Archive for the ‘Prematurity’ Category

What is a respiratory therapist?

Monday, October 30th, 2017

If your baby is in the NICU, you know that there are a lot of people caring for her and helping her to get stronger each day. One of those NICU team members may be a respiratory therapist. A respiratory therapist (or RT) cares for babies with breathing problems.

When your baby first arrives in the NICU, a respiratory therapist evaluates her breathing. The RT looks to see if your baby is breathing too fast, if the breaths are shallow, or if she’s struggling to breathe. Then, together with the rest of the NICU team, the RT develops a treatment plan to help care for your baby.

Here are some common conditions that a respiratory therapist may see in the NICU:

Breathing problems: Premature babies often have breathing problems because their lungs are not fully developed. Full-term babies also can develop breathing problems due to complications of labor and delivery, birth defects and infections.

Apnea: Premature babies sometimes do not breathe regularly. A baby may take a long breath, then a short one, then pause for 5 to 10 seconds before starting to breathe normally. This is called periodic breathing. Apnea is when a baby stops breathing for more than 15 seconds. Apnea may be accompanied by a slow heart rate called bradycardia. Babies in the NICU are constantly monitored for apnea and bradycardia (often called “A’s and B’s”).

Respiratory distress syndrome (RDS): Babies born before 34 weeks of pregnancy often develop RDS. Babies with RDS do not have enough surfactant, which keeps the small air sacs in the lungs from collapsing.

Pneumonia: This lung infection is common in premature and other sick newborns. A baby’s doctors may suspect pneumonia if the baby has difficulty breathing, if her rate of breathing changes, or if the baby has an increased number of apnea episodes.

Many babies who need treatment for breathing problems benefit from respiratory therapy. In fact, neonatal respiratory therapy has become its own medical sub-specialty. A neonatal-pediatric RT is trained to use complex medical equipment to care for the smallest babies with mild to severe breathing challenges. They visit their patients daily or as often as needed and are an important part of your baby’s NICU team.

Have questions? Text or email AskUs@marchofdimes.org.

October is RSV Awareness Month

Monday, October 2nd, 2017

Respiratory syncytial virus (RSV) is a common virus that infects the lungs and breathing passages. Almost all babies get it before the age of 2. Your baby can get RSV at any time of year, but it’s most common from November to April.

Symptoms of RSV

For most healthy children, the symptoms of RSV are similar to those of a cold and can last about two weeks. They can include:

  • Cough
  • Fever
  • Irritability
  • Runny nose
  • Sneezing
  • Sluggish or being inactive
  • Trouble breathing
  • Wheezing

Some babies have a high risk of getting severe RSV. This includes babies who were born premature, have lung problems, heart problems or other chronic illnesses. Severe RSV may lead to other serious infections, like:

  • Bronchiolitis, an infection that causes swelling in the smallest air passages in the lungs
  • Pneumonia, an infection in one or both lungs

RSV is the most common cause of bronchiolitis and pneumonia in children younger than 1 year of age.

If you notice any of these symptoms, call your baby’s health care provider right away:

  • Cough that gets worse or she coughs up yellow, green or gray mucus
  • High fever. High fever is a temperature greater than 100.4 F in babies younger than 2 months, 101 F in babies aged 3 to 6 months or 103 F in babies older than 6 months.
  • Looks dehydrated
  • Loss of appetite
  • Thick nasal discharge
  • Trouble breathing or mouth and fingernails look blue

Prevent the spread of RSV

You can help protect your baby from RSV by:

  • Keeping her away from people who are sneezing or coughing
  • Making sure everyone who touches the baby has clean hands
  • Keeping your baby away from crowds of people
  • Not allowing anyone to smoke near your baby

Treatment for RSV

There is no specific treatment for RSV. If your baby has RSV, you can help to relieve the symptoms by making sure she drinks lots of fluids, using a rubber suction bulb to help clear mucus from her nose, and using a cool-mist humidifier. If your baby has a fever, talk to her health provider about using acetaminophen.

