Question about birth at 28 weeks?

Lucky507 · December 2012

I am a foster to adopt mom and just got a call about a baby who is up for adoption. The baby was born at 28 weeks with most likely little to none prenatal care. He did not have any drugs In his system either. He was born 11/20 and has just been moved this week to a crib in the NICU. I have so many questions but I really don't know where to start. What are some of the challenges that I can expect? What are things that I should really worry about? Ae there specific questions that I should ask the nurses? I have never had a baby and my son was adopted at age 4. I have a ton of experience with babies but not preemies especially this early of a baby. Any help oe advice would be greatly appreciated.

Sept30Madison · December 2012

There's a link to the preemie resource blog at the top of the preemie message board page.That's a good place to start as well as the March of Dimes website. I also really liked the preemie book written by Dana Linden.

The range of complications from a 28 weeker is quite broad. There could be many medical issues, or the baby could just be a feeder & grower while in NICU. The fact that he's been moved to a crib about a month after birth (and 33 weeks adjusted) is a really good sign.

The particular prognosis of the child is really dependent. Make sure to ask the neos and the nurses about his likely prognosis and if they expect him to have any long term issues.

Some questions I would ask for a preliminary idea on his general medical condition: Is he on any oxygen assistance (vent, cpap, or nasal cannula) right now? What were his previous oxygen needs? Does he have apnea or brady episodes and, if so, how many and what's the severity? Has he had any infections? Are his head ultrasounds normal? Are his vision and hearing tests normal? Do they expect him to be a feeder/grower only? How is he doing with weight gain? How is he doing with maintaining body temp?

Since he is only 33 weeks adjusted, he likely still gets all of his food by NG tube. You could ask them when they plan on trying the bottle (this usually does not occur until somewhere in the 34-36 week range).

Mrs. Alice · December 2012

Sept30Madison:
There's a link to the preemie resource blog at the top of the preemie message board page.That's a good place to start as well as the March of Dimes website. I also really liked the preemie book written by Dana Linden.
The range of complications from a 28 weeker is quite broad. There could be many medical issues, or the baby could just be a feeder & grower while in NICU. The fact that he's been moved to a crib about a month after birth (and 33 weeks adjusted) is a really good sign.
The particular prognosis of the child is really dependent. Make sure to ask the neos and the nurses about his likely prognosis and if they expect him to have any long term issues.
Some questions I would ask for a preliminary idea on his general medical condition: Is he on any oxygen assistance (vent, cpap, or nasal cannula) right now? What were his previous oxygen needs? Does he have apnea or brady episodes and, if so, how many and what's the severity? Has he had any infections? Are his head ultrasounds normal? Are his vision and hearing tests normal? Do they expect him to be a feeder/grower only? How is he doing with weight gain? How is he doing with maintaining body temp?
Since he is only 33 weeks adjusted, he likely still gets all of his food by NG tube. You could ask them when they plan on trying the bottle (this usually does not occur until somewhere in the 34-36 week range).

Good points! My twins were 28 weekers so I can tell you how our experience went. They needed breathing assistance from cpap and ventilators for the first month. After that point they were considered more "feeders and growers" in the NICU since they were not critical after that point. Because of their premature lungs, one of my twins developed a preemie lung condition called BPD which made it harder for him to get off of oxygen.

It can take a several weeks for preemies to learn how to eat from a nipple. Developing the suck, swallow, breath coordination usually isn't mastered until they are around full term gestational age. My twins also had many "spells" where they would drop their oxygen saturation and heart rate which is pretty common with preemies since their nervous systems are still developing. They needed to come home with monitors that measure breathing and heart rate because of this. Both came home 10 days before their due date.

The first year and first winter we had to be very careful about their exposure to germs since their immune systems were not as strong and they were at higher risk for RSV. It's also important to make sure preemies are staying on track with developmental milestones so he/she will likely be followed by an early intervention program and might need therapy services at some point. My boys never did qualify for therapy but have been evaluated a couple times. Besides their small size for their age, they no longer have any conditions related to prematurity and have begun catching up on some milestones. Challenges we've faced are slow weight gain and feeding issues particularly with my twin who was IUGR. It can take 2-3 years for preemies to catch up to their full term peers and until then you correct age based on their due date.

With all that said, there is really a wide range but typically 28 weekers fair pretty well and are at a decreased risk of long term complications compared to a preemie born earlier. Lots of luck and well wishes to you!

P.S. The Premature Baby Book by Dr. Sears is a good read to help you navigate the NICU and help with caring for a preemie at home.

Lucky507 · December 2012

Thanks ladies! All your words of wisdom are so helpful. I was googling things before and started to get worried about whether or not I can do this. You for sure put my mind at ease. I meet with the case workers on Monday and will find out more information then. I will definitely keep you all updated.

Cst2CstBride · December 2012

I agree with everything that has been said. I would ask to talk to the neonatologist and ask what, if any complications you can expect. The baby will likely have eye exams until his due date to check for ROP. Because he is being monitored it will either not be a problem or require some intervention but should be treatable if there is any issue.

Dd was born at 27 weeks and only needed CPAP for a few days and nasal cannula for a week. The 28 weeker next to her was on CPAP for a month but learned to eat faster than dd and went home a week before her even though they were gestationally the same age.

Dd had almost no issues given her early birth and IUGR/ she was 1lb 11oz at birth. Her only issue after dc was torticollis. She would not turn her head to the left. She developed a significant flat spot on the back right of her head and her right forehead started growing out and pointy. With PT and home exercises it resolved completely and you can't tell anymore. She is now ahead of her adjusted age and catching up to her actual age.

Good luck. The NICU should be able to talk you through what to expect.

heaven22tw · December 2012

I just recently adopted 28 weeker. One that was 5 states away. please email me at heaven22tw@Yahoo.com. im willing to share anything you might need help with!!!! our DD is 3 months on the first and doing great:)

vsalt31 · December 2012

meganole25:
I just wanted to say that you are amazing. There were some babies in our NICU that I just knew would not be going home with their birth parents. It's so amazing to know wonderful people like you are in this world.Please keep us updated.nbsp;

All of this! Best wishes to you.

PhillyGal34 · December 2012

vsalt31:
meganole25:
I just wanted to say that you are amazing. There were some babies in our NICU that I just knew would not be going home with their birth parents. It's so amazing to know wonderful people like you are in this world.Please keep us updated.nbsp;

All of this! Best wishes to you.

Agree. Also ask about kangaroo care. It's great for the baby and for you.

You are doing an amazing thing. Keep us updated!!

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