Prematurity

Terri Forehand is back to discuss a common malady for premature infants. Good information for an author writing about this age group.

Welcome back, Terri!

Apnea is one of the most frightening symptoms for parents of premature infants. Apnea is a pause in breathing for 15-20 seconds. It is associated with the infant’s color changing to a pale or bluish tint and with the heart rate slowing for a period of time. It can be alarming for those witnessing an episode of apnea for the first time and requires reassurance and education from the staff for those frightened parents.

The major reason premature infants experience apnea is their immature respiratory center of the brain. Preemies have bursts of big breaths followed by periods of short or shallow breaths or breathing pauses. It is most common in sleeping infants which is also reason for concern for new parents.

Bradycardia or the slowing of the infant’s heart rate is also a common symptom of prematurity and often goes along with the episode of apnea. Other causes for the premature infant to drop their heart rate include during or after a feeding and during a bowel movement.

Treatment for apnea may include medications such as caffeine or aminophylline to stimulate breathing and CPAP (continuous positive airway pressure) or oxygen by nasal cannula. Nasal cannula is the preferred way to administer this treatment and is done with little tubes into the baby’s nose. Mechanical ventilation may be used for very premature infants until they can manage breathing on their own with the assistance of CPAP only.

Most infants grow out of these symptoms close to their original due date as their brain centers mature. If premature infants still are having apnea spells but otherwise could go home, they can go home on an apnea monitor. Parents are trained to apply the monitor and to know how to use it as well as what to look for in their baby if the alarms go off.

Once the premature infant matures and the apnea resolves, it will not come back. Education and reassurance will help new parents of the premature infant to feel confident in caring for their infant during the last few days before discharge and when finally at home with their new baby.

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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.

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.