A premature or pre-term baby, is a baby who was born before the 38th week of pregnancy. The risk for
most complications is, however greater for the baby born before the 34th week.
Common problems encountered by the pre-term infant are
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The baby's organ systems are often unready to make the rapid readjustments necessary for
independent life. The stresses of birth that a sturdy full-term handles with ease are not so well
tolerated by the tiny pre-term infant.
Breathing distress and the lack of essential oxygen.
Susceptibility for chilling or hypothermia.
Circulation problems.
Vulnerability for infections.
Feeding difficulties and extra nutritional needs.
Eye disease e.g. retinopathy of prematurity.
Blood disorders.
Most of these problems are attended to by the medical personnel while the baby is in the Neonatal unit.
As the baby stabilises, the focus is shifted to other issues surrounding the care and stimulation of the
little one. Parents become more able to be involved, the question of bonding (caregiver-baby interaction)
and their ability to enhance their baby's developmental potential becomes more of an issue.
Other members of the professional team, especially Occupational and Speech therapists become
more involved to assist parents in the skills they need for the special handling needs of their tiny infant.
The infant with a high risk for developmental problems must be screened for neurological problems,
which could be a barrier for normal function. During the last trimester of pregnancy, the brain growth is
exceptionally rapid and complex and if the baby is born too early, his brain should continue to grow as it
would in the womb. But in the world outside the womb, the infant's immature nervous system may be
exposed to a number of abnormal or harmful conditions, which could cause brain injury, e.g.:
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abnormal environment
insufficient nutrition
lack of oxygen
metabolic imbalances
kernicterus
infection
seizures
intra-cranial hemorrhage (bleeding in the brain)
hydrocephalus (too much fluid in the brain)
The above problems could have far reaching consequences for the baby's development, and should be
attended to while the baby's brain is still rapidly developing. This increases the chances for normal
function.
In early intervention, one of the most important considerations in developing competency is learning to
recognise the ways by which the infants communicate to caregivers about what effect a specific
intervention is having on them. There are models proposed, which help us understand the way which
newborn infants, especially premature infants, interact with the world outside the womb. The infant
interacts with his environment and gains
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physiologic stability
neurobehavioral organisation e.g., the motor abilities needed to interact, self-regulation, ability
to focus attention and respond to external stimuli etc.
Infants who are born before term often lack maturity and stability in part (or all) of the systems
involved and are thus unable to co-ordinate them to interact with the environment
appropriately.
When an infant who lacks stability and control is required to elicit a response to a stimulus or
the environment, signs of instability are likely to appear. Infants give clear signals of stress
when they are thus affected. When a parent/ care-giver persists in eliciting interaction from a
stressed infant, the infant's physiological stability may be affected, which may even threaten
the infant's wellbeing. Stress reactions can be prevented by monitoring the infant's signals.
Help in this regard is offered by an occupational therapist who is specialised in treating pre-
term infants, and this is the reason that the BTC is also currently involved with some neonatal
units in Pretoria.
A PREEMIE’S BILL OF RIGHTS
By Read McCarty
The Wee Make A Difference Foundation
I deserve ….. your recognition that I may be completing many months of my physical and
neurological development outside the protection of my mother’s womb. Even as you give me
the life sustaining care I so badly need, as much as possible I deserve to have the boundaries,
quiet, warmth, gentle stimulation, dim lighting and fetal positioning I would have in my mother’s
womb.
I deserve ….. to be understood and treated as the individual I am. I deserve to have my
language of cues and signals understood by you, my caregiver. My grimaces, hand stretches,
frowns and hiccups are as meaningful as any words, but delivered in the only language I know.
I deserve ….. periods of uninterrupted quiet so I can use my energy to grow and not hopelessly
trying to overcome excess light, noise and over stimulation.
I deserve ….. the warmth, tenderness and comfort of being held by my parents as soon as my
medical condition allows.
I deserve ….. the positive energy of love ….. your kind thoughts and words as you care for me
….. my father’s soft touch ….. my mother’s gentle words ….. a volunteer’s quiet rocking. I
deserve these things because in your heart you know their worth even though their absolute
clinical value will never be proven.
I deserve ….. your understanding that what is normal and routine for you, as my caregiver, is
abnormal and frightening for my mom and dad. So please answer kindly no matter how many
times they ask the same question. They deserve your support and the support of other families
as they go through the roller coaster experience of the NICU.
I deserve ….. your recognition that my parents are an integral part of my caregiving team and
should be allowed and encouraged to the best of their ability to help care for me during my stay
in your hospital.
I deserve ….. your understanding that part of your job is to help my family and me bond as we
learn to trust each other as they prepare to bring me home.
I deserve ….. continuity of care from the NICU to my home ….. from my neonatologist to my
primary caregiver ….. so together my family and I can reach our full potential.
You deserve my thanks and recognition
I am here because of YOU!