Associate Professor Milivoj Jovančević, MD, PhD, paediatrician
This is undoubtedly an extremely stressful experience for the parents. Instead of the planned and usual period of emotional preparation for the delivery and arrival of the infant into the home and lives of family members, a period of fear and worry sets in (usually suddenly). The delivery may occur only slightly earlier (pregnancies shorter than 38 weeks), but in some cases it occurs significantly earlier (e.g. after 26 weeks). The more immature the infant, the more problems the infant will face during the first days and weeks. It is difficult to bare the uncertainty of the final outcome of medical treatments, but, unfortunately, it is not possible to answer questions about the infant’s future health at such an early stage. Cooperation between the parents and the support they receive from healthcare staff are therefore extremely important. At the same time, the active role of parents in the process of caring for and feeding the infant who is in the neonatal intensive care unit is also significant. “Palčići” (Thumblings), a Croatian organisation for parents of premature infants, provides significant support at the national level. Experiences shared by parents who are/have been in the same situation, positive stories and practical advice are an invaluable help for parents who are facing such a situation for the first time.
When the weight, maturity and general health of the newborn infant make them ready to leave the hospital, parents receive detailed instructions on future activities, special medical check-ups and preventive measures. A health department nurse should be notified about the infant’s arrival home, as she can be of great help by providing advice and emotional support. It is important to find a paediatrician who will look after the infant’s health. The infant should be registered with a paediatrician as soon as possible. The doctor should then receive copies of the infant’s medical records. The first check-up can then be scheduled and future activities arranged. If the parents notice alarming signs or behaviour, they should contact their paediatrician without delay.
In the first days, it is important to monitor the infant’s adaptation to domestic circumstances, response to food, progress and behaviour. In order for communication with the child to proceed smoothly, it is important to help parents repress their fears, insecurities and unpleasant memories of past events. Family members, health department nurses and paediatricians all play an important part in this process.
Infants born extremely prematurely are typically included in a multidisciplinary monitoring and psychomotor development stimulation programme. As such, they are monitored by neonatologists, neuro paediatricians, physical therapists, later also psychologists, speech pathologists and therapists. Depending on the infant’s specific difficulties, ophthalmologists, pulmonologists and cardiologists may also be involved. It is important to carefully follow all instructions provided by those involved in infant monitoring and perform all the necessary tasks (e.g. development exercises).
In the process of infant care, bathing and changing, avoid products that may contain harmful ingredients. The “less is more” rule applies here: when bathing the infant, use only water. Furthermore, various beauty products such as cremes and oils have not proven to be effective. If, despite everything, you feel you should use a cream, choose renowned labels and products that do not contain preservatives, dyes or perfumes. It is important to note that despite being natural and generally healthy, olive oil is not suitable for newborn and infant skin. Namely, oleic acid dissolves fats which keep dead surface skin cells together. This layer provides protection and an area for “good” bacteria to live in. It is not necessary to bathe the infant every day (especially not during the winter months). However, in extremely hot weather, several baths a day will not hurt.
When it comes to immunisation, proceed as if the infant had not been prematurely born. For infants born before the 32nd week of pregnancy, protection in the form of regular monthly injections is recommended during the season of respiratory syncytial virus infections (usually November, December – March, April). Consult your paediatrician about vaccines which are not part of the compulsory immunisation programme. These include rotavirus vaccine (the virus causes severe forms of diarrhoea and is extremely contagious because it spreads through air) and immunisation against aggressive types of the Streptococcus pneumoniae bacteria (pneumococcus). In certain indications, these vaccines are available from the Croatian Institute of Public Health.
In the first months, it is important to reduce the risk of other infections. Priorities include handwashing before interacting with the infant (feeding, care), airing the room and ensuring clean air. Take regular walks outside, but avoid spaces with indoor air-conditioning (shopping malls). If the household includes a preschool child, it would be good to temporarily exclude this child from preschool (for at least a few months) to reduce the risk of infection.
With time, parents will grow more confident about their actions, and their communication with their child will become richer and more intense. By constantly developing awareness that they have done and will continue to do everything they can to help their infant develop successfully, parents generate feelings of satisfaction, happiness and optimism about the future which the infant, in their own unique way, feels, and which help in their emotional development.