What to Expect the First Year (129 page)

Begin the protocol below only on a baby who has stopped breathing, or on one who is struggling to breathe and is turning blue (check around the lips and fingertips).

How will you know if you need to start resuscitation techniques? Assess your baby's condition with the Check, Call, Care method recommended by the American Red Cross.

Check to make sure the location is safe to stay in. Then check baby for consciousness. Try to rouse a baby who appears to be unconscious by tapping the soles of her feet and shouting her name: “Ava, Ava, are you okay?”

If you get no response, have anyone else present call 911 for emergency medical assistance while you continue to Step 3 without delay. If you are alone, provide about 2 minutes of care, then call 911. If you can, periodically call out to try to attract help from neighbors or passersby. If, however, you are unfamiliar with CPR or feel overwhelmed by panic, bring a phone to baby's side immediately (or, if there are no cordless or cell phones nearby and if there are no signs of head, neck, or back injury, go to the nearest phone with your baby), and call 911. The dispatcher will be able to guide you in the best course of action (put your phone on speaker or handsfree mode if possible).

IMPORTANT: The person calling for emergency medical assistance should stay on the phone as long as necessary to give complete information to the dispatcher. This should include the name, age, and approximate weight of the baby; any allergies, chronic illnesses, or medications taken; and present location (address, cross streets, apartment number, best route if there is more than one). Also tell the emergency dispatcher baby's condition (Is baby conscious? Breathing? Bleeding? In shock? Is there a pulse?), cause of condition (fall, poison, drowning), and the telephone number where you can be reached. Tell the person calling for help not to hang up until the EMS dispatcher has concluded questioning and to report back to you after completing the call.

Move baby, if necessary, to a firm, flat surface, carefully supporting the head, neck, and back as you do. Quickly position baby faceup, head level with heart, and proceed with the C-A-B survey below.

If there is a possibility of a head, neck, or back injury—as there may be after a bad fall or car accident—go to Step B (Breathing) to look, listen, and feel for breathing before moving baby. If baby is breathing, don't move him or her unless there is immediate danger (from traffic, fire, an imminent explosion). If breathing is absent and rescue breathing cannot be accomplished in the baby's present position, roll the baby as a unit to a faceup position, so that head, neck, and body are moved as one, without twisting, rolling, or tilting the head.

Open the airway: Gently tilt baby's head back slightly while lifting the chin.

Begin rescue breathing: Form a tight seal with your mouth over baby's nose and mouth.

1. Position your hands.
Position the three middle fingers of your free hand on baby's chest. Imagine a horizontal line from nipple to nipple. Place the pad of the index finger just under the intersection of this line with the breastbone, or sternum (the flat bone running midline down baby's chest between the ribs). The area to compress is one finger's width below this point of intersection (see
illustration
).

CHEST COMPRESSIONS

2. Begin compressions.
Using two or three fingers, compress the sternum straight down to a depth of 1½ inches (your elbow should be bent) for 30 compressions. At the end of each compression, release the pressure without removing your fingers from the sternum and allow it to return to its normal position. Each compression should take less than a second.

Tilt baby's head back slightly by gently pushing down on baby's forehead with one hand while pulling up on the bony part of the jaw with two or three fingers of your other hand to lift the chin (see
illustration
). If there is a possibility of a head, neck, or back injury, try to minimize movement of the head and neck when opening the airway.

IMPORTANT: The airway of an unconscious baby may be blocked by a relaxed tongue or by a foreign object. It must be cleared before the baby can resume breathing (finger sweep, see
description and illustration
).

Maintaining your baby's head in the same position, airway opened (A), take a breath in through your mouth and place your mouth over baby's mouth
and nose, forming a tight seal (see
illustration
). Blow 2 slow breaths (lasting 1 second each) into the baby's mouth. Pause between rescue breaths (so you can lift your head and breathe in again, and to let the air flow out of baby's mouth). Observe with each breath whether the baby's chest rises. If it does, allow it to fall again before beginning another breath. After two successfully delivered breaths (as evident from the rising chest), repeat the C-A-B cycle of 30 compressions and 2 breaths.

