Bringing Your Premature Baby Home from the NICU

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.

By Dr. Mackenzie Rodgers

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.