{"id":792,"date":"2024-10-17T10:28:51","date_gmt":"2024-10-17T07:28:51","guid":{"rendered":"https:\/\/pagim.net\/?page_id=792"},"modified":"2024-11-19T17:55:09","modified_gmt":"2024-11-19T15:55:09","slug":"%d7%a9%d7%9c%d7%91-%d7%94%d7%a9%d7%97%d7%a8%d7%95%d7%a8-%d7%94%d7%91%d7%99%d7%aa%d7%94","status":"publish","type":"page","link":"https:\/\/pagim.net\/en\/%d7%a9%d7%9c%d7%91-%d7%94%d7%a9%d7%97%d7%a8%d7%95%d7%a8-%d7%94%d7%91%d7%99%d7%aa%d7%94\/","title":{"rendered":"The homecoming phase"},"content":{"rendered":"

Coming home<\/strong><\/p>\n

At home<\/strong><\/p>\n

How much you dreamed of this moment, waking up in the morning, staying in your pajamas, bending over the crib and seeing your baby. Tidying up the room, buying baby products, buying clothes \u2013 all of this is behind you, and you are one step away from full-time parenthood. Simply taking him in your arms and being just you, together, at home, at your own pace and in your own quiet, without the beeping of monitors and approvals from nurses. At home, it quickly becomes clear to you that you are not "normal" parents like the parents of a baby born at term. Many premature babies still need various treatments, supervision and follow-ups, and many more than children born at term. You are usually perceived by those around you as slightly more "hysterical" parents, more concerned about his well-being and health, his development and nutrition. You are subject to the limitations and instructions you received at the preemie and are forced to come for more follow-ups. Learn to filter out "noise", listen to your intuition and the instructions you received at the preemie. In any case, we have collected some advice for the first period at home:<\/p>\n

Exposure to the world<\/strong><\/p>\n

One of the first pieces of advice that parents usually receive before discharge from the hospital is to avoid large crowds, crowded enclosed spaces (such as shopping malls), children and the elderly, and certainly not anyone who is sick. Despite our strong desire to act as if the hospital stay is a part of the past and that the child is just like any other child once discharged, this may be an illusion. The premature baby is at high risk for various health problems. Do not hesitate to explain this to relatives who want to visit, and even if you think they do not understand, it is better to have an offended aunt for two weeks than a child in intensive care.<\/p>\n

It is definitely recommended, depending on the weather, to go for a walk, in the fresh air, on the street or in the garden.<\/strong>.<\/strong><\/p>\n

Were they first or last?<\/strong><\/p>\n

Whether at Tippett Halav or at the private doctor or the health insurance fund, the first or last visitors are less exposed to other patients. Find out in advance if you can arrive first. Keep in mind that this option is more available at Tippett Halav and in cases of meetings with the pediatrician, this appointment will not always be available. Again, this is the place to coordinate expectations with the pediatrician, explain how anxious you are about the issue (especially in cases of extreme prematurity, low birth weight, chronic lung disease, etc.) Don't forget that the doctors are aware and understand the risk of infections in premature babies, talk to them and anticipate the issue. Some doctors will be available to you by phone and will be able to save you a visit or make special time in cases where the situation requires or allows. Don't forget - sometimes there will be cases where this option simply will not be available, it's stressful, it can cause anxiety, but when you need a doctor's examination - you must come.<\/p>\n

Primary nutrition<\/strong><\/p>\n

Breast milk is the best and most adapted food for the baby's needs. If the mother was able to pump and breastfeed a premature baby, the assumption is that she will continue to do so at home. There are quite a few cases of women who were unable to breastfeed a premature baby, but calmly at home, managed to achieve breastfeeding even with premature babies who were born at very low weights and weeks. Sometimes several different types of bottles are needed until they reach the bottle that is most comfortable for the child, so you can find out which bottle and nipple the premature baby used and initially find similar substitutes. We recommend that you first buy a small amount of bottles of different types and when you find the bottle that the child likes - use it. Try to reach some kind of agreement with the store regarding the return of unused bottles and receiving a credit for them. Some premature babies allow and even request that bottles be brought "from home" so that you can get the baby used to a certain type of bottle while still in the premature baby and continue with it even after discharge. Be sure to continue with the premature baby's instructions regarding nutrition. If you have received \u2013 combining bottles with breastfeeding, giving a supplement, or any other instructions. Don't forget to continue to monitor and consult with your pediatrician regarding any changes in diet and instructions, according to the baby's needs and growth.<\/p>\n

