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Tiny Fighters

Imagine this, you are pregnant and at home watching your favorite show with your

family, when suddenly your water breaks. This should be the happiest day of your life, shouldnt

it? Except you are three months early and your baby is about to face the fight of its life. About 15

million babies are born prematurely every year, and a couple months ago I was given the

opportunity to meet some of those kids at the California Pacific Medical Centers annual NICU

Halloween party.

A family friend asked if I would be interested in helping her set up, and work the annual

Halloween party she was organizing. This party welcomes back all the premature survivors that

were able to grow up and begin their lives. When I got to the hospital to help set up, I was

greeted by nurses dressed from head to toe in the most elaborate Halloween costumes possible.

Decorations covered every inch of every wall, and a path of balloons guided me to a room filled

with carnival games. When I walked into the room I was instantly hit with the smell of delicious

cotton candy. I went to my assigned booth and waited as the start of the carnival was

approaching.

Moments after I sat down, I heard the sound of tiny feet running on the carpet headed my

way. Soon the room was filled with little kids of all ages accompanied by their parents. All the

kids were given name tags that had their name and how many pounds they were when they were

born. It was crazy to look at all those kids and see how much they have grown since their time at

the hospital.

After the party ended one of the nurses brought me upstairs for a tour in a room where all

the preemies are held and cared for. I was amazed at the size of the babies and all the equipment

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needed to help care for them. On the walls of the hospital were before and after pictures of some

of the kids that were able to leave the hospital, and on the pictures were some of their miraculous

stories. Reading those stories and seeing all of those kids inspired me, not only do my senior

project on this topic, but to set my goal to become a nurse. Half of the kids I saw that day were

not expected to make it to their first birthday, yet they were running around the hospital healthy

and happy. For my senior project I chose to volunteer at the California Pacific Medical Center

and to make and donate burp cloths to the premature babies in the hospital to show my support

for all the families going through a premature birth. I want to bring awareness to not only the

struggles the baby goes through, but the stress and struggles the parents go through as well.

Working with premature babies is something that I am very interested in pursuing in the future,

which leads me to research the question: What are the long-term health effects of a premature

baby?

Being a premature baby can lead to many long-term health effects. Of the fifteen million

premature babies born each year, about one million die due to complications of being born

prematurely (Preterm Birth). Preterm is defined as babies born alive before thirty-seven

weeks of pregnancy are completed (Preterm Birth), an average pregnancy usually lasts forty

weeks after the last menstrual period. Preterm birth complications are a huge threat to a baby's

life, and are the leading cause of death among children under five years of age. They are

responsible for roughly one million deaths (Preterm Birth), and even most of the survivors

have a high chance of facing a lifetime of disability, including learning disabilities and visual and

hearing impairments (Preterm Birth). Premature births are subcategorized based on gestational

age. If a baby is born before twenty-three weeks the baby is considered extremely preterm, if the

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baby is born between twenty-eight weeks and thirty-two weeks then the baby is considered very

preterm, and if it is born between thirty-two and thirty-seven weeks then it is considered

moderate to late preterm (Preterm Birth). While I helped out at the California Pacific Medical

Center, I was exposed to premature babies of all ages and sizes.

Making my way up to the second floor of the California Pacific Medical Center in San

Francisco, I was overcome with tons of emotions. It was my first day working with my mentor

Mary Needham, a registered nurse (RN) III of twenty years. I was nervous, scared, but most of

all excited. I had no idea what to expect at the hospital. The second floor is where all the

premature babies were. In each designated room there were multiple incubators all lined up. In

each incubator was a tiny little miracle, wrapped in warm blankets and surrounded by little

bumpers to keep them very still. The floors in the hospital were extremely quiet. All I could hear

was the high-pitched squeaking sounds my sneakers would make on the hard floors. The smell of

hand sanitizer lingered throughout the entire hospital which became coherent to me after

observing first-hand the amount of hand sanitizer and soap they use on a daily basis. When I

looked around the room, I could see tons of machines with lots of different purposes, parents

visiting their babies, and devoted nurses in their blue scrubs doing their best to care for the

babies. I was lucky enough to help care for some of the premature babies and even witnessed a

C-section all on my first day. I was given blue scrubs to put on and I pulled my hair back in a

hair tie to keep myself as sanitary as possible. After getting dressed, I got to scrub in by washing

my arms up to my elbows and scrubbing away all the extra skin on my arms. I understood the

risks of infecting a premature baby, especially in their critical conditions so I nervously scrubbed

away until my arms were bright red. As the day went on I was fortunate enough to get up close

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with some of the babies. It broke my heart seeing the struggles they go through everyday, and

how difficult it is for them to do something as simple as breathing on their own. After visiting

the hospital I have a much better understanding of what goes on in the Neonatal Intensive Care

Unit (NICU) and am so lucky to have had the opportunity to witness it myself.

