Micro Premies: Terri Forehand

I’m pleased to host neonatal nursing expert Terri Forehand. She will be doing several posts on the unique problems as it relates to gestational age. This is very important for writing medical accuracy into novels as to what these tiny charges and their parents face.
Welcome, Terri!

The neonatal intensive care unit is a frightening place for most visitors. Infants from 23 weeks gestation and older can be found attached to as many tubes and wires making the technical and medical environment confusing and overwhelming.

In the midst of the confusion of an NICU is an awesome atmosphere of healing and growth. The sole purpose of such a place is to mature these tiny creatures into healthy infants who suck, swallow, and breathe without mechanical assistance. In short, is nothing but amazing.
Follow us here to learn about each gestational stage of such infants whether for your own information or for details for your next novel. Today, we’re starting with micro premies.
Gestation: 23 weeks.
Most medical professionals consider a fetus over 23 weeks to be viable, meaning they can be assisted to grow and mature into a full term infant outside of the womb. No one that I know would ever guarantee an infant this young will mature without many hurdles and without the risk of complications that go along with prematurity. But there are many success stories over the course of years of researching neonatal care and progress is outstanding.
The fetus born at 23 weeks gestation will have loose thin skin. Skin grows faster than fat develops and at this stage the fetus doesn’t show much fat development so they are all skin and bones.
After 23 weeks the fetus will begin packing on pounds and increasing in weight. The fetus at 23 weeks is approximately 8 inches long and just over one pound and growth is rapid for the next few weeks.
The essential problem with survival of a 23 week fetus outside of the womb is breathing. Lung development at this age is very immature and the lining of the lungs is stiff making the exchange of oxygen more difficult. One of the main goals of the NICU team at this stage is to promote adequate oxygenation with supplemental oxygen and a variety of mechanical adjuncts to assist with breathing.
Another classic characteristic of a 23 week gestational infant is the eye lids most often are still fused closed. The combination of loose thin skin, extra hairy limbs, and fused eyelids make for increased anxiety for new parents and an overwhelming fear of what comes next.

Have you ever written a NICU scene for your novel?

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Terri Forehand is a pediatric/neonatal critical nurse and freelance writer. She writes both fiction and nonfiction, is the author of The Cancer Prayer Book released in 2011. Her picture book titled The ABC’s of Cancer According to Lilly Isabella Lane is due out in 2012. She writes from her rural home in Indiana which she shares with her husband of almost 30 years and an array of rescue animals.  

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