Sodium Chloride Supplements
Babies can experience low levels of sodium (salt) in their blood. To increase sodium levels, they are given sodium chloride supplements and/or the volume of their feeds are reduced. Sodium chloride supplements are given to the baby in a small volume of milk or using a nasogastric tube. As soon as sodium levels return to normal, the supplements are weaned-out. The medical team will monitor the baby’s blood during and after supplementation to ensure the sodium levels remain within normal limits. If sodium levels remain low with treatment, the baby may require referral to another specialised area in the hospital.
Vitamin K
Vitamin K helps the blood to clot to stop bleeding. Babies are born with low levels of Vitamin K and are at risk of developing a bleeding disorder called ‘haemorrhagic disease of the new-born’. To reduce the likelihood of developing this bleeding disorder, babies get Vitamin K at birth.
Cork University Maternity Hospital (CUMH) gives parents information about Vitamin K during the antenatal period and on admission to the delivery suite. If you give your consent for your baby to receive Vitamin K, they will receive a Vitamin K injection (Konakion) into their thigh muscle at birth. This is a once-off infection, given in the delivery suite. However, if your baby is urgently transferred to the neonatal unit (NNU), they will receive the injection there. There may be a slight swelling around the injection site for a few days.
Alternatively, Vitamin K can be given orally (taken by mouth). With oral administration, your baby will receive Vitamin K 3 times over 1 week; at birth, day 3 of life, and day 7 of life. If you have a strong preference for oral administration over injection, please tell the medical team.
Galfer
Premature babies are prone to having low levels of iron in their blood, called anaemia. Iron has many important functions in the blood such as the transport of oxygen throughout the body. To increase iron levels, an iron supplement called Galfer is used. Galfer comes in liquid form and is taken orally.
In general, preterm babies who are less than 35 weeks’ gestation and are exclusively breastfed are given Galfer. Although breastmilk is best for baby, it generally contains a little less iron than is required by a preterm baby. If your baby requires iron, Galfer will be given to them daily. You may need to give your baby Galfer after they leave CUMH and until further review in the Outpatients Department. If so, you will be given a prescription for Galfer at discharge.
The formula feeds designed for both preterm and term babies are supplemented with iron and are typically richer in iron than breastmilk. Hence, Galfer is not normally given to babies who are being formula fed. If you decide to wean your baby off breastmilk onto formula, consult your doctor about discontinuing this medication.
If your baby requires medication the medical team will teach you everything you need to know before you leave the hospital
Abidec®
Abidec® is a liquid multivitamin supplement. It is often prescribed to babies who are less than 35 weeks’ gestation and when more than half of their feed is breastmilk. Although breastmilk is best for baby, it sometimes does not meet the vitamin and mineral requirements of a preterm baby. In general, Abidec® use is stopped before discharge home.
Vitamin D
Vitamin D is known as the ‘Sunshine Vitamin’ because our bodies can make Vitamin D from the sun’s ultraviolet B rays hitting our skin. Vitamin D has many important functions in the body such as supporting the immune system and building and maintaining strong bones and teeth.
The overall population in Ireland have low levels of Vitamin D. Reasons for low Vitamin D levels include dense cloud coverage, the extent that clothing covers skin, and the use of sunscreen; all prevent us getting enough exposure to sunlight. The condition caused by very low Vitamin D levels is called Rickets. This condition is rare, but can occur if a baby does not get enough safe exposure to sunlight and/or Vitamin D supplementation.
The best form of Vitamin D supplements is Vitamin D3. The recommended daily dose for all babies is 5 micrograms (μg) over the first year of life. Some premature babies require greater than the standard dose of Vitamin D3 to help with their growth. The medical team will identify this requirement. Vitamin D3 is available in liquid form in pharmacies and there are many Vitamin D3 products available. You can find a list on the website www.hse.ie/vitamind
Caffeine
Caffeine supports premature babies with their breathing. It is used in the neonatal unit in a number of situations. For example, during apnoea of prematurity, i.e. when a baby pauses or briefly stops breathing or when a baby comes off mechanical ventilation to ‘continuous positive airway pressure’, CPAP or to start normal breathing.
Caffeine is administered on a daily basis, and is generally given orally but can be given intravenously (into vein). As soon as the baby is stable, they will be either weaned off caffeine, or it will be discontinued immediately.
A baby prescribed caffeine will have their breathing rate continuously monitored for up to 5 days after their last caffeine dose. This is because caffeine has a long half-life in the body - it can stay in a baby’s body for up to 5 days. Babies are not discharged home on caffeine. If a baby is ready for discharge, but have received caffeine with the past 5 day, they will be kept in the NNU until 5 days have passed since they last received caffeine.
If your baby requires medications on discharge home, the medical team will teach you everything you need to know before you leave the hospital, i.e. how much to give, how best to give it, when to give it, etc., as well as providing you with a prescription.