"Release" party, Thanksgiving, alliance<\/strong><\/p>\n

As a general recommendation, it is best not to expose the premature baby to a large number of people, young children or the elderly. Of course, it depends on the premature baby's condition, age, etc. However, many parents are interested in a celebration to mark the release, to celebrate a union, to feel "normal"; to try to see everyone at once and not bring too many people home alone. Consult with the obstetrician and your family doctor on this issue. Sometimes you will receive conflicting advice, but this is where your responsibility as parents begins to emerge. There are no longer doctors who will decide for you. There are only recommendations, and sometimes you will have to choose between different recommendations. This is not an easy task, but we are confident that you will reach the right decisions for you and your children.<\/p>\n

Follow the drop of milk<\/strong><\/p>\n

Before or immediately after discharge, contact the Tipat Halav clinic closest to your place of residence (at the health insurance company or at the stations belonging to the Ministry of Health). Ask a Tipat Halav nurse to make an appointment for you for the coming week. You will go there in the coming years to vaccinate the baby and monitor his growth and development. Make the appointment for opening or closing time, to avoid exposing the premature baby to other people and babies, for fear of contracting diseases. As part of a national project, a number of Tipat Halav nurses have undergone specialized training on premature babies. It is recommended to ask for a nurse who has undergone appropriate training in your area.<\/p>\n

Child development <\/strong><\/p>\n

What is meant by \u201cfollow-up at the Child Development Institute\u201d?<\/h2>\n

Among the many recommendations you will receive upon discharge from the neonatal intensive care unit, this recommendation will also appear. You may have already met with professionals in the field of child development during your stay in the neonatal intensive care unit, such as a physiotherapist, occupational therapist, speech therapist, or dietitian. After discharge, this professional team will meet with you to help promote the premature baby's development, reduce gaps, and prevent complications.<\/p>\n

Each baby is also monitored for development within the framework of "Tipat Halav," a multi-professional clinic uniquely tuned to the development of premature babies.<\/p>\n

Who will you meet at the Child Development Institute?<\/h2>\n

In the first stage, a developmental assessment is carried out by a neurodevelopmental doctor, a nurse and a physiotherapist. The doctor is the head of the team and guides the continued monitoring and treatment. If necessary, especially in premature babies with low birth weight or with eating or feeding difficulties, you will also meet with a dietitian, at any stage that is necessary. The baby undergoes a general, neurological and developmental examination and the doctor, and any professional - will assess whether there is a gap in the baby's functioning from what is expected for his age, what the recommendations are for reducing the gap if there is one, and what the recommended frequency of follow-ups is. At the same time, the parents will meet with a social worker who will provide information about the rights that are due to parents of premature babies and provide assistance in terms of exercising rights if necessary. Subsequently, the parents will meet, as needed and according to the doctor's decision, with professionals from the fields of occupational therapy, communication disorders (communication clinician), and developmental psychology.<\/p>\n

Why is it important to come to the Child Development Institute?<\/h2>\n

Since the Child Development Institute provides a multidisciplinary approach by a multi-professional team working in close collaboration, it is recommended to arrive early (up to three months from the moment of discharge from the hospital) in order to allow for the detection of developmental problems at an early age, early treatment as needed, and parental guidance on a variety of topics, such as: correct facilitators, transitions between facilitators (lifting the baby).<\/p>\n

and specific exercises that promote the baby's motor achievements and improve head and body control. According to the Ministry of Health guidelines, all premature babies born under 1500 grams must undergo follow-up at the Child Development Institute. Perinatal doctors can recommend this follow-up for additional babies, based on the course they underwent in the hospital. In light of the significant achievements of intervention at a young age, when the brain is in a process of rapid changes, it is important to emphasize the early signs that suggest a disability and to receive professional recommendations regarding the intervention of developmental treatments and treatments in the home setting.<\/p>\n

Premature infants from a neurodevelopmental perspective<\/h2>\n

One of the main issues that concerns parents of premature babies is the consequences of prematurity on their child's development. Below are answers to some of the common questions that parents of premature babies ask:<\/p>\n

