing and treatment. Following up the evolution of the IVH / PVL is done by examining the neurological status, reflexes, etc., in accordance with age, as well as by periodic ultrasound examinations. It is important to note that the ultrasound evaluation is completely harmless to the child and thus can be repeated without side effects. This is a major advantage over all existing modern methods of examination.
Children are very suitable patients for ultrasound, due to the reduced subcutaneous fat in newborns and open anterior and posterior fontanelles, allowing for the visualization of brain structures in detail. Screening of the central nervous system makes it possible to determine the potential risk of a serious disease and to take the necessary measures to prevent it. It is performed by a neonatologist and / or a pediatric neurologist.
In children with PVL, the follow-up, the treatment and the rehabilitation are carried out by a team of specialists: a neonatologist, a pediatric neurologist, a physiotherapist, a therapist, and eventually a psychologist. Early start of motor rehabilitation is important to prevent delays in motor development.
What signs in the baby should I pay attention to?
Some symptoms in children with increased risk are useful in reporting the opportunities for development of cerebral palsy (CP).
Such symptoms can be:
- increased sleepiness,
- restlessness or excitement,
- high cerebral crying,
- weak sucking reflex,
- inability of the child to hold the head in line with the body (tilts forward or backward)
- profuse salivation,
- reduced interest towards environment
- asymmetry in motion
- twitching - short or long,
- staring eye, etc.
If you notice these or other symptoms, which are of your concern, you should call and talk to your GP, your neonatologist or neurologist.
5. Premature baby retinopathy
Premature baby retinopathy is a significant health problem. The first exam of the eyes, and if necessary, the initial treatment of retinopathy is also done in the NICU. Your neonatologist will inform you of the characteristics of the disease, at what stage it is with your child, what the treatment is, etc. At discharge, both in medical history and orally, you will be explained when and where to perform the follow-up of the child. Your GP will refer you to a pediatric ophthalmologist. You have the right to choose the ophthalmologist for your baby. Your treating ophthalmologist will set the schedule for follow-up, treatment and exam frequency. Basic methods of treatment in severe forms of retinopathy are the cryotherapy, the laser therapy, and the surgical treatment.
Retinopathy prevention is limited to prevention of prematurity. The most important for this disease is the effective screening of premature infants and the early adequate treatment. A universally conducted eye screening for designated categories of premature newborns is a fact in our country.
Children need a special policy to guarantee them their natural right of a life, good health, full training and development. They should be a priority of the state policy. The state has exclusive options to create the most favourable conditions for the development of our children and to provide special care for vulnerable groups, including our preterm children. Today, the country is in debt to the children. In this regard, a certain compensatory role is played by the NGOs, the various foundations and associations. Associations of families with children suffering from certain chronic diseases are particularly important because of their mutual support in solving the complex medical and social problems of these children.