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Caring for Sick Neonates

by Deborah M. Consolini, MD

Difficulties arise when a sick or premature infant must be taken away from the family after birth because of illness. The parents may not be able to see a critically ill infant during stabilization and may be separated from the infant because of transport to a different hospital. Some infants require prolonged separation from their families because of lengthy hospitalizations and treatments. Experts now recommend that neonatal transport teams encourage physical contact between parents and their sick infant before moving the infant to the specialty care center.

Many hospitals have recognized the importance of encouraging contact between infants and their families. In most places, parents are encouraged to visit, taking precautions to minimize the risk of spreading infections. Many hospitals have unlimited visiting hours for parents. Some hospitals have areas in which parents can stay for prolonged periods to be near their infant.

In most hospitals, parents are encouraged to interact with their sick infant as much as possible. No infant, even one on a respirator, is too ill for the parents to see and touch .

Parents are also encouraged to provide direct care for the infant as a way to get to know the infant and to prepare for taking the infant home. Some hospitals increase contact between parents and premature or sick infants by encouraging skin-to-skin contact; this may help parents feel more confident about taking care of their infant at home. Infants who experience skin-to-skin contact gain weight faster when compared with those who do not receive such care. Mothers can also provide breast milk directly or pumped to be given through a feeding tube.

When an infant has a birth defect, the parents should see the infant as soon after birth as possible, regardless of the medical condition. Otherwise, they may imagine the appearance and condition to be much worse than the reality. Intensive parental support is essential, with as many counseling sessions as are needed for parents to understand their infant’s condition and recommended treatment and to accept the infant psychologically. To balance discussion of abnormalities, the physician should emphasize what is normal about the infant and the infant’s potential.

When neonates die without having been seen or touched by their parents, the parents may later feel as though they never really had a child. Such parents have reported exaggerated feelings of emptiness and may develop prolonged depression because they could not mourn the loss of a “real” child. Parents who have not been able to see or hold their infant while alive will usually be helped in the long term if allowed to do so after the infant has died. In all cases, follow-up visits with the physician and a social worker are helpful to review the circumstances of the infant’s illness and death, answer questions that often arise later, and assess and alleviate feelings of guilt. The physician can also evaluate the parents’ grieving process and provide appropriate guidance or a referral for more extensive support if necessary.

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