Babies who are at high risk from severe RSV may benefit from medication that helps prevent RSV from becoming severe. This medication is called palivizumab. It is given in monthly injections during the fall and winter months. However, this medication does not prevent infection with RSV and it does not help cure or treat children who already have severe RSV. If your baby is a high risk for severe RSV, talk to her provider about whether palivizumab may be an option.

Have any questions? Email or text us at AskUs@marchofdimes.org.

March of Dimes-funded researchers have identified genes involved in preterm birth

Friday, September 8th, 2017

Premature birth is a complex problem with no single solution. Each year, about 15 million babies worldwide are born prematurely, and more than one million of them will die. Over 50 percent of the time, the cause of premature birth is not known. However, scientists have always believed that genetic factors play a role. A new study led by the March of Dimes Prematurity Research Center-Ohio Collaborative, is the first to provide strong information as to what some of those genetic factors are. The team identified six genes that influence the length of pregnancy and the timing of birth. The findings were published Sept. 6 in the New England Journal of Medicine.

This international team of researchers looked at the DNA of 50,000 pregnant women from around the world. The identification of these six gene regions allowed scientists to learn that:

  • The cells within the lining of the uterus play a larger-than-suspected role in the length of pregnancy.
  • Low levels of selenium—a common dietary mineral found in some nuts, certain green vegetables, liver and other meats—might affect the risk of preterm birth. Future studies will look at selenium levels in pregnant women who live in areas with low selenium in their diet or soil.

The six genes that have been identified can now be studied in more detail. The population of women in this study was mostly from Europe. Researchers are already trying to determine if these gene associations are the same for women from Africa and Asia.

Louis Muglia, MD, PhD, co-director of the Perinatal Institute at Cincinnati Children’s and principal investigator of the March of Dimes Prematurity Research Center–Ohio Collaborative stated, “This is just the beginning of the journey, but we think it leads to an exciting horizon where we can really make a difference in human pregnancy.”

The March of Dimes believes that these new findings will lead to new diagnostic tests, medications, improved dietary supplements or other changes that could help more women have full-term pregnancies and give more babies a healthy start in life.

Retinopathy of prematurity

Friday, August 25th, 2017

If you have a premature baby, you may have heard of retinopathy of prematurity or ROP. ROP is an abnormal growth of blood vessels in the eye.

During the last 12 weeks of pregnancy, the eye develops quickly. When a baby is born full-term, the growth of the blood vessels that supply the retina is almost complete. The retina then typically finishes growing the first few weeks after birth.

However, if a baby is born too early, the blood vessels may stop growing or not grow correctly. These vessels can then leak and cause bleeding in the eye. Scar tissue forms, and if the scars shrink, they may pull the retina loose from the back of the eye. This is called retinal detachment. Retinal detachment is the main cause of vision problems and blindness in ROP.

Risk factors for ROP

Some babies are more likely to develop ROP. Risk factors include:

  • Premature birth. Although all premature babies are at risk for ROP, it occurs most often in babies born before 30 weeks of pregnancy.
  • Apnea. This is when a baby’s breathing stops for 15 to 20 seconds or more.
  • Anemia. This is when the body doesn’t have enough healthy red blood cells to carry oxygen to the rest of the body.
  • Heart disease
  • Infection
  • Trouble breathing or respiratory distress
  • Slow heart rate (also called bradycardia)
  • Problems with the blood, including having blood transfusions.

How is ROP diagnosed?

Your baby will get a special eye exam for ROP if she:

  • Was born before 30 weeks
  • Weighed less than 3 pounds at birth
  • Has any other risk factors for ROP

A pediatric ophthalmologist will examine your baby’s eyes. Babies born at 27 weeks or later usually have their first eye exam when they’re 4 weeks old. Babies born before 27 weeks usually have the exam later, because the more premature a baby is at birth, the longer it takes to develop serious ROP. Because ROP can develop later, it’s very important to take your baby to all of her eye exams, even after she is home from the NICU.

