NICU

Bringing Your Premature Baby Home from the NICU

By Dr. Mackenzie Rodgers

A new baby requires significant time caring for their needs, but it is also important for parents to care for themselves. While in the NICU and at home, new parents should ask for help from close friends and family.

A premature baby is one who is born early, before 37 weeks of pregnancy. In the US, each year about 1 in 10 babies are born prematurely. The earlier infants are born, the more likely they are to have health problems and require NICU care.

Babies born very prematurely require weeks to months of care and may need to stay in the NICU until their due date or beyond. Slightly premature babies, sometimes called late pre-term, may require only days of NICU care and may be ready for discharge several weeks prior to their due date.

All NICU parents want to know when their baby will come home from the hospital. While the exact timing will be different for every baby, they must all meet some basic criteria.

To be discharged home from the NICU, each baby must be able to maintain their temperature, take all their food by mouth, no longer require respiratory support, and be growing. Premature babies typically require heat from a warmer or incubator during their NICU course. For discharge, they must be able to maintain their body temperature in a crib for at least 24-48 hours.

Feeds may be given with a nasogastric or orogastric tube (a tube that passes through the nose or mouth to the stomach) while they are learning to coordinate sucking, swallowing and breathing while feeding. Babies must be taking all of their milk by breast or bottle without supplemental tube feeds in order to go home. Not all NICUs have a weight minimum for discharge but many require infants to weigh at least 4 pounds with good weight gain.

Some premature babies have breathing problems and may require oxygen or a ventilator to assist with their breathing. Premature infants need to be breathing on their own without oxygen or prolonged pauses in their breathing, called apnea, for discharge.

In addition to discharge criteria, babies undergo screening exams, including a state newborn screen, a hearing screen, and an eye exam (if indicated). Most NICUs require a car seat test. During this test, the infant’s oxygen levels are monitored with them secured in their car seat. Immunizations according to age should be given as well as the RSV prophylaxis, if baby meets specific criteria.

As the premature infant is nearing discharge, parents should participate in caring for them with the NICU nurses as often as possible to assure they are comfortable providing care. Parents should call their health insurance company and have the baby added to their policy. Parents should also consider enrolling in a CPR course if it is not provided by their NICU. It is important to pick out a pediatrician to care for your preemie after discharge and call them to assure they are accepting new patients. Most premature infants need to be seen by their pediatrician within two to four days after discharge. Once home, parents should plan to limit visitors and avoid public places until their preemies immune system is stronger, and discuss specific recommendations with their baby’s doctor at discharge.

A new baby requires significant time caring for their needs, but it is also important for parents to care for themselves. While in the NICU and at home, new parents should ask for help from close friends and family. A NICU stay can be an emotional and stressful time, and some women experience baby blues or more serious postpartum depression. It important for new moms to contact their obstetrician if they have any concerns or need additional support.

Dr. Mackenzie Rodgers is a neonatologist affiliated with Brookwood Baptist Medical Center.

Transitioning your child to becoming an older sibling is both exciting and challenging. While adding another child to the family provides your older child with a lifelong friend and playmate, the soon-to-be big sibling may feel reluctant to share their turf. Many parents worry about how their child will react to a new baby in the house and do their best to reassure their big kid that they are still very much loved and an important part of the family. There are some things you can do to make the transition easier for everyone. Here’s some simple do’s and don’ts for each stage of the process of adjusting to a newborn in the home.

DURING PREGNANCY What to expect: Your child may anticipate that a change is coming as they watch you prepare the nursery and get things in order. They may start to act up because they don’t fully understand what is going on and the idea of a new baby seems abstract.

• Do put off big changes like potty training or transitioning to a big kid bed. • Do get a baby doll for big brother or sister to practice baby care. • Do read books about families who add a new baby to the house. • Do take the siblings class at the hospital, if offered and age appropriate. • Do spend extra time with your child and reassure them that you love them. • Don’t blame your limitations on the baby or the pregnancy which can create negativity associated with the baby. • Don’t promise an instant playmate. AT THE HOSPITAL What to expect: When your child visits you at the hospital, expect him to be off their routine and possibly out of sorts. Your child may feel scared because she sees mom in bed and may worry you are sick. Some kids will seem aloof, worried, or act up because they are unsure of their surroundings. They may also feel nervous about meeting the baby everyone is excited about.

• Do greet them excitedly. • Do make a big deal about the baby and the new big sibling. • Do give them some undivided attention. • Do take lots of photos of the big sibling moments. • Do have some items to play with during the visit. • Don’t frighten them when it comes to holding the baby. • Don’t stay too long, know your child’s time limitations.

AT HOME What to expect: It is normal for your child to feel left out and jealous. Your child may go out of their way to get extra attention in both a positive and negative way. It’s normal for your child to have a variety of emotions – excitement, joy and pride, but also sadness, frustration and jealousy. It takes time to adjust to a new family member.

• Do let them help with baby care (bring a diaper to mom, go get a clean blanket, sing a song to baby). • Do set aside time to spend time alone with your big kid. • Do let them know baby loves them and looks up to them. • Do set up for distractions – have some books available to read while you are nursing or busy with baby care. • Do make baby wait while you help your big kid. • Do show them the benefits of being a big kid – big kids eat ice cream, play at the park, watch movies, and stay up later. • Do reassure them you love them. • Don’t place expectations that are too high. • Don’t expect things to be exactly the same as before. Whenever you add another person to the family, it is a big transition. Things will be different. • Don’t be surprised if your child has some behavior issues; try to be patient.

Adding another child to the family is a huge transition for any family. In time, things do fall into a routine and you will not remember when your newborn wasn’t part of the family.

Sarah Lyons is a freelance writer who has been published in more than 150 parenting publications.

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