Caring for Your Preemie at Home
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In America, about 10% of all babies are born too soon, with nearly 60% of twins, triplets, and other multiples arriving before 37 weeks of pregnancy is complete. While your preemie may be healthy enough to go home soon after birth, research shows that more than 90% of infants born prior to 34 weeks—and almost half of those born between 34 and 36 weeks—need to spend some time in the neonatal intensive care units (NICU) before being discharged. Some premature babies remain in NICU care for weeks and others stay for months. Either way, that means there are a whole lot of premature babies out there who need extra care and attention. And, more often than not, that special care continues once you take your precious little one home. Here’s how to care for your preemie at home.
What is considered a premature baby?
Late preterm: Born between 34 and 36 weeks.
Moderately preterm: Born between 32 and 34 weeks.
Very preterm: Baby at less than 32 weeks of pregnancy.
- Extremely preterm: Born at or before 25 weeks of pregnancy.
What are common health concerns for premature babies?
While all premature babies are different, the general rule is, the earlier in pregnancy a baby is born, the more likely they are to have health problems. With that, your preemie may experience short-term complications within the first weeks of birth, including issues with…
Breathing: Premature babies can have an immature respiratory system that, among other issues, can bring about apnea, which is when a baby stops breathing for a short time.
Heart: The most common heart problems premature babies experience are low blood pressure and patent ductus arteriosus (PDA), which involves an opening between the aorta and pulmonary artery.
Blood: Anemia and jaundice are common in premature babies.
Brain: The earlier a baby is born, the greater the risk of bleeding in the brain. While most cases are mild, some hemorrhages can cause permanent injury.
Temperature control: Preemies can lose body heat quite quickly, so if their body temperature drops too low, hypothermia can result.
Gut: An immature gastrointestinal system can result in complications like necrotizing enterocolitis (NEC), where the cells lining the bowel wall are injured.
Metabolism: Some preemies have a hard time converting stored glucose into something more usable and others may develop abnormally low blood sugar (hypoglycemia).
Immune system: An underdeveloped immune system can lead to an elevated risk of infection.
Common Long-Term Health Concerns for Preemies
Again, the earlier a baby is born, the more likely they are to have long-term health problems. Some possible issues that may arise include: cerebral palsy, impaired learning, developmental delays, vision and/or hearing problems, dental issues, and/or chronic health issues, such as asthma and feeding problems. Premature infants are also at increased risk of Sudden Infant Death Syndrome (SIDS).
Kangaroo Care for Your Preemie
Snuggling your diapered-but-otherwise-naked baby to your bare chest is called kangaroo (or skin-to-skin) care and it’s been used for decades in hospitals to help premature babies not only survive, but thrive. In fact, kangaroo care is considered “essential” for promoting the growth and development of premature infants. In-hospital skin-to-skin kangaroo care has been shown to stabilize Baby’s heart rate, improve breathing and oxygen saturation levels, decrease crying, increase sleep, help preemies breastfeed and gain weight, and leave the hospital earlier. Plus, a 2020 report in the The Journal of Pediatrics shows that one hour of kangaroo care a day can significantly improve a premature infant’s neurodevelopment. And even more research found that early-and-regular kangaroo care significantly decreases Baby and Mom’s stress hormone levels and helps to mitigate postpartum depression rates. Skin-to-skin is a staple of NICU preemie care, and it should be a staple of at-home care, too, notes to the American Academy of Pediatrics (AAP). Try to do it during bottle feeding, after a bath, or perhaps first thing in the morning to reap all the same benefits that your baby got while in the hospital.
If you’re offering kangaroo care—or simply babywearing—with a baby carrier, know that preemies should not be carried in backpacks or other carriers that hold them upright, according to the AAP. This position can potentially make it more difficult for preterm babies to breathe. If you’d like to use a baby carrier with your precious preemie, have a conversation with your pediatrician first.
