When your premature baby was born you understood that there would be medical issues that needed to be resolved before you could take him or her home. As your baby progressed in the NICU, he or she became more stable and did well, and now you wonder, “When can I take my preemie home?”
A premature baby has some basic tasks to master before he or she can go home. Your baby must:
- Breathe all the time
- Stay warm in a regular crib
- Feed well
These may sound like simple tasks, but for a preemie these are complex activities they are not ready to do until they have completed developmental stages usually accomplished by full term babies before they are born.
Breathing is one of the most fundamental tasks of living, but before a baby is born he or she does not need to breathe regularly; the task of getting enough oxygen to the body is accomplished through the placenta. The parts of a baby’s brain that control breathing are not fully developed before about 34-35 weeks gestation (where 40 weeks is the expected full term “due date” in a normal pregnancy). Before this time babies may experience apnea of prematurity, pauses in breathing. There is tremendous variability in how much apnea of prematurity a premature baby may experience. In the neonatal ICU cardio-respiratory monitors watch heart rate and breathing patterns and pulse oximeters monitor oxygen levels to catch these pauses in breathing, apnea events. If the heart rate goes too low or oxygen level goes down for too long an alarm will sound and a care provider will intervene to stimulate the baby, or give some added oxygen or manual breaths, if needed. These events typically decrease with increased maturity and stop by full term. The care team will monitor the frequency and severity of these apnea events and will not send a baby home until the baby has matured enough to be discharged home without monitors. This usually means observing until a baby has not had an apneic event severe enough to require intervention while sleeping or alone for 5 days or more.
Premature babies are small. Their small size makes it difficult for them to keep warm. A premature baby needs to stay warm to grow. If they are exposed to the world without adequate support to remain warm they will burn too many calories and will not grow. To help babies remain warm they are usually kept in an incubator. After they reach about 4 pounds (1800 grams) the team caring for your baby will consider weaning him or her from the incubator to a crib. This is usually not done until your baby’s temperature is stable in an incubator with temperature of 28 degrees Celsius, or less.
Finally, the ability to feed well is also critical for a baby to thrive and grow at home. The process of coordinating sucking, swallowing and breathing is fairly complex and premature babies initially do not do this well. It is common for babies not to be able start taking feeds by mouth until about 34 weeks gestation. After they start showing some interest in sucking and swallowing it can take weeks before they are able to take all of their milk from the bottle or breast. The usual standard in the NICU is for a baby to take all of his or her feedings by mouth (by bottle or from the breast) before they are sent home. This is usually the last piece to come into place before a baby is able to safely go home.
All of these tasks represent normal developmental stages for a premature baby and each baby progresses through these stages at different rates. The time to attain the abilities to feed well, maintain temperature and breathe regularly, without apnea, can vary considerable from baby to baby. The Neonatal ICU team caring for your baby will help explain how your baby is progressing and give your baby the support he or she needs. They will not be able to give you a good idea about when your baby will be able to come home until you are within a couple days of the big event. Each baby sets its own pace, and this makes predictions difficult. In this case, like many others, your baby is in charge!