A premature birth is a very stressful experience, not only directly after the birth, but later

on in the babys life as well. If the child is lucky enough to survive and be released from the

hospital, it is still at the risk of grave vision problems, hearing impairments, or severe mental

retardation, so the years to come will be a big struggle as well. Because of an early birth,

important organs such as the lungs do not develop fully, which leads to bigger problems later on

in the childs life. Immature lungs can cause irreversible brain damage owing to impaired

oxygen supply. The lungs develop much later than, for example, the heart which supplies oxygen

from the placenta to all the organs in the utero (Nilsson 151). Because the oxygen supply travels

to the fetus from the umbilical cord, the underdeveloped lungs do not affect the baby until its

birth. When the lungs are immature, they are subject to a condition called Respiratory Distress

Syndrome or RDS. RDS occurs when the lungs do not produce a lubricant (surfactant) needed

for the air sacs to open and stay open, so as to transfer oxygen (Nilsson 151). Most of the effort

going towards saving the babies lives are focused on making the lungs efficient enough so the

baby is able to breathe independently. Helping out in the hospitals I was exposed to many babies

with inefficient lungs that had to have tubes in their nose and mouth that gave them little puffs of

air to keep their lungs open long enough to make it easier for them to breathe. Their undeveloped

lungs are a huge burden on the babies, especially because they are so young. Things like crying

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takes so much energy from the baby, energy that they do not have to spare. It makes the

breathing notably harder when breathing normally is already a battle.

While working with Mary Needham, I was given a first-hand experience of what goes on

in the hospital. As she worked with the babies she explained to me everything she was doing and

tried to help me have a better understanding of why certain things happen and how it affects the

baby. In an interview with Mrs. Needham, she explained to me some of the major effects of

being born prematurely had on the babies. She told me that blindness is one of the long-term

effects, but said due to research, new policies, and technology they hardly ever see blindness as

an effect from a premature birth. Nurses are now able to give a range of oxygen levels,

depending on the amount of oxygen that particular baby needs at their age and size, which has

helped decrease the number of babies with vision damage. Another long-term effect she had

mentioned was cerebral palsy, a disorder that affects body movement and muscle coordination,

which she unexpectedly experienced with one of her own little patients. Besides all the big

effects that I mentioned before like blindness and hearing deficiency, there are also things that

people do not usually think about like feeding aversions. Imagine that you have started your life

with only negative procedures happening in and near your mouth, Mrs. Needham explained,

Breathing tubes, feeding tubes, suctioning - and then add noxious smells. This can add up to

babies not wanting to eat and take anything by mouth and then they need to have gastric tubes

placed and work with a feeding specialist to overcome their aversion. All of these effects are

very serious, but luckily we have ways of decreasing the likelihood of these effects from

occurring.

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One of the major keys in helping with the development of a premature baby and the

decrease in long-term effects begins with their incubators. A state-of-the-art incubator provides

a premature baby with an environment quite similar to conditions in the utero (Nilsson 154).

The babies must be kept warm at all times, and because they are so susceptible to diseases, it is

critical to keep them away from bacteria and diseases. This is exactly what their incubators do

for them. In an incubator, it is easier for the baby to thrive and gain weight, much easier than if

they remained in the womb. Mrs. Needham emphasized to me how helpful incubators are to all

the nurses in the NICU explaining:

The incubators take the place of a mom's womb. They are temperature controlled, and
somewhat sound controlled. We can weigh babies inside them - we used to have to weigh
each baby on an outside scale every night and oh my goodness even though you are just
moving the baby back and forth, the lines get all tangled up like spaghetti. Having a scale
built into the bed was a game changer for us and especially the babies. It is less traumatic
weighing the baby inside their bed and staying inside a warmed quiet environment helps
the babies get good restorative sleep where they are not burning precious calories that
they need to grow and thrive.

In the book, A Child Is Born, they described the incubators, much like a greenhouse, (Nilsson

154) saying that the preemies thrive inside the incubators.

One of the issues of being or having a premature baby is that they are strikingly small.

One of the smallest premature babies recorded was born two weeks before the existing abortion

cut-off limit at nine-and-a-half inches long and weighed less than 10 oz (Pickles). A big concern

for parents of premature babies is if their child is going to stay one of the tiniest in their class

forever. Some preemies, especially those with chronic lung diseases or feeding disorders,

continue to lag in growth even after their due dates, but begin to grow in later months or years,

faster than other babies which helps make up for their slow start (Linden 457). Fortunately the

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catching up in growth does not stop in the babys childhood, but it continues on through

adolescence.