NOTE: If the chest doesn't rise and fall with each breath, your breaths may have been too weak or the baby's airway may be blocked. Try to open the airway again by readjusting baby's head (tilt the chin upward a bit more) and give 2 more breaths. If the chest still does not rise with each breath, it is possible the airway is obstructed by food or by a foreign object—in which case, move quickly to dislodge it, using the procedure described in When Baby Is Choking
here
.

If you're alone, provide care for about 2 minutes before calling 911. If a phone is close by, bring it to your baby's side. If not, and there is no evidence of head or neck injury, carry baby to the phone, supporting the head, neck, and torso. Continue rescue breathing as you go. Quickly and clearly report to the EMS dispatcher, “My baby isn't breathing,” and give all pertinent information the dispatcher requests. Don't hang up until the dispatcher does. If possible, continue compressions while the dispatcher is speaking. If it's not possible, return to CPR immediately on hanging up.

IMPORTANT: Continue CPR until an automated external defibrillator (AED) becomes available or emergency medical assistance arrives.

Most parents-to-be expect their babies to arrive right around their due date, give or take a couple of days or weeks. And the majority of babies do arrive pretty much on schedule, allowing them plenty of time to prepare for life outside the womb and their parents plenty of time to prepare for life with a baby.

But in about 12 percent of births in the United States, that vital preparation time is cut unexpectedly—and sometimes dangerously—short when baby is born prematurely and/or too small. Some of these babies weigh in at just a few ounces under the low-birthweight (5-pound, 8-ounce) cutoff, and are able to quickly and easily catch up with their full-term peers. But others, deprived of many weeks of vital uterine development, arrive so small that they can fit in the palm of a hand. It can take months of intensive medical care to help them do the growing they were supposed to have done in the cozy, nurturing confines of the womb.

Though the low-birthweight baby (whether born early or born small for gestational age) is still at higher risk than larger babies, rapid advances in medical care for tiny infants have made it possible for the great majority of them to grow into normal, healthy children. But before they are carried proudly home from the hospital—and sometimes even after they're home—a long road often lies ahead for these babies and their parents.

If your baby has arrived too soon and/or too small, you'll find the information and support you'll need to navigate that road in the pages that follow.

Learning to eat outside the womb isn't easy at first, even for a full-term baby who must master the basics of nursing from a breast or a bottle. For preterm or low-birthweight babies, the challenges may multiply. Those who are born just 3 or 4 weeks early are usually able to breastfeed or take the bottle right after birth—again, after mastering the basics. Ditto for babies who were born close to term but at a low birthweight. But babies born before 34 to 36 weeks usually (but not always) have special nutritional needs that traditional feeding can't satisfy—not only because they're born smaller, but because they grow at a faster rate than full-term babies do, may not be able to suck effectively, and/or may have digestive systems that are less mature. These littlest babies also need a diet that mirrors the nutrition they would be receiving if they were still growing in utero and that helps them gain weight quickly. And those vital nutrients need to be served up in the most concentrated form possible, because preemies and low-birthweight babies can take only tiny amounts of food at a time—partly because their stomachs are so small, and partly because their immature digestive systems are sluggish, making the passage of food a very slow process. And since they can't always suck well or even suck at all, they can't take their meals from a bottle or a breast—at least not right away. Luckily, breast milk, fortified breast milk, or specially designed formulas can usually provide all the nutrients preemies and low-birthweight babies need to grow and thrive.

As a parent of a premature or very-low-birthweight infant, you will find that feeding and monitoring weight gain become two of the most consuming aspects of caring for your baby in the hospital—in terms of both time and emotion. The neonatologists and nurses will do everything they can to ensure that your preemie receives the nutrition needed to gain weight. Just how your baby receives that nutrition depends on how early he or she was born: