Almost half of all twins are premature babies, and most of these will spend some time in the hospital following their birth. If it’s possible, you should prepare yourself ahead of time for this , just in case. Consider visiting the intensive care nursery at your hospital to see what the premature babies look like, and learn a little about the extensive care and equipment. Your babies may never end up there, but by giving yourself some knowledge ahead of time, you’ll feel more emotionally prepared to deal with it if you do.
While my twins were born healthy and full term, my oldest son was not. Due to a car accident he entered the world at 32 weeks gestation, after months of bedrest and hospitalization, steroid injections and IV drugs to stop labor. So I do know a little about the experience of the NICU, and while it was slightly terrifying at the same, it as also an amazing place where tiny little babies fight for their lives. I’m including images on this page as it will help you to see a little of what happens in the NICU and what you can expect if one or more of your babies spends some time here. Visit this page for recommendations on preventing prematurity
After your twins are born they will be stabilized in the delivery room and then transfered in an incubator to the Neo Natal Intensive Care (NICU) or and Intermediate Intensive care facility. Here each baby will receive a full medical examination , blood will be drawn for testing of Rh factor , oxygen levels and glucose to determine the health condition of your babies. Some twins only need observation for a day or two, others longer. Having some information ahead of time – just in case – will hopefully lessen your fears.
It is normal for the whole family to feel scared and worried at this time. No one plans to have a premature baby. The NICU is full of specialists and equipment and it is their job to take care of your little ones. Learn what you can now, just in case.
Some of the equipment you’ll see in the NICU are radiant heat warmers to help regulate their body temperatures. Their are isolettes and incubators with portholes along the sides. Some NICU’s have isolates that will hold 2 babies – there are some studies to show that twins who are left together to cuddle do better than those that are separated. Ask your doctors!
There are monitors everywhere -babies with tubes up their noses, probes attached to the skin for heart rate, oxygen and breathing- most of these are attached to alarms which will sound off. This was the scary part for me ! Babies are monitored for blood pressure with cuffs. Many premature babies have problems with apnea where they stop breathing for a moment or two. There may be babies in oxygen tents as well or ones with oxygen masks .
Babies who are not able to suck effectively to feed ( usually less than 34 weeks gestational age) are fed by a gavage tube. I fed my son this way with expressed breast milk. A thin tube is inserted through the nose or mouth and then threaded down into the stomach. I would hold the syringe of milk and gravity would cause the milk to flow down directly into his stomach. This allows your baby to eat and gain weight, without having to use their energy to suckle. Some preemies are not ready for this and will be fed intravenously.
Some of the medical staff you’ll find are –
-neonatologist who specializes in newborns
-pediatrician – usually handling babies who are 35 weeks gestation or at least 5 lbs at birth
-interns and residents who are learning on the job
-radiologist who specializes in giving and reading the Xray and ultrasounds tests and results
-nursing staff – the neonatal nurses who you as parents will interact the most with and learn from, as well as RN’s
-lactation consultant – to help with breastfeeding
-physical or occupational therapist
-social workers to counsel and support parents
And many others – the NICU is a busy place!
Common problems of premature babies
Jaundice – this is caused by a buildup of a substance called bilirubin that is a pigment formed by the break down of red blood cells. It is normally removed by the liver and during pregnancy the placenta and the mother’s liver take over this function. Sometimes after birth before the baby’s own liver takes over this job a build up in the babies blood causes the skin to turn yellowish and is called jaundice. These babies are treated with phototherapy ( similar to a tanning bed) These lights are called bili-lights.
Problems regulating body temperature-Preemies are unable to regulate their own temperature as most have not developed the body fat needed to do so. This is a very important part of neonatal care and a requirement before babies can leave the nursery,
Difficulties with breathing A full term infants lungs contain a substance called surfactant which keeps their lung sacs from collapsing. Premature babies may not have enough of this and makes breathing difficult. These babies can have respiratory distress syndrome ( RDS) which is a very common complication of prematurity. This is treated with oxygen either with a mask, tubes or tent.
Problems with the nervous system Sometimes blood vessels in a baby’s brain can rupture and bleed causing a hemorrhage.This can result in seizures, swelling, irritability and breathing problems. It can lead to developmental problems, seizure disorders, or vision or hearing problems.
Difficulties with vision Retinopathy of prematurity occurs when the blood vessels of the retina grow abnormally causing bleeding into the eye and scar tissue to form. This occurs most often in tiny babies or those born earlier than 28 weeks gestation. Annual eyes exams are very important as the babies may develop crossed eyes or lazy eye.
Risk of infections Since their immune systems are not mature they are at risk for developing sepsis which is bacteria in the blood, pneumonia or meningitis.
Eating difficulties With an underdeveloped digestive system, poor circulation and infections can result. Preemies also often lack the sucking reflex needed ( usually occurring around 34 weeks gestation. Babies must be able to suck and swallow and digest as well as breathe all at the same time. As babies are in care and grow and develop they can transition from IV’s, to gavage tube feeding to nursing.
Premature and low-birthweight babies are also at a higher risk of SIDS
All of these are complications that can happen to premature babies. It does not mean they will ! This is just to give you an idea of the possible complications that can arise after birth.