Do premature babies develop like normal babies?<\/h3>\n

The answer is "yes and no." If we look at the progress of preterm and neonatal medicine in recent decades, we can see a significant improvement in medical care that supports the cardiovascular, respiratory, and gastrointestinal systems. The general improvement in the care of premature infants has significantly reduced the level of brain damage that causes severe neurological damage, but newborns born prematurely, especially extremely premature (under 32 weeks of gestation), are still at risk of brain damage. On the other hand, there is constant improvement in the care of various systems, such as: ventilation, maintaining body temperature, treating anemia, and preventing the growth of abnormal blood vessels in the eye.<\/p>\n

Why is the risk of developmental harm relatively high in premature babies, especially extremely premature babies?<\/h3>\n

The brain of a premature baby and the blood supply to the brain, like the premature baby itself, is still far from mature, especially in premature babies born before 32 weeks of pregnancy or with a birth weight of less than 1500 grams, and therefore - the earlier the birth and the lower the birth weight, the higher the risk of brain damage. Additional causes of brain damage in premature babies are: respiratory disease, infections, lack of closure of the fetal connection between the body's blood circulation and the lungs, or damage to the intestines of premature babies. The young age and low birth weight of premature babies, together with the health complications typical of premature babies, may cause decreased blood flow, bleeding, or inflammatory damage to the premature baby's brain. The severity of the damage to the brain is enhanced due to the immaturity of the brain and significantly increases its sensitivity to damage - all of this at significant stages of brain development. The encouraging part is that despite the high risk of brain damage, as a result of improved treatment in recent decades, there has been a significant decrease in brain damage that causes severe developmental disabilities.<\/p>\n

What are the implications of brain injuries?<\/h3>\n

Significant brain injuries, the incidence of which increases significantly in the risk groups defined previously, include: cerebral palsy (5%), visual impairment (3%), hearing impairment (3-1%),<\/p>\n

Intellectual disability (7%), social communication impairment such as autism (10-5%) and epilepsy (2%) to milder impairments (which are common) including coordination problems, sensory processing problems, language impairments and social communication difficulties, the prevalence of which ranges in various articles between % and 20-50 premature babies.<\/p>\n

The risk of developmental impairment in premature infants born after 32 weeks of gestation is significantly lower (assuming that the stay in the premature infant was without complications). These premature infants may also suffer from mild neurological complications at a higher frequency.<\/p>\n

When do you see the damage?<\/h3>\n

Brain imaging in US or MRI in prematurity is a useful tool for early detection of brain injury. It should be remembered that this is a prediction and although we know the risk of developing an injury in connection with a particular finding on imaging, there is always the chance that there will be no injury at all. It is important to note that neurological examination during prematurity is very limited and insensitive (unfortunately also for predicting normal development), so assessments of developmental injury based on neurological examination alone should be taken with limited confidence. Developmental examination can identify risk, but the level of certainty increases as age advances.<\/p>\n

How will I know if my baby is developing well?<\/h3>\n

The development of a baby born at term is similar to that of a premature baby according to his corrected age. Neurological development can be affected by a lack of weight gain in the premature baby, and a neurological problem can be reflected in small head circumferences for age. Hence, monitoring weight gain and head circumference is of great importance in premature babies. An increase along the growth curve of head circumference and weight is very encouraging in terms of neurological development, but on the other hand, deviation from the curves increases the risk of developmental impairment. The high risk of hearing and vision impairment in premature babies requires tests at the age of several months. An ophthalmologist will check the maturity of the blood vessels in the retina. The auditory system is tested by BERA\/ABR tests that test the neural activity of the auditory system directly by electrodes that record its activity. This is not the place to go through all the milestones of a baby's development, but it is important to note a number of developmental "milestones" (up to the age of one and a half) that parents should pay attention to. We note again that a proper neurological examination before discharge is limited and neurodevelopmental problems may appear in the first months of life:<\/p>\n

Around 3 months of age: The baby should make eye contact, follow and smile at their parents, make meowing sounds, and lift their head when lying on their stomach. Lack of eye contact, inability to lift their head from the bed (hypotonia), tilting the head to one side (torticollis), movement of one side more than the other, or lack of response to sounds are red flags.<\/p>\n

Around 6 months of age: Most babies will roll over from their stomach to their back and vice versa, move from side to side in bed, reach for an object and pass it from hand to hand. They will mumble and have a mutual "conversation" of making sounds with their parents. Red flags will include increased muscle tension, mainly in the legs (which will make swaddling difficult) or one side of the body (which will cause asymmetry in body movements) as well as the baby's lack of responsiveness to the environment (reaching for objects or turning the body or eyes to people approaching them), or a baby who does not make sounds (a baby who is too quiet).<\/p>\n

