When Can Premature Babies Go Home?

Milestones a NICU Baby Must Reach Before Discharge

'Newborn premature baby girl, just two days old, resting on her mother's breast.'
Taking a Preemie Home from the NICU. Casenbina/E+/Getty Images

While they’re in the newborn intensive care unit (NICU), premature babies (also known as preemies) have several milestones to meet before they are allowed to go home with their parents. Before NICU discharge, premature babies need to be able to do the following.

Breathe Without Oxygen

One of the first milestones that many premature babies meet is being able to keep their oxygen saturation high without needing extra oxygen or other respiratory support.

Many preemies need some kind of respiratory support soon after birth. Some babies may need only extra oxygen. Babies who are very small or are born very early are at risk for a chronic condition called bronchopulmonary dysplasia or BPD (a serious lung condition) and may need extra oxygen even after they’re ready to go home.

Outgrow the A's and B's

The 'As and Bs,' sometimes also called "spells," are common conditions in preemies. "A" stands for apnea, which is a period during which breathing stops for more than 20 seconds. Apnea can cause the "B," bradycardia, which is a decrease in the baby's blood oxygen level and a heart rate under 80 beats per minute.

While babies are in the NICU, their heart rate and breathing pattern are carefully monitored, and periods of apnea and bradycardia are caught quickly. By about 34 to 36 weeks gestational age, most developing babies have outgrown A's and B's.

Those who haven’t may be sent home with an apnea monitor.

Take All Feedings by Mouth

Premature babies are not as strong as full-term babies and aren’t able to coordinate sucking and swallowing until about 32 to 34 weeks gestational age. Most premature babies are nourished with total parenteral nutrition (TPN, an IV fluid) at first, and they are fed through a feeding tube until they’re strong enough to drink from the breast or from a bottle.

Before babies can be discharged from the NICU, they should be eating from a bottle well enough that they are gaining weight steadily on an ad lib feeding schedule (meaning feeding them when they're hungry or on demand, as opposed to by the clock), although this is not absolute. This usually happens around 37 weeks gestational age, although some babies—especially those who have had severe respiratory problems— may take longer.

Maintain a Stable Temperature

Most premature babies need to sleep in an incubator at first to stay warm. An incubator is an apparatus with a clear dome that's enclosed and has a heated platform on which babies lie. Premature babies aren’t able to keep themselves warm as well as full-term babies and will get too cold if they are not skin-to-skin in kangaroo care or kept in an incubator.

Being able to stay warm outside an incubator and sleep in a crib is a big milestone that preemies need to meet before they can leave the NICU. It is a milestone that is based on weight more than gestational age, and most babies are able to keep themselves warm by the time they weigh about four pounds.​

Pass Various Tests

Your baby might have to pass a blood test, as well as a hearing test, before discharge.

Doctors may also want to administer a "car seat test" to check your baby's heart and breathing while he or she sits in a car seat. 

Going to a Step-Down Nursery

If your baby is getting better but isn't totally ready to go home, he or she might first move to what's called a step-down nursery. Before discharge, make sure that you learn infant cardiopulmonary resuscitation (CPR), so you know what to do in case of an emergency.

Talk with your child's doctor or nurse to make sure that you know exactly how to care for your child when you get home, ask any questions that you have, and find out if you can "room in" with your child during his or her last night or two to get the hang of things.

 The good news is that although some babies leave the NICU with temporary or chronic health conditions, the majority of babies who leave the NICU develop into healthy children.


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"Leaving the NICU ." March of Dimes (2013).