Discharge of your premature baby from the Neonatal Unit

When you need to dress your baby, please note that the amount of layers of clothing/blankets must reflect the temperature of your surroundings.

You can get a sense of whether your baby is comfortable, with a feel of the neck and the abdomen. The hands, feet and nose may feel cool, without the baby being cold.

We recommend:

• Close-fitting one-piece suits (not too tight).
• Cotton and wool materials rather than synthetics.
• When outdoors use a hat and in cold weather also mittens.

We recommend:

• Around the time of discharge, you can start taking your baby out in the pram, starting with a maximum of 30 minutes.
• Once your baby reaches a weight of 3 kg, then he or she may sleep outside in the pram during the daytime. Before reaching this weight, your child does not have sufficient subcutaneous fat and will therefore spend too much energy on keeping warm rather than growth.
• Be aware of wind, frost and air moisture levels, as these cools the baby down. It is not good for children to sleep outside in a fog or severe frost (minus 10 degrees).
• Do not position the pram in direct sunlight due to the risk of overheating.

In order to create an optimal indoor climate, we recommend:

• The normal room temperature, that you are used to at home.
• Sufficient heat in your babys bathing and changing area.
• A cooler temperature in the bedroom, but do avoid drafts and position the cot/bed away from windows and exterior walls.

Before discharge, your baby must be able to feed from the breast or bottle, as well as showing general well-being and the ability to gain weight.

The baby should eat as often as he/she likes, but with a minimum of 6-8 meals per 24-hour period.

The baby shows signs of getting sufficient nutrition, if he/she has 4-6 wet nappies as well as regular stools over a 24-hour period.

Generally, premature babies have many "pushing sounds", but this doesn't necessarily mean they have difficulties with passing stools. These sounds will become fewer as your baby matures.

Breastfed babies

Babies that are breastfed may have frequent stools, maybe with every nappy change.

Babies older than 4 weeks and only breastfed, may experience less frequent stools, with up to 10 days between passing stools.

Bottlefed babies on infant formula

Babies that are bottlefeeding on infant formula should have at least 1 stool per day.

Normally the baby's stool is yellow and gooey. It may be green if the baby has a stomach cramp or if it has been a while since the last stool.

If the baby has problems with hard stools, you can give them Lactulose or Movicol. Always consult with your family doctor/health care professional before giving your baby medication.

All babies should have Vitamin D supplementation.

Premature babies also needs Iron supplementation.

You will receive information regarding vitamin and iron supplementation before discharge.

Breastfed babies

Breastmilk is complete and therefore normally covers the baby's feeding needs. But it is important, during a breastfeed, that the baby receives both the first thinner milk, satisfying thirst, and then the final fatter milk (hind milk), which makes the baby feel full.

Some babies will be satisfied by feeding from one breast only, while others will need to feed from both.

As the baby grows, there will be days when the baby's need for food increases significantly. The baby will self-regulate the amount of the milk by eating more frequently during this period. This is called demand feeding. The more the baby demands/feeds at the breast, the more milk is produced.

During a mothers normal menstrual period, regardless of bleeding or not, hormone changes may affect the breast-milk flavour. The baby will adjust to the new flavour but may briefly reject to take the breast.

Bottlefed babies

The amount of milk, for babies receiving infant formula, is about 1/6 of the baby's body weight per day, spred over 6-8 meals per day.

It is normal that the amount ml per feed can vary through the day, and it is a good idea to add 10-15 ml more to the bottle, than the amount you expect your baby to eat. As the baby grows, it will require bigger feeds.

Varius infant formula preparations are available and you should consult with your family doctor/health care professional, if you are uncertain as to which product is best for your baby.

If there are lumps in the breast from accumulated milk, maybe together with redness, heat or pain, it is important to empty the breast of milk.

It is best if the baby feeds from the breast, but if this isn't sufficient to aid the problem, then you must express the milk by hand or pump.