Around 9 months of age (corrected): Most babies will begin to crawl and\/or sit up, put objects in a box, follow an object that has disappeared, begin to say syllables, respond to their own name, and develop a clear distinction between familiar and unfamiliar people. The range of acquisition of these abilities is wide, and a distinction must be made between a delay in acquiring the ability to crawl or skipping a stage. Motor delay can be a "red flag" at this age if there is increased muscle tension, asymmetry in body movements, and a delay in establishing communication by seeking parental contact.<\/p>\n

Around one year of age (revised): The baby is expected to pull himself up to a standing position and walk along objects, is expected to tap blocks and try to feed himself with a spoon. Linguistically, he can acquire first words, point to objects he is interested in and seek contact with his parents to get their approval for his actions or to show them new things he has learned. New red flags in addition to the movement problems described earlier are lack of pointing and lack of reciprocal contact with parents.<\/p>\n

Around the age of one and a half years revised: The baby is expected to walk, build a tower of 3 blocks, scribble on a piece of paper, acquire a vocabulary of 20-50 words, recognize several body parts and animals, understand simple instructions such as "bring the ball" and play reciprocal play. Red flags are a lack of word acquisition and a lack of reciprocity in the connection between the baby and the environment.<\/p>\n

What can a parent do to promote the development of their premature baby?<\/h2>\n

During the stay in the neonatal intensive care unit, it is of great importance to create a connection of touch, voice, and visual contact between the parent and the premature infant \u2013 it all depends on the infant's health. Body-to-body contact, speaking or singing, and making eye contact have been proven in many research studies to improve the development of premature infants and the bond between the parents and the premature infant. It is very important during the stay in the neonatal intensive care unit and even after discharge to maintain optimism regarding the premature infant's future development, partly because the prediction of developmental damage is limited, but mainly because optimism will improve the bond between you and the premature infant.<\/p>\n

What is the importance of monitoring in child development institutes?<\/h2>\n

After discharge, the premature infant should be treated as any other newborn infant and according to the recommendations of the premature infant care team. Parents of premature infants born before 32 weeks of pregnancy, with a birth weight of less than 1500 grams, or with suspected brain damage or developmental delay should begin follow-up at the Child Development Institute by the age of three months (depending on urgency). Initial diagnosis and follow-up are of great importance. Many studies have shown that early identification of a developmental problem and early intervention have led to improvements in the abilities of premature infants at later ages. Working in a multidisciplinary team is critical to providing care that meets both the needs of the premature infant and the support for the family during the upbringing of a child who is at risk for significant developmental problems.<\/p>\n

In conclusion<\/h2>\n

Prematurity, especially extreme prematurity, carries a risk of developmental delay. Gaps can be narrowed and the development of the premature baby can be promoted. From the parents' perspective, maintaining optimism, along with receiving recommendations and working together with child development professionals, will help promote and improve the functioning of the baby and his family.<\/p>\n

Participated in writing the episode:<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
Institute Director<\/td>\nDr. Lydia Gabis<\/td>\n<\/tr>\n
Neurodevelopmental doctor
\nAnd in charge of a clinic<\/td>\n		Dr. Omer Bar Yosef<\/td>\n<\/tr>\n
Speech therapist<\/td>\nDr. Ariella Yokel, Head of the CT Team
\nDorit Shmartz, Adi Golan-Yitzhaky<\/td>\n<\/tr>\n
Physiotherapists<\/td>\nYaffe Krakow-Bogen, Head of Physiotherapy Team
\nSherry Stoller<\/td>\n<\/tr>\n
Occupational clinics<\/td>\nShamona Lev-On, Head of Occupational Therapy Team
\nTova Shoten<\/td>\n<\/tr>\n
Psychology<\/td>\nRebecca Sofrin, Head of the Psychologist Team
\nDeal Saba<\/td>\n<\/tr>\n
Organizations<\/td>\nMeirav Herman-Raz, Head of the Social Welfare Team
\nSharon Segal-Prizat<\/td>\n<\/tr>\n
Clinical Dietitian<\/td>\nYael Shemaya<\/td>\n<\/tr>\n
matron<\/td>\nElla Aviv<\/td>\n<\/tr>\n
Linguistic editing<\/td>\nShirley Fisher<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u00a0<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

