Krystyna Bober-Olesińska, MD, PhD: problems of premature babies do not end on the day of discharge from the hospital

Along with the discharge from the hospital, another long and difficult chapter in the life of a premature baby begins. Whether he or she quickly catches up with term babies is now largely up to the parents. Mother’s milk feeding, specialist medical care, vaccination and immunization are of great importance for his physical development. It is equally important to build his psyche, because many of the problems of adults are caused by their prematurity.

1. Dr Krystyna Bober-Olesińska: – Breastfeeding plays a key role in the maturation of the immune system of a premature baby
2. Doctors predict that a premature child should “catch up” with term-born equals within two years
3. – If we include information in the excerpt that the premature baby has no post-vaccination complications, doctors from the clinic are less afraid of giving further vaccines – says Dr. Krystyna Bober-Olesińska
4. You can find more such stories on the TvoiLokony home page

Monika Zieleniewska, MedTvoiLokony: The task of a neonatologist is not only to treat a prematurely born newborn, but also to take care of its mother.

Dr. Krystyna Bober-Olesińska: The hardest part for moms who give birth prematurely is accepting that nothing can be changed anymore. Man was born and is. Moms very often analyze what went wrong, that there was a premature birth, and we have to convince them that this analysis is of course important, but in terms of sibling planning. On the other hand, for a child the most important thing is what mom can offer him and how much she can love them. And it is not easy to accept a newborn that lies in an incubator, has hundreds of drains in it, and strangers take care of it, while in the mind’s eye you see it at the breast. These are worlds so different that both moms and staff have to do a tremendous job to survive this moment.

How are you helping them survive?

Of course, we meet mothers who are ready from the beginning to love and accept and work with us, but we also have women who we need to help. This does not mean that they love less or accept less, they just have to do some work. And even the need to cope with the task of maintaining lactation and bringing their own milk allows them to survive. This is their participation in the child’s recovery, extremely important in building their competences as mothers.

It is also a method of bonding.

And that is why we regret that mothers cannot spend time with their children in neonatal intensive care and pathology units. And this is especially important before leaving home, if only so that we can assess how they are coping with the care. We try, if it is possible, that the mother kangaroo the baby. It has been proven that kangaroo care is an emotional support for a child, kangaroo babies eat better breast milk, grow better and develop better.

For mums, however, contact with the baby is invaluable, if only from the perspective of maintaining lactation. We know how many beneficial properties her milk has. It contains antiviral and antibacterial ingredients, ready-made antibodies, a number of trophic factors that favor maturation, bacteria that act as probiotics and many other bioactive substances. This is a really long list. In addition, breastfeeding plays a key role in the maturation of the newborn’s immune system.

1. See also: Everything You Need to Know About Breastfeeding

On discharge, give the mother of the premature baby a whole lot of recommendations.

How should she feed, give vitamins, how often iron, folic acid, how should she feed herself. We also remind the mother that she should first visit a pediatric clinic, we inform you when it is necessary to go to an orthopedic clinic, for eye and hearing control, when the child should be assessed by other specialists, such as a physiotherapist, neurologist, etc.

So it is not easier when you leave the ward?

This begins a very difficult period that lasts about two years. Over the years, our premature baby should catch up with babies born on time. Parents’ education and commitment are important, especially at the beginning they have to devote a lot of time to the child. It is difficult, but then you can see the results.

Should a premature baby also be assessed by a psychologist?

Of course, because the problems of these children do not end on the day of discharge or even in the second or third year of life. Even if they do not have motor impairments, when they are a little older, they may develop discrete coordination disorders that make it difficult to function in school. There are already studies showing that premature babies are at risk of mental disorders such as hyperactivity, autistic disorders, mood disorders, learning difficulties or difficulties in establishing social bonds. You have to pay attention to all of this and the work of a psychologist cannot be overestimated here. I remember that an experienced psychologist told me that if a premature baby at the age of 30 takes irresponsible credit, it is to blame for his prematurity.

Vaccination is a hot topic right now. How is the vaccination of premature babies?

Mothers of premature babies should not be afraid of vaccinations. Preterm babies need them more than full-term babies, because the incidence of serious diseases against which vaccines protect them is higher in this group. Pediatric scientific societies, both world and Polish, recommend vaccinating premature babies, and many studies prove that they are safe.

Is vaccination different from full-term babies?

It takes place in the same cycle as term babies. Provided that the baby is in a stable condition when its due date. The smallest premature babies are given their first vaccinations while still in the hospital. When the toddler is 6, 7, 8 weeks old, and his condition is stable, although he cannot go home yet.

Parents have no doubts?

Vaccination in hospital has its advantages. First, parents generally trust the doctors who care for their children, so they consent to them. Secondly, we can monitor potential complications around the clock.

What complications do you observe?

The described complication is apnea. However, they are very rare and are generally absent in newborns who have reached term.

So if there are no complications …

… We can put it on the discharge card. If we include this information in the card, doctors from the clinic are less afraid of administering more vaccines. At the beginning of vaccination, the children were postponed, and the doctors sent the children for neurological consultations. Fortunately, the implementation of the immunization program for premature babies is now looking better. A lot also depends on the determination of parents who are becoming more and more aware that vaccinations of premature babies are important and must be ensured.

Who decides if a child can be immunized?

Qualification for vaccinations is made by a pediatrician from the clinic. Premature babies are subject to the same contraindications for their implementation as all other children.

Neonatologists emphasize that infection prevention is the most important thing for premature babies.

Until the age of 2, they have an increased risk of infections requiring hospitalization, mainly of the respiratory tract. In addition to the vaccination program, we have a special drug program dedicated to premature babies – the prevention of RSV infections.

What is it about?

In Poland, it covers children born up to the 28th week of pregnancy, all children diagnosed with bronchopulmonary dysplasia and children born up to the 33rd week of pregnancy, if at the beginning of the epidemic season (in Poland it lasts from October to April), no are 6 months old. Prophylaxis consists in giving children antibodies against RSV. They receive a maximum of 5 doses and this is the best option. Nevertheless, already 3 doses are considered effective. Moms often say that the baby is vaccinated because we give the antibodies intramuscularly, but it’s better to use the name immunization.

Is RSV particularly dangerous for premature babies?

The most dangerous of all respiratory viruses. Every year in the winter, he is responsible for a large group of infections. Everyone has contact with him before the age of 2. Usually, in immunocompetent people, adults and children, the infection is mild in the form of a cold, cough, runny nose and sore throat. However, the youngest children, especially up to 6 months of age, may develop severe pneumonia and bronchiolitis. In such cases, our premature babies often require admission to hospital and re-oxygen therapy or even connection to a ventilator. And then the successes we have achieved in the fight against the immature pulmonary parenchyma regress. One of the complications may also be the reappearance of apnea.

Therefore, premature babies constitute the most important risk group for severe RSV infections, next to children with heart defects, cystic fibrosis or neurological diseases in the course of which swallowing disorders occur.

The editorial board recommends:

1. Together for premature babies – for the sake of their future
2. Formula milk – what are its types? Indications and contraindications for use
3. Pregnancy calendar – the course of pregnancy month by month [WE EXPLAIN]
4. Are you planning a pregnancy? Start with research – take care of your and your baby’s health

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