Preemies don't exactly look like the babies you've pictured in your mind throughout the pregnancy as a new dad, especially if they weigh less than 5 pounds. If your baby is born before 35 weeks, this is what he may look like:
Big-eyed: The lack of fat in his face gives your preemie a wide-eyed look.
Boys may have underdeveloped genitalia: Don't worry, dad — they'll grow.
Hairy — except on his head: Preemies often are still covered with lanugo, a fine, downy hair that helps keep them warm before they develop enough subcutaneous (under-the-skin) fat. Babies born before 26 weeks, on the other hand, may have no hair anywhere and may have very red, gelatinous skin.
Skinny: Babies born before 35 weeks often don't have a good layer of fat.
Thin-skinned: The blood vessels are more visible in a preemie's skin.
As a new dad, you may not have that same rush of parental feelings that blind your partner to your baby's obvious — to you — shortcomings, such as no hair, a lopsided head, and limbs that seem to fly off in all different directions.
Common problems with premature babies
Premature babies often have respiratory problems because their lungs aren't well developed. Artificial ventilation may be started almost immediately and is gradually decreased as the baby tolerates the reduction in extra oxygen. Some babies need special types of ventilation to overcome resistance in their lungs.
Most premature babies have feeding problems. Tiny babies, under 28 weeks, may not be fed by mouth for weeks or months because their digestive systems are too immature to handle food. Intravenous feeding is given instead, and as the baby grows, tube feeding is started. Nippling is begun very slowly because it can tire a preemie and use up her energy stores.
Basics of all the wires connected to premature babies
Sometimes knowing what's what when it comes to the wires and machines attached to your baby can calm your anxiety. Your average preemie may sport the following wires and attachments.
Breathing apparatus
If the baby can't breathe on his own, he may be attached to a ventilator via a tube that goes through his mouth or nose down to his lungs, which delivers a certain number of breaths per minute, or to nasal prongs, which deliver extra oxygen to his lungs via — naturally — prongs that fit into his nose. Try very hard not to do anything that may dislodge the breathing tubes.
Monitoring equipment
Because preemies have an unfortunate habit of forgetting to breathe, often even babies who don't need breathing equipment are hooked up to a monitor that flashes a series of incomprehensible numbers, some with little flashing hearts next to them.
The monitor is attached to the baby by wires that lead from the baby's chest, and possibly also from his hand or foot, or even from his umbilical cord if a line was placed there right after birth.
The machines monitor pulse (that's the flashing heart), respiration (the number of times the baby breathes each minute), and oxygenation levels. Preemie heart rates are from 110 to 160 beats per minute, on average. Respirations are 40 to 60 per minute. Oxygenation in the 90s is good. Blood pressure may also be continuously monitored in very sick babies.
The baby's temperature may also be monitored frequently, if not continuously. Because preemies have little in the way of fat stores, they get cold easily, and stress and the extra work of being sick and trying to grow can use up energy that may otherwise help keep them warm.
The incubator or bed the baby's lying on also has its own thermometer to make sure it doesn't get too hot or too cold.
Intravenous lines
Most NICU babies receive intravenous medications and nourishment, at least at first. IV lines can be very precarious in preemies and need to be replaced frequently. The medications are sometimes hard on the veins, which "blow," necessitating a new IV.
The NICU nurses don't do it on purpose, believe us; spending time putting a new IV in a preemie is rarely on the "fun things to do in the NICU" list.
If your baby has an umbilical line, he may not have a peripheral line (a line in the extremities or head), but umbilical lines can't be used for very long because they're a potential source of infection.
Basics of preemie setbacks
Some common NICU complications include the following:
Intraventricular hemorrhage (IVH): IVH is a bleed into the brain that can range from mild (graded I) to very serious (graded IV). Around a third of babies born between 24 and 26 weeks have a bleed, but any baby born before 34 weeks can have an IVH. Bleeds may occur at the time of delivery or afterward.
Necrotizing enterocolitis: Called NEC by the NICU staff, this inflammation of the immature digestive system usually occurs after feedings are started. NEC can seriously damage the intestines. Feedings are temporarily stopped so the gut can heal, and IV feedings are given instead.
Respiratory disease: Long-term ventilation can save your baby's life but can also contribute to bronchopulmonary dysplasia, damage to the lungs that can take months or years to fully heal. This problem is more common in tiny babies known as micropreemies. Some babies with respiratory disease are discharged to home while still receiving oxygen, which is decreased gradually as they develop the ability to breathe better on their own.
Respiratory infection: The tubes can allow entry of germs into the lungs. Pneumonia may develop, and the baby may need antibiotic treatment.