Questions and answers.<\/strong><\/p>\n

Here are a number of questions and answers to help provide an initial response to the issue. We would be happy to hear suggestions for additional topics that you think are missing from the site.<\/p>\n

 <\/p>\n

When does the grace period end?<\/strong>
\n<\/strong>The answer to the question of when the grace period ends is not at all simple.
\nThere is a cold external observation that claims that after a year or two, the delays are no longer taken into account. There is a more individual observation that gives the child more freedom and less attachment to schemes, and of course \u2013 there are families, whether children or parents, for whom the consequences of the delays never go away.
\nIn order to help those premature babies cope with the reality they face, we bring here a list of support and assistance institutions for the continuation of the premature baby's life. We hope that we have helped you as much as we can during the premature baby years and wish you the easiest possible way to cope with what lies ahead. Examples of helpful associations: Nitzan, Akim, Shekel, First Step, Shekel, Etgarim\u2026.<\/p>\n

 <\/p>\n

When is my breastfeeding time? <\/strong>
\n<\/strong>A full-time employee who returns to work after maternity leave (paid) will be entitled to one less hour of work per regular workday, for breastfeeding purposes, for up to 4 months after the end of paid maternity leave.
\nAn employee who went on unpaid maternity leave following paid maternity leave will receive breastfeeding time if she returns after the end of the four months following maternity leave, until the end of the four months.
\nAn employee who returns to work after these 4 months have elapsed will not be entitled to breastfeeding time.<\/p>\n

Until when can we vaccinate against rotavirus? <\/strong>
\n<\/strong>The vaccine against rotavirus is limited to newborns, and therefore parents of premature babies sometimes miss the opportunity to vaccinate their child due to the burden of treatments, tests, and events.
\nWe recommend that you contact your health insurance fund branch after your discharge to clarify until when you can receive the vaccine through your health insurance fund (there are two types of vaccines and the Ministry of Health sometimes changes the treatment definitions).<\/p>\n

 <\/p>\n

Are we entitled to a referral for child development?<\/strong>
\nAny premature baby born weighing less than one and a half kilograms is automatically eligible for referral to the Child Development Center (Medical Director Circular).
\nIf your personal doctor or Tipat Halav nurse did not refer you - contact the office directly and ask for a referral. Link to PDF of the circular It is very important to know what your child development center contains because a "real" child development center contains a variety of options, including speech therapists, psychologists, physiotherapists and more.
\nThere are cases where developmental monitoring and medical monitoring are confused, and both should be followed if necessary.
\nIn addition to the automatic referral, there is an unequivocal directive to give priority to premature babies in queues at child development centers. Due to the long queues, a directive was recently issued that budgets the customs.
\nThe time for various inquiries and allows a refund for private inquiries after a predetermined waiting time.<\/p>\n

What should I know about syllable testing? <\/strong>
\nA syllable test, also known as an ABR test, is a brainstem conduction test for sound stimuli.
\nThe test should be performed while the child is sleeping. Two important things you should know are:<\/p>\n

    \n
  1. There are places that put the child to sleep using anesthesia, but there are also places that wait for the child to fall asleep naturally.
    \nEach of them has advantages and disadvantages, but it is important to know about the options before you take the test.<\/li>\n
  2. It is of great importance during the examination to check for fluid in the ear, wax, etc.<\/li>\n<\/ol>\n

     <\/p>\n

    What about the monitor? How do you raise a child without one? <\/strong>
    \n<\/strong>This is a very typical question for parents of premature babies.
    \nAfter getting used to and attached to monitor devices, most parents feel a certain pressure to raise a child who is not connected to monitors.
    \nExcept in cases where the child was released with clear instructions to rent a monitor, there is no need for a complex monitor, and what is true for all children is also true for premature babies.
    \nDespite all this, and out of understanding the parents' mental state, we definitely recommend using a home monitor of the type used by all Israeli children.<\/p>\n

    \u00a0<\/strong><\/p>\n

    I have a problem - who should I contact? <\/strong>
    \nOf course, to us - to the Lahav Association - for the premature babies in Israel.
    \nYou can contact us via email. info@pagim.net<\/a> \u00a0Or hotline: 03-9533935
    \nYou can contact us on any issue: rights, vulnerabilities, deficiencies, needs, questions, clarifications, laws, regulations, suggestions, and of course \u2013 joining and donations.<\/p>\n

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