Introduction to Premature Babies

All About Preemies: From Birth to Hospital Discharge

Your tiny bundle of joy is here and you are now parents of a premie. Congratulations! Unfortunately, few parents are prepared for being the parent of a premie, and life in the neonatal intensive care unit (NICU) is probably something you only saw on TV if that. What do you need to know from the time of your baby's birth until the time of hospital discharge?

While the number of weeks you were when you gave birth may be etched in your mind, know that Day 1 of your preemie's life is the moment that everything changed. On that day, whether it was due to preterm labor or health complications for you or your baby, your world got a whole lot brighter. But with new life, parents of preemies deal with the harsh reality of the fragility of a premature birth. Let's sort through those emotions and learn what to expect as your premature baby grows and develops day by day.

1
Understanding Your Emotions

'Newborn premature baby girl, just two days old, resting on her mother's breast.'
What should you know as the parent of a premie from the time of birth until the time of hospital discharge?. Casenbina/E+/Getty Images

Premature birth is a traumatic experience for any family. The normal fears every parent experiences are amplified by the heightened risk of health problems that you may feel unprepared to handle. Having a premature baby is hard in so many ways!

It's OK to allow yourself to cry, laugh, scream, and pray as you live with the ups and downs of caring for your preemie. There are so many emotions and the one you are experiencing can vary minute to minute. No emotion is right or wrong, and it's normal to feel overwhelming joy and incredible anger or sadness all at the same time.

Work through each emotion without judging yourself, your partner, or close family. If at all possible, only talk with friends and family who can be positive and nonjudgmental. Acknowledging all of your feelings, both the good and the bad is important in coping with having a premature baby.

The emotions you feel can be intensified if well-meaning but less than tactful people ask what caused your premature delivery. When people ask you why it happened, you may alternate between breaking down in tears and wanting to deck the person. People don't usually make these comments to cause you pain. Rather, most people aren't sure what to say. If you're tiring or getting angry about these comments, gently remind your loved ones that nobody knows why premature births occur and you would appreciate that your loved ones simply love you and support you at this time.

2
Parenting in the NICU

Newborn NICU baby sleep soundly
Your main role in the NICU is to love your child. Jill Lehmann Photography/Moment/Getty Images

Becoming a parent in the NICU is no easy task. You may have never imagined what the NICU environment would mean for you and your newborn child so it's normal to feel out of place and uncomfortable in such a restrictive environment. 

Depending on how early your baby was, he or she may be in the NICU for a few days or a few months. The most important role you play in NICU life is as a loving parent to your child, and an advocate for your baby to the doctors and nurses who are providing care.

It can be helpful (and reduce anxiety) to familiarize yourself with some of the equipment you will see that makes the scary noises and beeps both day and night. NICU equipment, from umbilical catheters to ventilators to ECMO (extracorporeal membrane oxygenation, a type of life support that infuses oxygen into the blood and removes carbon dioxide), is often less frightening if you understand the particular role each of these devices plays in supporting your baby.

3
Health Concerns For Your Premature Baby

Close up of African American premature baby
What health concerns may be an issue in a premature baby?. ERproductions Ltd/Blend Images/Getty Images

In general, babies born in the earliest weeks of pregnancy are at risk for the largest number of health problems related to prematurity. However, many preemies are healthy from birth and need NICU care only long enough to grow big and strong.

It can be frightening to hear about all of the potential complications of prematurity, but keep in mind that most children do not experience all of these problems. Having a knowledge of common health issues is also helpful when trying to understand many of the "preventive" procedures performed with premies, and why some of the stringent rules in the NICU are necessary. Common issues include:

  • Apnea of prematurity
  • Jaundice
  • Respiratory distress syndrome (RDS)
  • Intraventricular hemorrhage (IVH)
  • Reflux
  • Retinopathy of prematurity
  • Patent ductus arteriosis (PDA)
  • Bronchopulmonary dysplasia (BPD)
  • Sepsis

If you are wondering what your child should weigh, what the most common concerns at a different stage may be, and when things such as kangaroo care may be initiated, looking at images and descriptions of premature babies week by week can help ease your mind.

There are also some long-term health issues associated with prematurity, but the risk of these conditions has improved remarkably in the past few decades.

4
Bringing Baby Home From the NICU

Mother and baby in car.
What happens when your baby is ready to go home from the NICU?. Guido Mieth/Taxi/Getty Images

Though you've probably thought about taking your baby home very often, when the time for NICU discharge comes, you will probably feel a bit of anxiety (understatement).​

After having care around the clock, you will be responsible for your baby alone. Though great joy accompanies this important milestone, you may find yourself feeling unprepared and very nervous about caring for your baby without the support you received in the NICU. If you are feeling this way, you are normal. You are not alone!

Don't worry. The NICU staff will not let you leave until specific milestones are met. These include:

  • Your baby will need to be able to maintain her temperature outside of an incubator (usually when a baby reaches around 4 pounds).
  • Your baby will need to be able to take all feedings by mouth (or via an NG tube or G tube which you will be taught how to use carefully).
  • Your baby will need to be able to breathe on room air (or in some cases have oxygen) and maintain adequate oxygen levels.
  • Newborn screening must be done (the PKU test is different for premies).

Taking care of a premature baby is much different than taking care of a full term baby, so even if you have older children, life may be different on the other side of the NICU doors.

And while taking care of a premature baby is a little different from taking care of a full term baby, you will learn to with the support of the NICU staff during this transition.

Your NICU staff will carefully teach you how to care for your premature baby at home.

5
Preventing Future Premature Births

Pensive pregnant woman holding stomach in examination room
How can you prevent having a preterm birth in the future?. Hero Images/Getty Images

If you've had a premature baby, you may be nervous or even terrified at the thought that another pregnancy will bring another preterm birth.

Learning the risk factors for premature births as well as what you may be able to do to prevent future premature births are important discussions to have, even if the last thing on your mind is getting pregnant again.

Many people go on to have full-term births after a premie. Having a careful discussion with your doctor or a physician such as a perinatologist who specializes in preterm births, can be invaluable in helping you to make an informed decision when planning another pregnancy.

Bottom Line on Your Premature Baby

Having a premature baby often comes as a total surprise, and most people have had little exposure to the lights and noises of an active NICU.

Emotions can span the spectrum, and considering that these emotions are added to normal "postpartum blues," the transition to having a child in the NICU is difficult at best. Having a good support system is critical. This is a time to call in your supportive, nonjudgmental family members and friends and leave toxic friends behind. You need those in a position of supporting you to be behind you 100 percent.

It can help to learn about some of the equipment and complications which can arise, but remember that most babies do not need all of this equipment or experience all of the complications. There is a fine line between educating yourself and becoming overwhelmed, and only you know where to draw that line.

You may find yourself dreaming of the day your baby will be able to go home, but at the same time dreading the responsibility of caring for a preterm baby yourself. Fortunately, the NICU staff will usually err on the side of leaving you overly prepared, but you may get frustrated by this as well.

Finally, after having a preterm birth, the last thing you probably want to hear is how to reduce your risk of it happening again. And with family and friends, discussions of cause should be off limits. Instead, talk with your doctors about your fears, and save any discussion with loved ones for later. If you have a friend or family member who can advocate this preference for you, all the better. If you are still struggling, you may need to gently remind people that what you need at this point is support in caring for your preterm baby, not a discussion about why she came early.

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