Special Babies

Premature Infants

An infant born before thirty-seven weeks and weighing less than five and one-half pounds is considered premature. Her appearance and physical abilities depend to some extent on just how early she was born. A premature infant looks different from a full-term infant–she is small, limp and frail; her skin is reddish and appears tissue-paper thin; and she has little or no fat or muscle. Her head appears disproportionately large. Vernix and lanugo are abundant, fingernails and toenails have not grown out, and her tiny ears are soft and hug her head. Her cry is more feeble, and she is more difficult to soothe than a full-term infant.

A premature infant is physically vulnerable until she grows older. She sucks weakly, and her swallow and gag reflexes are unreliable. Tube feeding is sometimes necessary. Because her body temperature is unstable, often below normal, she is usually kept in a temperature-controlled isolette. Breathing may be more difficult–her respirations are irregular, rapid, and often shallow because her lungs are immature. She may need oxygen and help with breathing. Her ability to absorb food is less efficient than that of a full-term infant, although her need for nutrients, especially calories, protein, iron, calcium, zinc, and vitamin E, may be greater.

Giving birth to a premature infant may be upsetting and frightening. Your premature baby needs special medical attention that may separate her from you, but she also needs to be touched, stroked, and talked to, even while inside the isolette. Today, most modern hospitals encourage you to visit and care for your premature infant. If she cannot suckle at your breast, you can express milk, which can be fed to her through a tube from her mouth to her stomach or from a bottle with a soft “premie” nipple. Your milk is different from the milk of a mother of a full-term baby, and is better suited to the nutritional needs of your premature infant. By feeding and touching her, you help your baby through this difficult time.

Parents often feel guilty or responsible for the premature birth of their baby, even though in over 50 percent of premature births no specific cause of prematurity can be found. In the majority of the remaining cases, where the cause is known, the parents could have done nothing to prevent an early birth.

Parent support groups provide information, assistance, and emotional support to the parents of a premature infant. In addition to listening with understanding and giving practical suggestions, members of a support group may even supply you with clothing or patterns for clothing small enough for your baby. If you would like more information about premature babies, check with your local childbirth education group, caregiver, or hospital.

Small for Gestational Age Infants

In the past, some full-term babies who weighed less than five and one-half pounds were wrongly called premature. Babies who are small in size and weight for the length of pregnancy are more appropriately called small for gestational age–SGA. This condition may have any of several possible causes: an inadequate transfer of nutrients across the placenta to the baby; the effects of some drugs taken during pregnancy such as alcohol or cocaine; some congenital and genetic malformations; and certain infections of the fetus, such as rubella and toxoplasmosis.

The SGA baby presents some special challenges to the parents. These babies, like other high-need infants, do not move easily from state to state (for example from active to quiet alert or from drowsy to deep sleep). They are often fussy and more difficult to soothe than other infants. Parents of SGA babies have to spend a great deal of time calming and quieting their babies. Techniques that seem to work include frequent feeding, gentle rocking, talking quietly, and maintaining a calm environment. These parents soon learn that their babies can handle only one source of stimulation at a time. Too much stimulation, such as talking to the baby while feeding, making eye contact, or jiggling her while talking overwhelms this intense baby and causes her to cry or become agitated.

Over time, the SGA baby matures and becomes less intense and fussy. Your sensitivity to her special needs helps her while she matures.

Postmature Infants

A baby is considered postmature if she born well after the anticipated due date and exhibits the following characteristics: the absence of lanugo; little vernix; long fingernails and toenails; loose skin; pale, dry, peeling or cracked skin; and unusual alertness. In postmaturity, the amniotic fluid may be scant or stained with meconium. True postmaturity is rare even in babies born two or more weeks after their due date, but if your pregnancy lasts beyond forty-one or forty-two weeks, your caregiver will test for fetal well-being. If the test results indicate that your baby is not thriving, your caregiver may want to deliver the baby before spontaneous labor begins. Most postmature babies are treated the same as any full-term infant. If the postmaturity has caused special problems, they will be treated as needed.