Soothing Your Preemie With the 5 S’s
While all newborns benefit from three months of extra cuddling, sound, and rocking (aka fourth trimester care), premature babies need a bit more because they missed some of their all-important third trimester. That’s why it’s such a good idea to allow your premature baby to spend lots of time imitating their life in the womb with the 5 S's, which includes snug swaddling, shushy white noise, and gentle swinging motion. These womb-like sensations work to activate your little one’s in-born calming reflex, which is like their “off switch” for fussing and “on switch” for sweet slumber. Even more so, a 2018 report in the Journal of Maternal-Fetal & Neonatal Medicine found that when premature infants were exposed to Happiest Baby womb-like sounds it helped reduce complications associated with a lack of oxygen and an abnormal heart rhythm. In fact, intermittent hypoxemia and bradycardia significantly declined after sound exposure, which was played intermittently in 6-hour blocks.
Protecting Your Preemie From Infection
Because your premature baby’s immune system is still developing, they’re at an elevated risk for infections. To help keep the germs at bay, implement these stay-safe strategies:
Avoid crowds and visitors. Don’t visit public places with your preemie until your pediatrician gives you the go-ahead. At the same time, keep visitors to a minimum, making sure each well-wisher washes their hands for at least 20 seconds before touching your baby. (And make sure your home is smoke-free.)
Limit outings. At least for the first several weeks home, it’s important to keep trips outside the home to medical visits only, especially during extra-germy winter months.
Schedule smart. Try to schedule your preemie’s doctor’s appointments first thing in the morning when it should be less crowded. Alternatively, ask if you can bypass the crammed waiting room and cool your heels in an exam room instead.
Vaccinate your baby. It’s not only important to follow vaccine recommendations for your baby…but for you, too. All members of your household—and folks in close contact with your bub—should be up to date on the pertussis immunization (Tdap vaccination) and have had their annual flu shot.
Ask about RSV prevention. While there is still no RSV vaccine, your child’s pediatrician may suggest a monthly injection designed to help protect preemies from getting super sick with RSV. While the drug (palivizumab) does not prevent an RSV infection, it can help prevent serious RSV. Palivizumab is often recommended for premature babies born at less than 29 weeks and for those born under 32 weeks who needed extra oxygen for the first month of life. Preemies with congenital heart disease are also contenders for the shot.
Feeding Your Preemie
When hammering out your baby’s feeding schedule, it’s important to keep in mind that most premature babies eat between eight to 10 times a day and each feed should be no more than four hours apart. (This helps prevent dehydration.) Other important preemie feeding tips include…
See a lactation consultant. The combo of delayed development and possible delay of breastmilk coming in means premature babies often have difficulty nursing. If your preemie is having trouble breastfeeding, and that’s something you’d like to do, turn to a lactation consultant who specializes in preemies for help.
Use the same feeding supplies as the NICU. If your baby did well with the nipples and bottles used in the hospital, ask to take some home—and where you can buy them.
Inquire about infant formula. Your little one might need an infant formula with extra calories and vitamins that’s designed for premature babies. Always consult your pediatrician before starting a new baby formula.
Ask about iron. Premature babies don’t have as much iron stored in their bodies as full-term babies. That means, your pediatrician may want your baby to take iron drops for a year or longer.
Expect spit ups. It’s normal and expected for premature babies to spit up after a feeding. Small feedings and paced bottle feeding may help reduce spitting up.
Delay solids. Most pediatricians advise starting premature babies on solids 4 to 6 months after their due date, not their birth date. It often takes preemies more time to develop the ability to swallow food.
To calculate your premature baby’s adjusted age, subtract the number of weeks your baby was born early from your baby’s actual age in weeks (number of weeks since the date of birth). For example, if your baby’s actual age is 8 weeks and they were born 3 weeks early, your baby’s adjusted age is 5 weeks.
