As reported by the New Britain Herald, February 14, 2005.

Premature Babies Better Off with Hands-On Parents

By Tricia Stuart

FARMINGTON  - ‘Premature babies come into the world with all kinds of challenges," says Cathy Daguio, infant development specialist and developmental program coordinator at the University of Connecticut Health Center.

"Attachment develops in its own time but early experience and contact matters. Positive relationships early on help the relationship develop positively later, even in the face of early challenges. Part of [helping premature babies] is helping the parent be a parent. When the baby is ill that can be frightening," said Daguio.

A big part of what the baby needs is emotional support, according to Daguio. "Babies and families need nurturance. It’s a crisis for the family to have a baby with long-term health issues. It is highly complex medical management. It’s hard for the family to form a connection with a baby who doesn’t look right, who has these health issues, and who maybe doesn’t respond the way a full-term baby would. We put a lot of energy into informing the family about the baby’s needs, that it needs the family’s nurturance and presence and the emotional support of the family. Even if we are nice and gentle, we cannot replace the family for that baby," she said.

Parents don’t always know how to give reassuring touch to a baby, especially if that baby is in an incubator and has developmental problems from the beginning.

"When the baby can come out of the incubator and be held by the parent, we promote skin-to-skin contact so the baby can feel that closeness," she said.

Kangaroo Care is a coined phrase that means skin-to-skin contact. It started in Bogota, Columbia, and other areas where there were limited resources and where they didn’t have enough incubators to help premature babies.

"Babies who would not have survived experienced skin-to-skin survival," Daguio explained. "Temperature regulation was an issue."

Kangaroo Care was used in Australia, in Europe, and then came to the U.S. Babies slept better, and studies found that the babies were better off. It was later found to help sicker babies. A ventilator doesn’t prohibit skin-to-skin contact, Daguio said, and a dark, soothing environment helps.

The practice was extended in some U.S. cities, where the parent holds the baby for long periods of time. The mother or father may hold the baby. It is emotionally helpful for the baby to be able to smell the mother’s breast, even if the baby isn’t ready for feeding.

It used to be thought that premature babies needed extra stimulation, but further evaluation showed that it was all too easy for preemies to become overloaded by the sensory stimuli in their environment. Babies are protected and secure in the environment of the womb. When babies are pushed out into the harsh reality of life outside the womb, especially if they haven’t come to the full nine-month term, it’s a major shock on a vulnerable, inchoate infant.

"The challenge to neonatal care workers and therapists is to provide an environment that is nurturing, rather than bombarding, that will help them feel comfortable and to develop normally. The environment has to help them undergo the procedures, many of them painful, that are designed to help them," she said.

"A preemie’s sensory system may be easily overloaded and so may not be available for robust interaction. Parents learn to take their cue from the baby and these things may make it more challenging for the parent to connect with the baby."

The situation can be frustrating for the parents. They see experts who care for their baby, and it can make the parent feel a lack of confidence. The staff has to be careful in helping the parents feel confident. Daguio and her staff are acutely aware of this.

Infants and their families and the staff all go about the task of nurturing differently. Both technological and emotional aspects play a part in the development of a premature baby.

"It’s about supporting this growing organism who happens to be a person," she said.

Families come from all sorts of different backgrounds and abilities. We respect the unique personhood of the infant. We bring our expertise and training in development, and we consider the infant as part of the family," she said.

Caregivers are helping the developmental stage of the infant, and looking at the tasks and how those tasks are handled. They look at it from the baby’s unique stage of development and also from their experience in developmental issues; they observe and take in the whole picture, but they are no replacement for the parents.

While problem solving, and evaluating how to bring the caregiver-parent tasks and the relationship of the parent and child to the fore, it’s important how the parent reads and experiences their infant.

"Parents observe and comment, ‘Oh he awakens more now. ’The parent notices more because they aren’t as busy as the staff who have lots of babies to care for," Daguio said.

UConn is equipped to care for babies that other facilities can’t manage, Daguio said, but sometimes parents come from the other side of Connecticut and driving the distance regularly for months at a time can be a challenge.

"The big thing is helping the parents feel like parents," said Daguio.