Good advice for parents of late premature babies

All babies are different, but when a baby is born between weeks 35+0 and 36+6, we will often choose to put a feeding tube in the baby. We do this partly so that the baby can get the nutrition it needs, and partly to create peace and calm in order for breastfeeding to be established. The feeding tube gives the baby extra food without it having to use too much energy.

During the first hours of the baby's life, we continuously monitor the baby's blood sugar.

In the beginning, the baby should feed at least every 3 hours to keep the blood sugar up and to not lose too much weight. Since your breast milk has not yet started to flow, the baby will be supplemented by the mother's expressed milk or infant formula. This will be the case until the mother has enough milk for the baby to get their volume from the breast and/or until the baby has enough strength to feed on their own.

Both baby and mother need rest, so feeding, changing and expressing should take a maximum of 1 hour.

It is a good idea to stimulate the breast with hand milking and/or a machine every 3-4 hours – preferably from the 1st day. This helps to make the milk flow faster.

You can stimulate the let-down reflex before you put your baby to the breast – by doing breast gymnastics, manipulating the nipple, massaging the breast and expressing with your hand.

For most mothers, it takes 1-2 minutes from the time the baby starts sucking until the milk starts to flow. When you activate the let-down reflex first, your baby will get milk for as long as they can suck. This way, your baby gets more milk without using more force.

Over time, the baby will be able to take all its food at your breast. The road to full breastfeeding begins with your baby lying skin-to-skin on your bare chest, wearing only a nappy. Dad can also take part in this.

At first, the baby may only sniff or lick a little milk, but gradually it will start sucking and need less and less supplementation of food.

We will show you how you can help the baby at the breast.

When the baby is to be breastfed, it is a good idea to undress it and put it to the breast. Your baby may feed on both breasts if they have the energy for it.

You can change the baby after breastfeeding and before it is tube fed. In this way, the baby uses its energy at the breast and not on being changed.

When the baby has their first weight gain of more than 40 grams in 2 days, and you have good milk production, we start to reduce the amount of milk given via the tube by 25% for each weight gain. The last step is when only 10 ml is given in a cup. This can take place at home.

Your baby will be weighed every 2 days.

After a reduction in tube feed, the baby should spend the first 24 hours increasing its amount at the breast and feeling more hunger.

Some babies need 4 days at one stage, as they mature more slowly. Likewise, some babies can accelerate, so it is possible to be being weighed and assessed every day after 6 days.

Your baby will be ready for discharge when they gain weight and can take all of their requirements either at the breast or combined with cup feeds. If you choose to bottle feed, the baby must take their full volume.

You should expect to be hospitalized with your baby for up to 14 days.

A baby born in weeks 35+0 to 36+6 can often have a good weight and look 'finished', but for the baby, the time in the womb has been shortened, and thus the brain is still immature. Early birth means that the baby is more affected by bright light, sounds and sensory stimulation (e.g. touch), from which the baby would otherwise be protected whilst in the womb.

The premature baby's ability to process impressions is less developed than in a baby born at term. This means that the baby is more easily stressed by influences – it lacks the filter to sort out the essential from the unimportant. The signals the baby sends may also be more unclear than in babies born at term which can make it more difficult to interpret their needs.

Therefore, the principle for these babies is that they should have peace and quiet to grow. As parents, you can help your baby achieve this by following these instructions:

• Limit loud noises and bright lights.
• Limit the number of visitors and do not let your baby go from arm to arm with guests, as the baby will use a lot of energy on it. That said, it can be important that you as parents have someone close to you to share your experiences with.
• Create a good balance between sleep and the need for food so that the baby does not get stressed.
• Feel free to have the baby skin-to-skin or carry it in a wrap. We have a few wraps in the department for loan during the hospitalisation or you are free to use your own wrap.
• Help the baby stay warm by making sure they are adequately dressed. Feel free to ask the staff for advice. Remember a hat and socks and to wrap the baby in a duvet and possibly in a blanket.
• Ensure that the process of nappy changing is a calm experience. If necessary, wrap the baby in a muslin cloth so that they are not completely naked. You must not take too long to change your baby, as they can use too much energy on it.
• You may want to use the heat lamp we have in the changing room. The lamp can help your baby keep warm whilst you change them.

A premature baby also needs stimulation in the form of touch, eye contact and to be spoken to with a calm voice.

A small baby who becomes overstimulated and needs a break will typically lower their gaze, turn their head away or close their eyes, fall asleep or raise their arms, become restless or start to cry. Some parents find that their baby only becomes upset, restless and has difficulty sleeping after it has been overstimulated – i.e. a delayed reaction.

All babies cry, and it cannot be avoided. Common explanations can be hunger, fatigue, desire for contact, feeling unwell, needing a clean nappy, pain or overstimulation. The baby's personality also plays a role, so you have to try to find out what works for your baby. The closer the baby is born to term, the more robust they are both physically and mentally. The older the baby, the more stimulation they will be able to handle.

Your baby will be examined by a doctor at the department before discharge. After this, the baby must follow the regular child examinations with their own doctor.

The Danish Health Authority recommends the following vitamin supplements from 2 weeks until the baby turns 4 years old:

Vitamin D

10 micrograms (400 IU) daily. Give as drops.

Iron

For babies born before 37 weeks, iron supplements are started after 6 weeks and until the baby is 6 months old. This is done in collaboration with the health visitor.

Infant formula

If the baby is to continue with formula after discharge, each feed should be prepared immediately before use. This applies for every time the baby is given infant formula in order to prevent infections. The water can be boiled for one day at a time and stored in the refrigerator.

If you have any questions, please feel free to contact us.