Preemies and Sleep
It’s true: Premature babies tend to snooze more than full-term babies. (They average about 18 hours a day in the first few weeks at home.) The catch? They sleep for short periods of time. And unlike full-term babies who might sleep up to eight hours at night by 4 months, preemies often take 6 to 8 months before clocking eight hours. Other than actual hours slept, there are some key differences between a preterm baby’s sleep and a full-term baby’s sleep. Here are some things to consider when getting your preemie ready for night-night:
Turn on the white noise. While all babies benefit from white noise, premature babies crave it even more. The reason? Preemies who’ve spent time in the NICU have become accustomed to the continuous background noise in the hospital. In fact, experts note that premature babies often have trouble falling asleep in a quiet house. (Try one of our expertly designed white noise machines, including SNOO.)
Swaddle your baby. Research shows that swaddling seems to significantly increase total sleep time and quiet sleep time of premature babies in the NICU. And the AAP notes that continuing to swaddle at home can likely minimize stress of your baby’s new environment. Bonus: Swaddling helps preterm babies maintain a normal body temperature. (For no-stress swaddling try the award-winning Sleepea for babies weighing at least 5 pounds.)
Rethink your swaddling technique. While it’s recommended to swaddle your baby with their arms down, preterm infants should be wrapped with bent arms until they get close to their due date.
Always place your baby on the back for sleep. Premature infants are two to three times more likely to succumb to SIDS or other sleep-related deaths than full-term babies. One contributing factor: Preterm infants are significantly more likely to be placed to sleep on their tummies than term infants, according to a 2021 study. (All babies should be put to sleep on their back on a firm, flat surface, free of loose bedding.)
When to Call the Doctor About Your Premature Baby
According to the Department of Health and Human Services, you should call your preemie’s doc ASAP if you notice any of the following symptoms:
Diarrhea for more than one day
Fast or difficult breathing
Fever more than 100 degrees Fahrenheit
Fewer than eight wet diapers a day
Not feeding well
Yellow eye or skin color
Preemie Parents Who’ve Been There…
- A Preemie Mom’s PPD Recovery Story
- SNOO Put These Preemie Parents’ Minds at Ease
- The Only Thing That Could Calm This NICU Newborn
- Preemie Triplets: How SNOO Helped
- Centers for Disease Control and Prevention (CDC): Preterm Birth
- American Academy of Pediatrics (AAP): Caring for a Premature Baby: What Parents Need to Know
- March of Dimes: Special Care Nursery Admissions
- March of Dimes: Premature babies
- Mayo Clinic: Premature birth
- March of Dimes: Long-term health effects of premature birth
- Cleveland Clinic: Kangaroo Care
- Science Daily: 'Kangaroo care' offers developmental benefits for premature newborns
- Impact of Skin-to-Skin Parent-Infant Care on Preterm Circulatory Physiology. The Journal of Pediatrics. July 2020
- Benefits of Kangaroo Mother Care on the Physiological Stress Parameters of Preterm Infants and Mothers in Neonatal Intensive Care. International Journal of Environmental Research and Public Health. June 2022
- AAP: About Skin-to-Skin Care
- AAP: Baby Carriers: Backpacks, Front Packs, and Slings
- A prospective observational cohort study of exposure to womb-like sounds to stabilize breathing and cardiovascular patterns in preterm neonates. Journal of Maternal-Fetal & Neonatal Medicine. June 2017
- Nemours Children’s Health, KidsHealth: Caring for Your Premature Baby at Home
- CDC: RSV Prevention
- American Academy of Family Physicians: Caring for Your Premature Baby
- March of Dimes: Feeding your baby after the NICU
- AAP: Preemie Sleep Patterns
- Massachusetts General Hospital: Helping Your Premature Baby Settle in at Home
- Effects of nesting and swaddling on the sleep duration of premature infants hospitalized in neonatal intensive care units. Iranian Journal of Nursing and Midwifery Research. September to October 2016
- Transition to a Safe Home Sleep Environment for the NICU Patient. Pediatrics. July 2021
- AAP: Are some babies at higher risk for SIDS?
- What risk factors for sudden infant death syndrome are preterm and term medically complex infants exposed to at home? Paediatrics & Child Health. July 2021
- Agency for Healthcare Research and Quality: Transitioning Newborns from NICU to Home
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Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.