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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In general, there's not a "rule" which states how long your premature baby will have to stay in the neonatal intensive care unit (NICU). Instead, preemies have several milestones to meet before they are allowed to go home with their parents.

Many premature babies are discharged about the time they were originally due to be born, but this can vary. Some babies can go home well before they were expected to be born, while others will need to stay well beyond their due dates. Since many parents wonder when their little one can come home, it's good that there are some specific criteria you can watch for.

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 some kind of respiratory support soon after birth and some babies may need only extra oxygen. 

Babies who are very small or who are born very early are at risk for a chronic condition called bronchopulmonary dysplasia or BPD. This is a serious lung condition and some babies may be 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 and they are hallmarks of prematurity. Apnea refers to periods in which a baby stops breathing for more than 20 seconds. This lack of breathing results in falling oxygen saturation levels, which results in a lowering of the heart rate (bradycardia).

These "spells," as they're often called, are very common in premature infants. Nearly half of the babies born around 30 weeks gestation have them. The rate drops to around 7 percent when a baby reaches 34 to 35 weeks gestation. It is usually caused by the immaturity of the nervous system.

Most of the time babies are kept in the NICU until their A and B spells have resolved. Sometimes, if a baby is doing well and has met all of the other milestones for discharge, but continues to have mild As and Bs, she may 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 her spells could be dangerous. Your baby's doctor may give you the choice to keep your baby in the NICU a little longer or go home with a monitor. In that case, it will be up to you and how comfortable you are with monitoring your baby.

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. They are then fed through a feeding tube until they’re strong enough to drink from the breast or from a bottle.

Many NICU's want to see a baby not only gaining weight on scheduled feedings but 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, although some babies—especially those who have had severe respiratory problems— may take longer. Additionally, some 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 that 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.

Before being sent home, a baby needs to be able to maintain her body temperature in an open crib. The time at which your baby is able to do this will depend more on her weight than her gestational age.

In general, preemies can maintain their own body temperature when they are about 4 pounds.

Pass Various Tests

In addition to achieving the milestones noted above, specific screening tests will likely be required before you take your baby home. These may 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, she might first move to what's called a step-down nursery.

Learn Essential Care

Before discharge, make sure that you learn infant cardiopulmonary resuscitation (CPR), so you know what to do in case of an emergency. Additionally, you will receive a normal education that is done with full-term infants. This will likely include instruction on feeding, elimination, weight gain, and more. 

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 her last night or two to get the hang of things. 

A Word From Verywell

Every preemie will be different, so trust the NICU staff on when your little one is ready to come home. Rest assured that they will not send you home before you are comfortable managing any extra cares beyond those of caring for a healthy full-term newborn. 

Before your baby goes home, make sure to get your own support system in place as well. Bringing home a premature infant can be stressful and you may feel a bit overwhelmed when you're alone after the constant activity of the NICU. The good news is that the majority of babies who leave the NICU develop into healthy children.

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

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