It is also adviced to have a warm/hot bath or shower, use a warm compress and/or gentle but thorough massage of the area(s).

Experiencing a sudden fever, chills and/or general feeling of unwellness, despite the above treatment, then you must consult your family doctor.

It is important to continue with breastfeeding despite mastitis both to continue to stimulate milkproduction and to empty the breast completely.

Always start with feeding from the affected breast, as the baby has a stronger suck at the beginning of a feed.

You may experience a reduced amount of breastmilk from the affected breast, both during and for a while after an infection.

Prevention of mastitis

We recommend:

• After each breastfeed, feel/search the breast for potential lumps.
• Varm baths, compresses and massage if lumps are present.
• Use breast pads, ideally made of wool.
• Wear warm clothing from head to toe – even if going outside for a very short time.
• Avoid (getting) cold and drafts.

The premature baby missed the final stages in the womb and therefore his or her sensory system is immature. This is particularly of the note when considering the baby's physical self awareness.

The stimulation of the muscles happens in the womb when space gets tighter as the baby grows and this way provides muscle resistance during movement.

Support your baby in the foetal position.

Be aware of your own movements being calm and harmonious when handling your baby.

Firm but warm, loving touch is more comfortable and soothing than light touch.

Cradle and/or gently rock your baby with rhythmical movement, for example sitting in a rocking chair.

Try using a baby sling or wrap aiding your baby in to foetal position.

Always aid your baby with the physical support he/she needs to maintain a bodyposture with arms and legs gathered in towards the body and with hands close to the face, this helps the baby to "feel" and soothe itself.

• Place your baby at the side and the foot (bottom right or left corner, rather than the middle) of the cot or pram – maybe create a little nest for your baby.
• Baby's legs should be together and bent, feeling resistance against support (or cot sides), rather than being stretched out.
• Support your baby's shoulder with a blanket, so he/she can get their hands to their face.
• Alternate baby's headposition between middle position and turned to the right or left.
• Generally be aware of supporting the baby's head, to avoid it bending backwards for long periods.
• Most babies enjoy being wrapped tightly in a blanket or duvet. Obviously not too tight and ensure baby does not get too hot.

As a baby gets better at keeping their and legs close in to the body and keeping their head in mid position, it is important to allow them to lie on their side when awake, and to aid further rolling on to their front/stomach, where the baby can practice lifting its head.

The baby must be allowed regular active time lying on its front while awake.

Be aware that premature babies both can be under- and overstimulated, and that they will develop and acquire new skills every day.

It is important to give your baby time to "catch up". For further development focus on current needs and ability, and what he/she is about to learn. Do not put too much focus on what your infant can not do yet.

It can be a big change to come home and be a family again, and it may take time and effort to get used to the new situation.

It can also be difficult for family and friends to understand the experience you have been through. Here, it may be an idea to evaluate who can help and how they can help.

In addition, it may be necessary to cut down on the number of visitors to ensure you have energy enough to look after your baby.

If you have developed a bond with other parents while spending time in the Neonatal unit, then you might enjoy maintaining this contact after discharge.

If you have other children, then it is important for the whole family's well-being that you include them in spending time and helping with the new baby. Let them participate at a level that you can cope with and that they want and are able to.

Older siblings of a premature baby can easily feel neglected or overlooked. As parents, and maybe particularly the mother, has been absent due to the long hospitalisation. So now, with the whole family together again, the older children may need a little extra attention.

You can easily have visits from family and friends or even go out, as long as both you and your baby have energy for it. Take care to avoid people with colds and illnesses. If a family member become sick, they should limit close contact with your baby and make sure to have extra good hand hygiene.

Premature babies like to be held – they like the comfort gained from snuggling with you. This is partly due to their special sensitivity to sounds and other sensory input, which can rapidly create stress as their ability to "filter" their environment is still underdeveloped.