If your baby’s first eye exam shows that the blood vessels in both retinas have finished normal development, she doesn’t need a follow-up exam. If your baby’s eye exam shows that she has ROP and needs treatment, she should start treatment within 72 hours. Early treatment gives your baby the best chance of having healthy vision.

Treatment

Most mild cases of ROP heal without treatment and with little or no vision loss. In more severe cases, the ophthalmologist may perform laser therapy or do a procedure called cryotherapy (freezing) to eliminate abnormal blood vessels and scars. Both treatments help protect the retina.

If your baby has ROP, visit our online community at Share Your Story to connect with other parents for support and comfort throughout your baby’s treatment.

Have questions? Email us at AskUs@marchofdimes.org.

Getting ready for discharge from the NICU

Monday, July 31st, 2017

In general, your premature baby will be ready to go home around her due date. But your baby will have to reach certain milestones first. Her vital signsPreemie going home–temperature, breathing, heart rate, and blood pressure–must be consistently normal. This means that your baby:

  • Keeps herself warm
  • Sleeps in a crib, not an incubator
  • Weighs about 4 pounds or more
  • Has learned to breast- or bottle-feed
  • Breathes on her own

What can you do to get ready?

Make sure you talk to your baby’s health care provider and the NICU staff about caring for your baby at home. Here are some things to think about:

  • Do you have everything you need at home to take care of your baby? Do you have medicine and equipment your baby needs? Do you know how to give your baby medicine and use the equipment?
  • Are there any videos, classes, booklets or apps that may help you learn how to take care of your baby at home? Ask about taking a CPR class prior to bringing your baby home—knowing what to do in an emergency may make you feel more comfortable.
  • What do you want discharge day to be like? Do you want family or friends to be there when you and your baby get home? Or do you want it to be just you and your partner with your baby?

Many hospitals let parents “room in” with their baby for a night or two before going home. This can be a good way to practice taking care of your baby on your own while the NICU staff is still right there to help.

Car seat

You will be required to have a car seat before you leave the hospital. Preterm and low-birthweight infants have a higher chance of slowed breathing or heart rate while in a car seat. So your baby may need a “car seat test” before being discharged. The NICU staff will monitor your baby’s heart rate and breathing while she is in her car seat for 90 to 120 minutes. They may watch your baby even longer if your travel home is more than 2 hours.

Follow-up care

Make sure you have chosen a health care provider for your baby. You can choose a:

  • Pediatrician. This is a doctor who has special training to take care of babies and children.
  • Family practice doctor. This is a doctor who provides care for every member of a family.
  • Nurse practitioner. This is a registered nurse with advanced medical education and training.

If your baby has special medical needs, you may also need a provider who specializes in that condition. The NICU staff, hospital social worker or your baby’s general care provider can help you find someone.

Have questions? Send them AskUs@marchofdimes.org.

Medication before and during pregnancy

Monday, July 24th, 2017

Did you know that 7 out of 10 pregnant women take at least one prescription medication? According to the Centers for Disease Control and Prevention (CDC), the use of prescription medicine during the first trimester of pregnancy has increased more than 60% over the last 30 years. In the video below, Dr. Siobhan Dolan explains how taking some prescription medicines before or during pregnancy can hurt your baby. Learn how to make sure any medicines you take are safe for both you and your baby.

 

 

 

Have questions? Send them to our Health Education Specialists at AskUs@marchofdimes.org.

More babies being born too soon

Friday, June 30th, 2017

pregnant woman blood pressureFor the second year in a row, the preterm birth rate in the United States has gone up. Preterm birth is when a baby is born before 37 weeks of pregnancy. According to a preliminary report from the National Center for Health Statistics (NCHS), the preterm birth rate rose to 9.84% in 2016, up 2% from 9.63% in 2015.

 After seven years of a steady decline in the preterm birth rate, this increase is alarming.

