How to Care for a Premature Baby When They're Sick

How can I tell if my baby is sick?

Parents are the best at knowing when their baby just doesn't seem to be acting the same. Some premature infants are more susceptible to colds or respiratory infections. Babies can become dehydrated (lose of fluid and nutrients) quickly. A change in your baby's response or behavior could be a sign that your baby is sick. These include:

Change in your baby's breathing pattern
Excessive crying or irritability
Change in eating pattern
Difficult to wake up or not as active as usual
Coughing, not associated with feeding
Vomiting all or most of his/her feedings
Frequent liquid stools within a short period of time (6-8 hours)
Not as many wet diapers as usual and urine is a darker color
Blue or pale colored skin
Fever

Don't hesitate to call your pediatrician. No question is foolish or unimportant. Your doctor is there to answer all your questions.

What if my baby has a stuffy nose?

By adding humidity to the house, (turning on the shower, washing clothes or having a humidifier) it may help your baby to breath easier. If the stuffiness continues and your baby doesn't seem to be getting any better, it is wise to call the doctor to have it checked out. It could be a cold.

Are hiccups and sneezes normal?

Yes, hiccups and sneezes are normal. Normally the hiccups will just go away by letting them run their course. You can offer a little water and if you are breast feeding let him/her suckle at the breast for a minute or two. Hiccups may also be a sign that your baby is feeling a little stressed and needs to have some quiet time.

Sneezes will help to clear the passages of your baby's nose. It is nature's way of helping the infant get rid of dust or other irritants. Persistent sneezing may be a signal that the nose needs to be cleared with the bulb syringe. Sneezing also occurs when your baby has a cold.

How do I take my baby's temperature?

Axillary (underarm) temperatures

If you are using a glass thermometer, shake the mercury down by snapping the wrist sharply while holding the thermometer. Check to make sure the mercury is below 96 degrees F.
Place the tip of the thermometer under the arm pit making sure that it is in contact with both the skin on the arm and the skin of the chest.
Hold the arm down next to the side of the chest keeping the thermometer under the arm.
Keep in place for at least 3-4 minutes.
Axillary temperatures are slightly lower than rectal temperatures.

Rectal (in the bottom) temperatures

If using a glass thermometer, shake the mercury down by snapping the wrist sharply while holding the thermometer. Check to make sure the mercury is below 96 degrees F.
Place water based lubricant on silver end of thermometer.
Hold your baby either on his/her abdomen across your lap or place on the changing table as if you are going to change the diaper.
Place the tip or the silver end of the thermometer into your baby's rectum, no more than 1/2 inch.
Hold the thermometer in place for at least 2-3 minutes.
Wipe thermometer with a tissue.

Oral temperatures should not be done with babies.

It is a good practice to have already taken the temperature when you call your doctor or go to an appointment for an illness. It is always best to take the temperature rather than feel your baby's skin.

How do I know if my baby has a fever?

A fever is a temperature over 99 degrees Fahrenheit axillary or 100.5 degrees Fahrenheit rectally.

Your doctor should be called if:

Your preemie is under 2 months of age and the temperature is over 99 degrees F axillary or 100.5 degrees F rectally.
Your preemie has a temperature over 99 degrees F axillary or 100.5 degrees F rectally and other signs of illness.
Fever is present more than 3 days.
The temperature is less than 97 degrees F.

What kinds of infections are common in babies?

Babies can get many kinds of infections. Generalized infection or infection of the blood stream is referred to as sepsis; infection of the lungs, pneumonia; infection of the fluid that surrounds the brain, meningitis; infection of the urine, urinary tract infection or UTI. Babies can also get localized infections under the skin called abscesses or infections of the skin.

Infections in babies can be caused by bacteria (most common), viruses, or fungi. Infections can start before birth, near the time of birth, or while the baby is in the nursery.

Why do premature babies get infections so easily?

Babies have an inexperienced immune system. They have not had time to build up their own antibodies to fight infection. Preemie babies get fewer antibodies from their mothers since most antibodies go across the placenta to the baby in the last few months of pregnancy.

Preemie babies often have intravenous catheters. These may serve as routes of entry for bacteria.

Preemie babies frequently are given antibiotics for infections. These kill the bacteria most likely to cause infection, but enable other less common germs to grow more easily.

How does a baby with an infection act?

Signs of infection are not specific; babies may act the same no matter what is wrong with them. These may include any or all of the following:

less active or less alert
more apnea
new or increased respiratory problems
difficulty keeping his/her body temperature normal
poor tolerance to feedings
poor skin color
problems with low blood pressure
seizures (meningitis only)

How will my baby's doctors know if there is an infection?

Your baby's doctor may:

Obtain fluid samples from one or more body sites (blood, urine, spinal fluid) to send to the laboratory for culture. The laboratory will see if bacteria grow from this fluid.
Measure the number of white blood cells in your baby's blood. With infection there may be too many, too few, or more than usual number of young white blood cells.

How is an infection treated?

Bacterial infections are treated with drugs called antibiotics. There are several different antibiotics. Your baby may be on more than one at a time because no single antibiotic controls all infections. Your baby's doctor will select the ones to control the germs that are most likely causing your baby's infection. Different drugs are used when the infection is caused by a virus or a fungus.

Will there be permanent problems from infection?

Most of the time the baby's infection responds rapidly to antibiotics. Usually there are no permanent problems from infection. Permanent problems are most likely if the baby has meningitis, or if there has been severe low blood pressure for a long period of time.