To some people, seeing their baby immensely tiny would be a major concern, and

although having a very small baby is very alarming and could be very dangerous, there are

parents with babies whose smallest concern is the size of their child and their biggest is

wondering if their little one is going to make it home. I had the opportunity to talk to one of the

parents of a baby in the NICU, and she gave me a new perspective on the parents point of view,

for privacy reasons I will keep her identity anonymous. She explained to me that the hardest part

of the whole experience is having to leave her baby every night. She felt that she was lucky

enough to have this time off from her job to focus on the baby and her family, Im very

fortunate to have this time off to just focus on the baby, it was a huge weight off our shoulders,

but I know a lot of other moms are not as fortunate so I cant imagine how they manage

(Anonymous). Like she said, many parents of premature babies do not have the luxury of taking

time off and just be able to focus on their childs health, but rather must go back to work and

deal with a mountain of stress always building up. She also expressed to me how fortunate she

was considering the circumstances, because of how caring the nurses were. She immediately felt

comfortable enough to leave her baby in the care of the nurses.

Although the care that the babies receive from the nurses in the NICU is the best possible

care the preemies could receive, it can also affect the way they develop. Mrs. Needham

mentioned earlier in our interview that babies can develop things like feeding aversions. She

explained that when only negative things are going into your mouth you begin to stop trusting

the things being put into its mouth. Similar things like that can also affect the baby in the NICU.

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She told me that she has had many babies that have developed feeding aversions and whenever

anything touches their mouths, they gag. Since birth, they were trained to dislike things going

into their mouths. Unfortunately the tubes going inside the baby are trying to save the child and

make its life a lot easier, but it seems to be having a negative affect as well. It is very clear as to

why this development can be catastrophic later on as they grow bigger.

It is very evident that there are many health effects that come with being a premature

baby, but there are also ways to try to prevent a premature birth and ways of knowing if you are

at high risk of having a premature baby. There are three main factors that make you more prone

to having an early pregnancy. If you have had a premature baby in the past, if you are pregnant

with multiple babies at once, or if you have ever had uterus problems in the past or present

(Preterm Labor). One of the main causes to a premature birth is a preterm premature rupture of

the membranes (also called PPROM). This is when the sac surrounding the unborn child is

broken and causes labor to start early. When this happens the baby is not being given enough

nutrients to continue living inside of the mother so they have to have an emergency C-section in

order to try to save the baby. Easy ways to prevent these things from happening is to make sure

the mother is receiving prenatal care, waiting at least 18 months between giving birth and having

another baby, staying away from drugs and alcohol, and having a lot of stress. These are just

some of the many things you can do to try and protect yourself and your child from a lifetime of

hospital visits and an absurd amount of stress (Preterm Labor).

In conclusion, there are many long-term health effects of being a premature baby. But

with new technology and studies, there has been a significant decrease in deaths of premature

babies. A premature birth is a very serious thing and should not be taken lightly. Many families

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everyday are burdened with the news that they are going to have an early delivery which will

begin one of the toughest journeys they will ever have to face. It is extremely important that we

try to prevent premature births. We must do everything we can to protect the families in these

situations and help them as best we can. I hope one day we can stop all premature births so no

more families will have to go through something as painful and exhausting as this. All the

research I found really opened my eyes to the severity of premature births and the effects that it

has on not only the babies but the families as well.

Before researching the question, What are the long-term health effects of being a

premature baby? I had no idea what to expect. I now understand how important it is for a

mother to take care of herself, not only for her, but more importantly for her unborn child. I have

had family members go through a premature pregnancy and never knew the severity of it. Now I

can definitely look at my baby cousins in a whole new perspective, and now acknowledge them

as some of the strongest people I know.

This research has really shown me a new outlook on life. It has shown me the importance

of taking care of myself, and especially, to never take anything for granted. While shadowing

Mrs. Needham, I was given a sneak peek into the career choice I plan on pursuing and It has

made me very excited for the future ahead. After researching this topic I feel I have a better

understanding of what goes on in the NICU and the different ways it can impact a family. My

project has really inspired me to become a neonatal nurse. I hope to one day change someone's

life for the better, just like the preemie babies I had the pleasure of meeting, have changed mine.

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Works Cited

Books:

Linden, Dana Wechsler, et al. Preemies: the Essential Guide for Parents of Premature Babies.

second ed., New York, Gallery Books, 2010.

Nilsson, Lennart, and Lars Hamberger. A Child Is Born. New York, Jonathan Cape, 2011.

Electronic Source:

Pickles, Kate. Meet the World's Tiniest Baby. Daily Mail Online, 8 Sept. 2016,

www.dailymail.co.uk/health/article-3779739/Meet-world-s-tiniest-baby-Emilia-born-wei

ghing-just-8-OUNCES-feet-smaller-thumbnail.html. Accessed 20 Mar. 2017.

Preterm Birth. World Health Organization, World Health Organization, Nov. 2016,

www.who.int/mediacentre/factsheets/fs363/en/. Accessed 13 Mar. 2017.

Preterm Labor and Premature Birth. March of Dimes, Mar. 2016,

www.marchofdimes.org/complications/preterm-labor-and-premature-birth.aspx.

Accessed 21 Mar. 2017.

Primary Sources:

Anonymous. Personal Interview. 5 Mar 2017.

Needham, Mary. Personal Interview. 11 Mar 2017.

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