Reduce your risk

We don’t know why this is happening. But we do know that there are some things a woman can do to help reduce her chance of giving birth too soon. Here are some of them:

  • See your prenatal care provider as soon as you think you’re pregnant. And go to all of your prenatal care appointments. Go even if you’re feeling fine. Prenatal care helps your provider make sure you and your baby are healthy.
  • Don’t smoke, drink alcohol, use street drugs or abuse prescription drugs. Ask your provider about programs in your area that can help you quit.
  • Talk to your provider about your weight. Ask how much weight you should gain during pregnancy. Try to get to a healthy weight before your next pregnancy.
  • Get treated for chronic health conditions, like high blood pressure, diabetes and thyroid problems.
  • Protect yourself from infections. Wash your hands with soap and water after using the bathroom, caring for small children, or blowing your nose. Don’t eat raw meat or fish. Have safe sex. Don’t touch cat poop.
  • Reduce your stress. Exercise and eat healthy foods. Ask for help from family and friends. Get help if your partner abuses you. Talk to your boss about how to lower your stress at work.
  • Wait at least 18 months between giving birth and getting pregnant again. See your provider for a preconception checkup before your next pregnancy.

 

Know the signs

If you have any of these signs or symptoms before 37 weeks of pregnancy, you may be having preterm labor. Call your health care provider right away if you have even one of these signs or symptoms:

  • Change in your vaginal discharge (watery, mucus or bloody) or more vaginal discharge than usual
  • Pressure in your pelvis or lower belly, like your baby is pushing down
  • Constant low, dull backache
  • Belly cramps with or without diarrhea
  • Regular or frequent contractions that make your belly tighten like a fist. The contractions may or may not be painful.
  • Your water breaks

If you think you’re having preterm labor, call your provider. Call even if you have just one sign or symptom. There are several treatments that may help slow or stop preterm labor. And there are treatments, like antenatal corticosteroids (also called ACS), that can help reduce your baby’s chances for having health problems (like lung problems) in case he’s born early.

Have questions? Send them to AskUs@marchofdimes.org.

Preeclampsia: Impact on mom and baby

Wednesday, June 21st, 2017

May was Preeclampsia Awareness Month. We blogged about the signs, symptoms and causes of preeclampsia and how it may lead to premature birth. We also hosted a Twitter chat with Dr. Kjersti Aagaard of Texas Children’s Pavilion for Women, which generated some follow-up questions.

We’re happy to welcome back Dr. Aagaard and her colleague Dr. Martha Rac as guest bloggers. Both doctors are maternal-fetal medicine specialists at Texas Children’s. They will share some insight into who is most at risk of developing preeclampsia and how it can impact both mom and baby.

First, we must ask, who is at the highest risk for developing preeclampsia?

 Risk factors for preeclampsia include:

  • First time mothers
  • Pregnancy with a new partner than previous pregnancies – different partners may have varying genetic factors that may increase preeclampsia risk
  • Older mothers (>35 years old)
  • Black women
  • Medical problems including chronic high blood pressure, kidney disease, lupus, diabetes and heart disease
  • Pregnancies with multiples (twins, triplets, etc.)
  • Obesity
  • Preeclampsia in prior pregnancies
  • IVF pregnancies – particularly those with donor eggs. This is thought to occur as a result of genetic differences between the mother and fetus, causing the mother’s immune system to attack the “foreign” fetal tissue and cause excess inflammation.

In addition to the risk factors above, mothers with pregnancies spaced too closely together or very far apart can be at risk. Too close may be defined as 18 months or less and far apart as 4-5 years between pregnancies.

How does preeclampsia affect pregnancy?

Preeclampsia is classified as either mild or severe based on a woman’s symptoms, and how severely it affects her organs. It is a progressive disorder, which means that mild cases will eventually develop into severe preeclampsia, if not treated.

Preeclampsia can be very dangerous to both the mother and the baby. The very high blood pressure associated with preeclampsia can result in anything from seizures, stroke, liver and kidney dysfunction, bleeding problems, placental detachment and even death if left untreated.

