Milestones Preemies Must Reach Before Going Home

'Newborn premature baby girl, just two days old, resting on her mother's breast.'
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There's no single "rule" that determines how long your premature baby will have to stay in the neonatal intensive care unit (NICU). Preemies have several milestones to meet before they are allowed to go home with their parents.

While many premature babies are discharged about the time they were originally due to be born, this can vary. Some babies can go home well before they were expected to be born, while others will need to stay in the NICU well beyond their due dates.

If you're the parent of a preemie, you're probably wondering when you will be able to bring them home. Here are some criteria for you to become familiar with that will be used to determine when your preemie is ready to be discharged from the NICU.

Breathe Without Oxygen

Most of the time, babies should be able to breathe room air without oxygen before they are sent home from the NICU. Many preemies need respiratory support soon after birth while others will only need extra oxygen. 

Babies who are very small or who are born very early are at risk for a condition called bronchopulmonary dysplasia (BPD)—now also referred to as chronic lung disease (CLD). Some babies with this serious lung condition are allowed to go home with the use of oxygen via a nasal cannula.

Outgrow the As and Bs

"As and Bs" stand for apnea and bradycardia, which are considered hallmarks of prematurity. Apnea refers to periods in which a baby stops breathing for more than 20 seconds. The lack of breathing causes falling oxygen saturation levels, which in turn cause the baby's heart rate to lower (bradycardia). These responses are likely caused by the immaturity of the nervous system.

The "spells" (as they're often called) are common in premature infants. Nearly half of the babies born around 30 weeks gestation have them. The rate drops to around 7% when a baby reaches 34 to 35 weeks gestation.

Premature babies are typically kept in the NICU until their A and B spells have resolved.

If a baby is doing well and has met all of the other milestones for discharge, but continues to have mild As and Bs, they might be allowed to go home with a portable heart and breathing monitor.

Keep in mind that you won't be sent home if your child is at risk, or if it's thought that the spells they are having could be dangerous. Your baby's doctor might give you the choice to keep your baby in the NICU a little longer or go home with a monitor. In that case, you will have to decide how comfortable you are with monitoring your baby at home.

Take All Feedings by Mouth

Premature babies are not able to coordinate sucking and swallowing until about 32 to 34 weeks gestational age. Most preemies start out being nourished with total parenteral nutrition (TPN), which is a kind of IV fluid that provides all the nutrition that they need. Next, they will be fed through a feeding tube until they are strong enough to drink from the breast or from a bottle.

The NICU will usually want to see a preemie gaining weight on scheduled feedings as well as be able to do so on ad-lib schedules (feeding when the baby is hungry rather than by the clock). This usually happens around 37 weeks gestational age, but some babies—especially those who have had severe respiratory problems— might take longer.

Some premature babies are sent home with an NG tube or a G-tube.

Maintain a Stable Temperature

At first, most premature babies need to sleep in an incubator to stay warm. This is an enclosed apparatus with a clear dome and a heated platform for the babies to lay on. Premature babies are not able to keep themselves warm as well as full-term babies can. Preemies will get too cold if they are not skin-to-skin in kangaroo care or kept in an incubator.

A premature baby needs to be able to maintain their body temperature in an open crib before they can go home. The time at which your baby is able to do this will depend more on their weight than their gestational age.

In general, preemies can maintain their own body temperature once they weigh about 4 pounds.

Pass Various Tests

In addition to achieving discharge milestones, specific screening tests will likely be required before you can take your baby home. These might include a hearing test (either the otoacoustic emission or the automated auditory brainstem response tests), car seat safety checks, testing for hyperbilirubinemia, and screening for heart disease.

If your baby is getting better but isn't totally ready to go home, they might first move to what is called a step-down nursery.

Learn Essential Care

Before discharge, make sure that you learn infant cardiopulmonary resuscitation (CPR). This will help you be prepared in case of an emergency. Additionally, you will receive the same type of discharge education that is given to the parents of full-term infants, which usually includes instruction on feeding, elimination, weight gain, and other newborn care topics.

Talk with your baby'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 before you get ready to go.

You might also ask if you can "room in" with your child during their last night or two in the NICU to help you both get the hang of things.

A Word From Verywell

You might be anxious and eager to bring your preemie home, but trust that the NICU staff will guide you and let you know when your little one is ready. If you are nervous about caring for them on your own, rest assured that the NICU staff will not send you home until you are comfortable managing any extra care required beyond what is typical of a healthy full-term newborn.

After the constant activity of the NICU, you might find yourself overwhelmed to be alone at home. Caring for a new baby, whether a preemie or not, can be stressful as everyone tries to adjust. If you add on the special needs of a preemie, it can be a lot to take in and try to put into action. This is why it's important that you have a support system in place before you bring your baby home.

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  1. Jefferies AL. Going home: Facilitating discharge of the preterm infant. Paediatr Child Health. 2014;19(1):31-42.

  2. Zhao J, Gonzalez F, Mu D. Apnea of prematurity: from cause to treatmentEur J Pediatr. 2011;170(9):1097-1105. doi:10.1007/s00431-011-1409-6

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