It is understandable that as soon as you begin healing up, have visited with your new baby, and met with the hospital staff as to your little one’s well being, your first question will be, "When can we all go home?" When I had my babies over 30 years ago, that was the first thing on my mind! The wonderful saying from the Wizard of Oz went through my mind, "There is no place like home; there is no place like home!" These feelings will ring even louder when you have been in the NICU a few days or weeks, and you want to bring your little preemie home.
First, I preface this with the fact that every hospital has its own protocol and requirements for going home. This article is just a broad accumulation of information we have gathered for you. There will be some milestones your baby needs to first reach before this can happen. Whenever we write about these types of things we must add, "Ask your hospital for their specific requirements." That goes for clothing, visitors, and the timing for baby going home.
Right off the bat, the first consideration will be how early your baby was born.
Premature babies aren’t only looked at by gestational age. A preterm baby’s health and treatment in the NICU will also be affected by their weight.
Extreme(ly) preterm - Babies born earlier than 28 weeks gestation.
Very preterm - Babies born from 28 to 31 weeks gestation.
Moderate preterm - Babies born from 32 to 33 weeks gestation.
Late preterm - Babies born from 34 to 36 weeks gestation.
Early term - Babies born from 37 to 39 weeks gestation.
- Micro preemies are the smallest and youngest babies, born weighing less than 1 pound, 12 ounces (800 grams), or before 26 weeks gestation.
- Extremely low birth weight are those babies born weighing less than 2 pounds, 3 ounces.
- Very low birth weight are those babies born weighing less than 3 pounds, 5 ounces.
- Low birth weight are those babies born weighing less than 5 pounds, 8 ounces.
However, it’s not just how early your baby was born, or what your baby weighed at birth. The key milestones will be affected by the actual medical conditions a preemie may have due to being born before full development in the womb.
The most common problem premature babies have is difficulty breathing, also known as Respiratory Distress Syndrome (RDS) because preemies have lungs that are not yet fully developed. Your baby may need respiratory support until their lungs have advanced to the point they can breathe on their own. They may also have apnea or pauses in breathing. Apnea does improve as your baby's lungs grow stronger, and they are able to breathe without support. This is a definite milestone a preemie needs to hit before they can go home. It is common that a hospital will require a certain amount of time to go by without an Apnea episode before the baby can be released.
The second milestone that your premature baby will need to reach is regarding their temperature. No matter where your preemie started on the above scales, they will need to be in an open crib and able to maintain their own body temperature for at least 24-48 hours.
Thirdly, your preemie will also need to be feeding by either breast or bottle. This will be something you will have been working closely with the nursing staff. If you are not able to breastfeed your baby directly and can pump until you can, this will still provide a wonderful connection between you and your baby. One of the challenges of being a NICU Mom is not feeling part of your baby's care, so whatever you can do to help build that bridge is helpful for both you and your baby. Your preemie should be gaining weight steadily, and be well on the way to gaining more weight after going home.
These are just three milestones your preemie will need to reach before they are able to go home. I would imagine you are asking, "What can I do to help my baby reach these quickly?" First, I would recommend getting as involved in their care as soon as possible. It can be overwhelming to see your little baby surrounded by big machines! Take comfort in the fact that the medical team is there for you. Ask lots of questions - don’t feel intimidated. Your care team can help walk you through each machine and explain what exactly they are doing for your baby. Information is the key to better understand what is happening and how your preemie is responding. One of the most difficult things for new parents in the NICU is the feeling that they’ve lost control over what’s happening. Therefore it is important for parents to stay as connected as possible. Keeping a journal is also a very good idea. This can be very valuable in keeping track of milestones and recording things the medical staff may have said that you were not able to fully understand at the time. Another vital way that only you can help your baby is reassuring them with the voice they have been hearing and are used to. Talk with them, and when it is allowed, do so with kangaroo care, or skin-to-skin contact whenever possible. Research shows that if a mother does 90 minutes of kangaroo care at least four times a week, it can improve their baby's health, decrease the chances of lung disease, and shorten their hospital stay. Other close family members (eg. Father and/or siblings) can also have a positive impact with comforting words and kangaroo care.
One more milestone your preemie may need to meet before going home is having to pass a car seat test. Many hospitals require that parents bring in their car-seat and the baby is placed in it and attached to a cardiopulmonary monitor that evaluates the heart and breathing. Even after passing this, it is recommended that parents still limit the time preemies sit in a car-seat to about an hour, due to breathing issues.
Finally, ask your hospital if they offer the opportunity to room-in with your preemie before going home. This is an excellent way to do a "trial run" and get some great one on one experience in providing your baby's’ full care. The best part is that if you need some help, it is just a buzzer away!
Thank you for reading and if you have any questions, please reach out and we will try to help! You can reach us at firstname.lastname@example.org.
Have a Great Day!