Barnaul neonatologist Yulia Miller nurtures 650g newborns

Premature babies are little heroes. They begin their fight for health from the first minutes of life under the supervision of neonatologists. For 30 years, Barnaul physician Yulia Miller has been nursing tiny babies whose birth weight is often less than one kilogram. In a conversation with NGS22.RU, she spoke about how a child’s health is assessed in the first minutes of life, how to notice even the slightest changes, and what sudden infant death syndrome is.

“Catching warning signs in the little things”

Neonatologists work with children during the very first and most difficult days of their lives — from birth to 28 days. During this period, congenital developmental defects, hereditary diseases, or metabolic disorders may manifest. Doctors pay special attention to the condition of the heart and breathing.

“A child can’t tell you what hurts, so we rely only on indirect signs. A neonatologist must catch warning signs in the little things: changes in breathing, heart rate, skin color, stool or urination patterns. Interaction with mothers is especially important, as they are with the child and can tell if there have been changes,” explained Yulia Miller.

The first seven days of a child’s life are considered a borderline state. During this period, the doctor must understand whether the process is pathological or physiological. Professional skills are only a small part of a neonatologist’s work. The specialist must also be empathetic both to the child and to their family.

“Parents of sick newborns are under severe stress, so the doctor must be able to maintain tact and explain the situation, and also guide mothers on how to interact with the child, care for him, feed him,” emphasizes the doctor. “In addition, we ourselves burn out, so we regularly attend supportive therapy with psychologists to relieve stress, because we always have to keep our finger on the pulse.”

Why can premature birth happen?

Reasons why a child is born prematurely may be related to both the condition of the fetus and the health of the mother herself.

“From the child’s side, these can be congenital developmental defects that formed in utero, or various infectious factors. If the mother, for example, falls ill, she may develop placental insufficiency, which can lead to premature birth. From the mother’s side, even before pregnancy, various somatic diseases such as diabetes or high blood pressure can influence this. In addition, the average age of first childbirth has changed: if earlier a girl giving birth at 28 was considered ‘old primipara’, now that term has almost fallen out of use, and the average age of first-time mothers has shifted to 32. At this age, women are emotionally ready for childbirth, but their health is already not quite the same,” explains the neonatologist.

According to the specialist, on average in Russia, about 10% of children are born prematurely, in Altai Krai this figure is approximately 6%. Among other things, thanks to a comprehensive approach to care, clear routing of pregnant women and newborns, infant mortality in the region has significantly decreased in recent years. This rate is 20% lower than across Russia.

“Risks, of course, remain. One of them is the so-called sudden infant death syndrome. Its etiology has not been fully studied, some speak of an infectious nature, others of heart rhythm disturbances. In Altai Krai, about 3–4 children per year die from sudden infant death syndrome, in their sleep, when obvious causes simply cannot be found. Therefore, when discharging mothers from the hospital, we give them a memo on how to avoid this. For example, soft toys, bumper pads, or extra blankets are not recommended, nor is the child sleeping in the same bed with parents. In the first months of life, it is better to remove everything from the child in which they could become entangled and suffocate,” warns the medical professional.

Second mother

The time it takes to care for premature babies directly depends on the gestational age, that is, the process of carrying the fetus in the womb.

“If a child is born at 30 weeks, they will be in the hospital for about 6–8 weeks; if at 22 weeks, then, of course, longer. The shorter the gestational age and weight, the more time is needed for the baby to be safely outside a medical facility,” said Yulia Miller. “One of the main criteria for discharge is the mother’s readiness to care for the child without medical equipment, although we now practice cohabitation of parents with children in the hospital or intensive care unit, where there is a heated crib, oxygen supply system, and monitoring. For such children, tactile sensations come first, so a mother needs to be nearby, holding her hand on the child so that they feel her warmth, because their senses are reduced.”

When the child approaches full term, various methods are used: music therapy, conversations, and the now popular knitted octopuses that help tactile stimulation of infants.

Over the years of work, Yulia Miller has had to help children with very low weight — 650 grams, which is considered ultra-low body weight. Even babies with higher weight can have serious problems and need long-term care.

“When you discharge a healthy newborn or a nursed child, you see the result of the joint teamwork of doctors and parents. And this especially motivates you to continue working. Most pleasant is when on my birthday they send me not just a card, but a photo of the child I cared for. Some have children who are already adults, studying in schools or universities, and the parents still remember our work and send photos with gratitude,” shared the doctor.

According to her, there are also those who note that a neonatologist helps a child like a second mother.

“We did not give birth to these children, did not carry them, and, of course, did not breastfeed them, but when you put all your strength and resources into nursing, hearing such words is very valuable. I have a family where, for example, there were two premature children — now those kids already live in other cities, but we continue to call and meet on holidays. And every time it’s nice to see how they grow and what they achieve,” summed up Yulia Miller.