Large gatherings and lots of noise can cause premature babies to become restless. This unrest may not show until you return home where the baby may have difficulties settling down and concentrate on eating.

However, do not forget to allow yourself to show off your new baby, and try to slowly figure out what you can both cope with.

Reasons for crying can be hunger, boredom, tiredness or feeling unwell. It can be difficult to interpret exactly why your child is crying. You may have to systematically try to find out what the cause may be.

Some children cry more than others, and some children actually cry, all added up, for a few hours per day. This is perfectly normal for some children.

Reasons to avoid smoking near your baby:

• Tobacco smoke is harmful to children and their lungs. They are passive smokers who can't say no.
• A baby's airways are very small and thin. Therefore babies are affected quicker by smoke than adults.
• The passive smoke from the cigarette contains more tar and three times as much carbonmonoxide than the smoke, which the smoker inhales.
• Children exposed to tobacco smoke are more often sick with asthmatic bronchitis and otitis (middle ear infection).
• Children exposed to tobacco smoke have 2-4 times greater risk of respiratory diseases compared to children who are not exposed to smoke.
• Smoke decreases lung function. The mucous membrane becomes irritated, and thus the virus and bacteria more easily penetrate into the mucosa.
• Nicotine is transmitted through the milk to the breast-fed baby in a concentration that is three times as high as in mother.
• Mothers should not smoke during or before breast-feeding because nicotine content in milk is highest immediately after smoking.

The smoking policy of the children's ward is no smoking at home at all.

But ... the next best thing is to make smoking rules at home:

• Smoke outside and use a "smoking jacket", which must be removed after smoking before entering the home.
• Smoke at an open window, if you must smoke indoors.
• Wash hands after smoking.
• Never smoke in the room where your baby sleeps/spends time.
• Never smoke in the car.
• Tell family and friends, who are babysitting for your baby, your rules about smoking.

Board of Health has published the following 3 guidelines for the prevention of Sudden Infant Death Syndrome:
• Always put your baby to sleep on its back.
• Do not smoke.
• Ensure that your baby does not get too hot when it sleeps.

Read more in the Board of Health's booklet "Prevent cotdeath – and avoid plagiocephaly or flat head syndrome". Published by Board of Health, 2011 – www.sst.dk.

Danish law states that babies/children must be securely fastened during driving.

Observe the precautions about airbags and car seats in the car. Good information on babies and children car seats and airbags, are also available in the shops where car seats are sold.

Further support and information is available from Dansk Præmatur Forening – www.praematur.dk.

Information sheets and web sites: 

• "Giv dit barn lyst til at lære! Sansning – bevægelse – sprog" by Annika, Dessau, Helle Aagaard Nielsen, Erna Nørgaard. Folder available for purchase from Komiteen for Sundhedsoplysning at www.sundhedsformidling.dk.
• "Spædbarnsmassage". Folder available at www.facebook.com/Fysicon-132600512444.
• "Født for tidligt. Til forældre ved udskrivelse fra hospitalet." Folder published by Dansk Præmatur Forening – www.praematur.dk.
• "Forebyg vuggedød – og undgå skæv hovedfacon og fladt baghoved." Published by Sundhedsstyrelsen, 2011 – www.sst.dk.
• "Børn i bilen." Published by Rådet for Større Færdselssikkerhed – www.sikkertrafik.dk.

Books

• "Bogen om amning", Sheila Kitzinger.
• "Leg med din baby 0-12 mdr.", Mette Vainer Wegloop, Lone Spliid. Politikkens Forlag.
• Politikens bog om "Babymassage. For et gladere, sundere og mere tillidsfuldt barn", Peter Walker.
• "En krop i balance – støt dit barns motoriske udvikling", Lotte Edberg Loveless, Tina Sussi Jensen, Hanne Knoblauch.
• "Børn i bevægelse i Vesthimmerland".
• "Kærlige hænder – småbørnsmassage efter indisk tradition", Frédérick Leboyer.