The hospital staff called my newborn daughter, pictured above, a "borderline preemie."
When my daughter was born footling breech, five weeks early, at 5 lbs, my doctors referred to her as a "borderline preemie." Despite some minor development delays, today she’s thriving. In her honor, and to salute other preemie babies of the past, present, and future, this article highlights ways to care for a preemie at home once they’re discharged from the NICU.
Before holding baby, make sure your hands are clean. “In general, this is good practice with all newborns. All visitors should wash their hands before holding the baby,” says Dr. Deena N. Blanchard, MD, MPH, clinical instructor, Department of Pediatrics at NYU Langone Medical Center in Manhattan. “In addition, anyone who isn’t feeling well should avoid visiting the baby.”
There’s no reason to keep premature babies indoors for six weeks. “It is advisable to avoid all crowded and enclosed spaces such as malls, movies, and airplane travel until after the 2 month vaccines,” says Dr. Blanchard. “It’s safe for premature infants to go out for walks, once discharged from the hospital, as long as they are dressed appropriately.”
Maintain a schedule
“Babies in the NICU usually have a pretty structured schedule of when they eat, when they sleep, when they wake, when they need changing, when they need medication and when they need a temperature taken,” explains Sara Mosher, an Oregon-based NICU nurse. “Keep this schedule at home if you can. It will not only provide an easy transition for your baby to their new environment, but it will help give you a sense of control. You will be able to continue with something that is familiar in this new transition of bringing a NICU graduate home.”
Be conscious of vaccines
“Immunizations will be given according to baby’s age, but if your baby was very premature, he/she will require special immunization for a virus call RSV that can produce serious lung infection,” advises Dr. Natalia Isaza, MD, a neonatologist at Children’s National Health System in Washington, D.C.
Schedule appointments with specialists
According to Dr. Isaza, if your baby was very premature, once discharged, parents should make appointments with the following specialists:
Developmental pediatrician—To ensure that your baby is reaching his/her milestones and also provide support and guidance in helping your baby if those milestones are delayed.
Ophthalmologist—to evaluate their eyes for their risk of retinal problems and to follow their vision.
Pulmonologist—“If your baby is discharged home on oxygen or with an apnea monitor, the pulmonologist will be follow your baby, adjust the breathing medication, the oxygen, and the time that your baby will need the monitor,” says Dr. Isaza.
Other specialists may be required depending on your baby’s medical circumstances.
Be conscious of room temperatures
Dr. Blanchard says premature infants can have difficulty with temperature regulation. “One of the criteria for hospital discharge is that premature infants be able to maintain a normal body temperature. Once this is the case, then parents should keep the room between 68 to 72 degrees as with all newborns.”
Bathe baby normally
According to Dr. Blanchard, once discharged, premature infants can be bathed and dressed as you would a full term neonate. She adds: “This means infrequent bathing every third day or so, and dressed typically in one layer more than an adult would be comfortable in.”
Milestones: Remember to adjust baby’s “age”
My daughter didn’t walk until she was 21 months old. Her pediatrician kept reminding us that she was technically one month (almost 2) “behind” because she was born 5 weeks early. I constantly compared her to other babies—a hard habit to quit.
“Until age 2, all developmental milestones should be measured based on corrected age, not chronological age,” says Dr. Blanchard, in regard to preemies. “For example, most full-term infants will have a social smile between ages 8 to 10 weeks, an infant born at 34 weeks may not social smile until 12 to 14 weeks of age.”
Adds Blanchard: “All premature infants should be screened for developmental delays at each well visit with their pediatrician and referred for services as needed.”
Today, my daughter is 2, and works with physical therapists at a sensory gym, and has a speech therapist. She’s been in Early Intervention (pediatric therapy for children under age 3 via New York City) since her first birthday, and it’s been quite beneficial. Now she doesn’t stop running—or talking up a storm!
Talk to pediatrician about at-home feedings
“When following weight gain in premature infants, it’s important to correct the weight for gestational age until 2 years of age to determine growth percentiles,” explains Dr. Blanchard. “Premature infants should be weighted more frequently on a weekly to biweekly basis for 4 to 6 weeks after discharge from the NICU. In general, after discharge post premature infants will feed around every 2 to 3 hours.”
And lastly—don’t neglect YOU
“Ask for professional help if you need it,” says Mosher. “Postpartum depression is such a common occurrence, yet so many new parents are so afraid of the social stigma of seeking ‘mental health.’ There are counselors, psychologists, support groups and many other resources available for new parents that are facing baby blues.”
Sources: Dr. Deena Blanchard; Dr. Natalia Isaza; Sara Mosher, RN, BSN, MHA