If a mother-to-be suspects she may be experiencing preeclampsia, she should contact her doctor immediately.

How does preeclampsia impact the baby?

 This dangerous disorder can cause the baby’s growth to be restricted and increases the risk of stillbirth. In the most severe cases, preterm delivery may be required which may then expose the baby to the complications of prematurity such as under-developed organs, breathing difficulties, jaundice, anemia, a lowered immune system, etc.

In the worst cases, fetal death can occur from a sudden detachment of the placenta from the uterus.

For these reasons, women diagnosed with preeclampsia undergo additional monitoring such as: ultrasounds every 4 weeks to evaluate fetal growth, lab work to determine if there is multi-organ involvement, etc. and delivery no later than 37 weeks.

If you are worried you are at risk of developing this dangerous disorder, please be sure to consult with your doctor and discuss your concerns immediately.

Dr. Kjersti AagaardDr. Martha Rac

 

 

 

 

 

 

Many thanks to Dr. Aagaard  (left) and Dr. Rac  (right) for contributing their expertise. 

 

 

NICU dad x 2 – the story of Jack and Josie

Friday, June 16th, 2017

Kyle Daddio and son JackIf there is one father who can talk about being a NICU dad, it is Kyle Daddio.Kyle Daddio and daughter Josephine

His son, Jack, was born at 26 weeks, more than 3 months prematurely. His daughter Josephine “Josie” came along three years later, born at 26 weeks as well. Both babies weighed one and a half pounds at birth.

Jack spent 121 days in the NICU, while Josie clocked in at 91 days.

Fortunately, Jack is doing well now, and Josie has recently gone home from the NICU to join the family.

In honor of Father’s Day, we asked Kyle to share his feelings about being a NICU dad, and to offer tips to new dads going through a similar experience.

What was the hardest moment you experienced in the NICU? 

February 13th, 2014, when our son Jack was 7 weeks old. It was the worst day of my life. It was a Thursday and, like I had been doing every day, came into the NICU early in the morning before work to read the newspaper with Jack while he was in his isolette. On Monday evening of that week Jack’s nurse had noticed that his belly started to become distended and was concerned. They began pumping him with antibiotics, running tests and getting x-rays.

The result was that he had Necrotizing Enterocolitis, NEC, which is an infection in the bowels. By Thursday morning his condition had not improved and the NICU staff was doing everything they could not to have to perform surgery. On that Thursday morning while I was reading the paper with Jack, he flat-lined. I was rushed out of the room while all the nurses and doctors ran in. His stomach was so distended that his lungs did not have enough room to fully expand, and it eventually became too difficult for him to breathe even on a ventilator. I was let back in the room about 30 minutes later to see Jack on an oscillator. I called my wife Katie to come down to the hospital and the doctors notified us that surgery was now more possible.

When he flat-lined again at 2pm, surgery was now necessary and the surgeon came in to speak with us. He notified us that given Jack’s small size (2/1/2 lbs) they were unable to know exactly how severe the infection was, and that this type of surgery at his size, given his current condition, had a success rate of less than 50%. A nurse then approached Katie and I with some holy water and said “I read on your form that you’re Catholic. You should baptize your son now.” We baptized him, and then followed the nurses and doctors as they wheeled Jack into the operating wing.

In the hall approaching the OR, Jack flat-lined for a third time. They resuscitated him and brought him into the OR for surgery. At that point we had no idea what was going to happen. We went back down to the NICU family room and sat silently waiting for a report from the OR. Many of the NICU nurses came and sat with us during that time, which was an incredible gesture. After nearly 2 hours, a call came down from the OR that the surgery was successful and Jack would be back down to the NICU for recovery in an hour or so. They removed his sigmoid colon and gave him a colostomy bag. The surgeon later told us that from a surgical standpoint it was a very good situation. The infection was focused on a small area that could easily be removed and should not have long standing effects on Jack’s GI tract. He is now a happy and healthy 3 1/2 year old and has had no resulting issues.

