Caring for Preemies
By: Jill D. Chasse
There is a popular belief that preterm infants, those born before 37 weeks gestation, are positively affected by touch. It is important to both parents and practitioners to understand the context of this touch. When a baby is born significantly before his or her "due date" this newborn is subject to more poking and prodding than a full term baby would typically receive. Infants are subjected to a battery of tests and measures to ensure their safety and health. These babies are at a high risk for developmental delays, such as weak fine and gross motor skills, slow cognitive skills, late developing language skills, as well as attention and behavioral disorders. Physically, their bodies are just not ready for the world outside the womb and they may experience breathing difficulties and respiratory dysfunction, sight impairment, and jaundice, due to incomplete development of the liver. They are also at a risk for Necrotizing Enterocolitis (NEC), which is an infection of the stomach and intestines. NEC is most common in preterm and especially low weight babies. There is currently no cure. In order to prevent, catch, or diagnose a dysfunction or illness with preterm babies, close watch must be kept on all of the newborns' functions and fluids. Blood tests are preformed several times a week, and often several times a day. A prick in the heel to check bilirubin for jaundice seems as simple as a finger prick to test a diabetic's blood sugar, but when your heel is the size of a thumb with fresh new skin, and you have no idea why you're being held down on a cold table and stuck with a painful object, it's pretty traumatic. I can still see my preemie baby's confused look turn to horror every time they pricked her teeny heel. Often, a preemie will be subjected to even "scarier" and more painful procedures, such as IVs, catheters, feeding tubes, and phototherapy. Preterm infants have been studied to show adverse reactions to this negative touch, such as "hypoxia, bradycardia, sleep disruptions, or increased intracranial pressure."
Because of this connection between touch and pain expressed to preterm infants, it is imperative that parents and practitioners counteract the negative connotation with positive examples of touch, so a baby can learn and grow from these interactions. Gentle and loving touch will not only teach a baby that touch can be a positive thing, it will physically assist in physical and psychological growth. A study performed at the University of Alabama at Birmingham evaluated the effects of gentle touch on 42 preterm infants. "Nurses placed one hand on the back of each infant's head and one on each infant's lower back for 10 minutes, twice per day for 10 days. During these periods, infants showed significantly fewer stress behaviors (eg, clenching fists, facial grimaces)" (AORN, 2001).
In Bergen Community Hospital in NJ where my friend's son was born 3 months early, they promoted Kangaroo Care for tiny 1 ½ pound Tyler. Every day, although he was attached to three monitors and several tubes all over his little body, his mommy was encouraged to put him against her body and allow him to feel her skin. Kangaroo Care is a method of holding a preterm infant directly to his or her parents' skin. First initiated by two South American neonatologists, Edgar Rey and Hector Martinez, Kangaroo Care has been used throughout the world to increase bonding and emotional closeness, as well as regulating baby's heartbeat, body temperature, and initiation of lactation.
Positive touch such as Kangaroo Care, breastfeeding, and rubbing a baby's back is beneficial to both baby and parents, leading to stronger emotional, psychological and physical well-being.
AORN (2001)Touch Reduces Stress Behaviors in Premature Infants. Association of Operating Room Nurses, Inc. [Online]. [2004, January 19].
Harrison, L, RN, PhD, FAAN (2001). The Use of Comforting Touch and Massage to Reduce Stress in Preterm Infants. Neonatal Intensive Care Unit Newborn and Infant Nursing Reviews, Vol 1, No. 4. 235-241.
Robles, M., R.N., B.N. (2004). Kangaroo Care. Department of Obstetrics, Gynecology and Reproductive Sciences [Online]. [2004, January 19].