The key differences between the stabilization processes for premature babies and full-term babies
Most newborns require some form of medical support to transition to the outside world without any complications. It’s even more pertinent for premature babies, who are separated from the womb without fully developing the organs needed to survive on their own.
Around the world, it is estimated that 13 to 26 million newborns per year need respiratory support right after birth, and about 2 to 3 million require intensive care. Their lungs are too weak to breathe on their own, their heart and arteries too fragile to maintain an adequate blood supply, and their immune system too weak to guard against the slightest infection.
Nearly all hospitals can provide care for newborn babies, but not all can cater to premature babies.
The survival of premature babies depends on a markedly different set of stabilization procedures compared to full-term babies. In this guide, we’ll look at the essential components of the stabilization procedures for premature babies.
We’ll begin by establishing what a premature birth means, and then highlight the general differences between the stabilization procedures for full-term and premature babies, before finally delving into the nitty-gritty of the procedures for a premature newborn.
Full-term babies vs premature babies: where to draw the line?
The main factor that distinguishes a full-term birth from a premature birth is what’s known as the gestational age. This refers to the time needed for a neonate to develop to a considerable capacity. This is usually at 37 weeks into the pregnancy.
Generally, any baby born before this period is considered a preterm baby. However, preterm births can be further classified into multiple categories. According to the World Health Organization (WHO), the different classes of premature birth include:
- Extremely preterm: 28 weeks or less.
- Very preterm: Between 28 and 32 weeks.
- Moderate to late preterm: Between 32 and 37 weeks.
Premature birth happens when labor sets in prematurely or the baby needs to be surgically separated from the womb to protect both the baby and the mother from health problems due to pregnancy complications.
Some premature babies do not need any special intervention, though some extra care might be required. For instance, a baby born at 37 weeks might need special attention, but only during the first 24 hours.
However, depending on the health condition, premature babies often need a host of stabilization processes that could span anywhere from days to weeks and even months.
While a full-term baby could be stabilized with simple processes such as drying, providing warmth, clearing airways and stimulating it, preterm babies could require a number of different medical procedures to help stabilize them, including:
- Ventilation support and/or oxygen.
- Delayed bathing until their temperature is stable.
- Temperature regulation.
- Monitoring symptoms of infection or sepsis.
- Monitoring symptoms of hypoglycemia.
- Frequent, ongoing feeding.
- Assistance from a dedicated lactation consultant.
Why does a preterm baby require more intensive care?
Preterm babies are thrust out into the outside world when they’re not yet ready to survive on their own. The first few minutes or hours after birth are often decisive when the infant needs to transition from fetal to neonatal life. Medical intervention is required to ensure a successful transition, as any setback could have a serious, lifelong physiological and psychological impact on the baby.
Some of the most critical issues that medical teams often need to deal with in premature babies include:
- Lung aeration: Clearing out lung fluids and promoting gaseous exchange in the body with oxygenation and ventilation.
- Inadequate cardiovascular output: Poorly powering their circulatory system.
- Immature hormonal and organ systems: Incapable of controlling various bodily functions, from thermoregulation to neuro protection and glycemic processes.
- The stress of physiologic adaptation: Physical and psychological trauma.
- Cold stress: Owing to poorly keratinized premature skin and radiant heat and water losses.
The different levels of premature birth stabilization processes
Standard stabilization processes for preterm babies differ based on the classes of premature birth. Not all family nurses and hospitals can cater to all stages of preterm birth, and some focus on specific stages.
A well-baby nursery caters to babies from moderate to late preterm birth (born close to their due dates). A well-baby nursery can also stabilize ‘very preterm’ babies or babies born with medical conditions that require intensive care.
Special care nursery
Designed for moderate to very preterm babies, special care nurseries often provide respiratory assistance and other similar interventions. They can also cater to full-term newborns who need to be closely monitored and placed on drugs.
Level 3 neonatal intensive care unit (NICU)
According to some sources, level 3 is the highest level of NICU. While this care unit can cater to premature babies of any class, they differ in style and substance across different hospitals. Some key components of level 3 care include respiratory support and intravenous feeding for babies that can’t take milk on their own.
Level 4 NICU
Some hospitals go as far as creating a deeper level of NICU for extremely premature babies, generally known as ‘micro-preemies’ (often as young as 22 to 26 weeks old). This unit provides highly advanced forms of medical support, such as extracorporeal mechanical oxygenation (ECMO), as well as a wide range of neonatal surgeries.
Key components of the stabilization process for premature babies
While almost all nurses are trained to assist in deliveries, not all are equipped to handle preterm births. If you’re interested in this specialization, a program such as the Neonatal Nurse Practitioner program from Baylor University is a great place to start.
As a neonatal nurse, some of the neonatal care components you’ll be working with every day include:
- Delivery room considerations: This entails the ‘Golden Hour’ strategies for stabilizing babies during the first few moments after birth.
- Positioning support: Looking out for health challenges when a baby is transferred to a different care unit, from postpartum depression to post-traumatic stress disorder.
- Ventilation and oxygenation: Measures for preventing respiratory distress when the baby transitions from breathing through the placenta to using their lungs.
- Glucose homeostasis and early vascular access: Preventing issues resulting from premature organ formation, such as hypoglycemia resulting from poor metabolism.
- ● Thermoregulation: Maintaining a balanced temperature. According to NPR, the recommended body temperature for neonates is between 36.5°C and 37.5°C.
- Managing infection risks: Protecting neonates against infections before, during and after delivery.
- Developmental support systems: Creating a conducive, non-invasive environment for monitoring and regulating the stress-free development of the newborn.
Premature babies face a significantly greater health risk compared to full-term babies, and this requires a different approach to risk management. While full-term babies can be stabilized by simple processes such as warming and breastfeeding, premature babies require specialized stabilization procedures, including ventilation/oxygenation, thermoregulation and the intravenous administration of antibiotics.