As a father and husband, how did you take care of yourself as you were taking care of your family throughout this difficult period?

My one advice I always tell other dads is you have to cry. You have to process your emotions at some point otherwise you will never get through it. For me, it was most mornings in the shower. On the nights that we actually slept, I would wake up in the morning and think “how am I going to get through another day of this. This isn’t how it was supposed to go.” Once those emotions hit you, you can’t push them down, you have to let them out, otherwise you’re not helping yourself and its going to begin to affect those around you.

The second thing you should do is use your support system. We were lucky enough to have our family near when Jack was born in NY, and they were absolutely amazing. When Josie was born in Colorado, family began jumping on flights the second they got the news. My father arrived the day before we delivered and my mom and brother arrived the day she was born. They made sure we had nothing to worry about other than being at the NICU with our kids, and they were very good about taking us out to get our mind off of everything. Taking us out for dinner, taking us to the movies, anything to step away from everything for a few hours.

Any tips for new NICU dads on how to support your wife or partner during this process?

My wife takes care of everything in the house, so anything I could do to shorten that list was help to her. With our son Jack, he was born while we were visiting our family in NY, so we were living at my aunt and uncle’s house for the nearly 5 months while he was in the NICU. It was an incredible gesture for them to have us but it wasn’t home. So I traveled back to Chicago to get some items that would help with our everyday lives.

With our second trip to the NICU with Josie, we had our 3 year old son Jack at home, so spending time with him so that Katie could be at the hospital with Josie was my main focus. Jack had school every day and therapy in the afternoon 2 days a week, and I was lucky enough to be able to work from home for the first 2 months of Josie’s NICU stay and help with Jack.

The most important focus for me was to make sure that Katie was getting as much time as she needed with our baby at the hospital.

What’s some advice you wish you’d had when your baby was born prematurely?

Knowing the possibilities. What are the chances that our child could be born prematurely? Why could they be born prematurely? If they’re born prematurely, what are the risks and things that can happen in week 1, week 2, etc.? We had no knowledge of anything dealing with prematurity. We had never been introduced to the March of Dimes or knew anything they did with prematurity research. It wasn’t on our radar and so we never thought about it. Our doctors never spoke about it and we never thought we were at risk so why would it ever happen to us? We joke now that after 212 days in the NICU between our two kids that we have a full year of nursing school under our belts. I have learned things and seen things that I would never have thought of prior to this experience.

We want to thank Kyle for sharing his story and giving his advice. We wish him, other NICU dads, and all fathers, a wonderful Father’s Day.

Please feel free to send a message to Kyle and his family or to share your NICU story with us.

Thank you to all nurses!

Wednesday, May 10th, 2017

Nurse holding babyIf your baby was in the NICU, you most likely spent a great deal of time with her team of nurses. Likewise, if you had a difficult pregnancy, a nurse was probably by your side assisting you the whole way.

Nurses are critical in the care of mothers and babies. Many families who have had a baby born prematurely or with a health condition have told us just how fantastic the nursing staff was at their hospital. Nurses are hardworking, compassionate, highly educated professionals who work around the clock to ensure that you and your baby get the care you need.

In honor of National Nurse’s Week we want to thank all of the nurses that have impacted March of Dimes’ families. In particular, we wish to congratulate the four nurses who won the March of Dimes Graduate Nursing Scholarship Awards.

To recognize and promote excellence in nursing care of mothers and babies, the March of Dimes offers several $5,000 scholarships annually to registered nurses enrolled in graduate programs of maternal-child nursing. The March of Dimes Dr. Margaret C. Freda Graduate Nursing Scholarship Award was established in 2016 to honor long-time March of Dimes National Nurse Advisory Council Chair, volunteer, and friend, Dr. Margaret Comerford Freda. This award is given each year to the highest scoring graduate nursing scholarship applicant. Congratulations to our winners!

Did you have an amazing nurse that took care of you or your baby? How did he or she impact your NICU stay?

Share your story and help us thank all nurses for their unending dedication and incredibly hard work.