What Type Of Preemie Do You Have And When Can He Go Home ...

First, the good news: Advances in medical care mean the outcomes for preterm babies have improved in recent decades, and even the smallest of premature babies have a greater chance of surviving and living healthy lives.

Nevertheless, giving birth early can feel overwhelming. Will your preemie baby be okay? How long will he stay in the neonatal intensive care unit (NICU)? What's the long-term outlook?

The answer to these questions depends on a number of factors, but arming yourself with general knowledge of outlooks by birth date can help you to feel more in control and better prepared to handle your baby's hospital stay.

Key Takeaways

• Every preemie’s NICU stay is unique. How long your baby stays in the NICU depends on when he was born, his size, and how well he meets key milestones — like breathing on his own, maintaining body temperature, feeding by mouth, and steadily gaining weight.
• Medical advances have greatly improved preemie outcomes. Thanks to breakthroughs like prenatal steroids and folic acid, even babies born very early now have much higher survival rates and better long-term health prospects than ever before.
• Your baby’s due date is a good guide for going home. In general, the earlier a baby arrives, the longer his NICU stay — but many preemies are ready to head home just before or around their original due date once they’ve hit key growth and developmental goals.

How preemies are categorized

Your preemie's care, length of stay in the NICU, and chances of complications depend on the category of preemie he is. In general, the earlier your baby is born (and the smaller he is), the longer and more complicated the stay in the NICU.

The general categories are:

• Extremely preterm: Babies born at or before 28 weeks of pregnancy
• Very preterm: Babies born between 28 and 32 weeks of pregnancy
• Moderate preterm: Babies born between 32 and 34 weeks of pregnancy
• Late preterm: Babies born between 34 and 36 weeks, 6 days of pregnancy
• Early term: Babies born between 37 and 39 weeks of pregnancy

"The categorization was developed because different organ systems start to mature at different weeks," notes Kyle Monk, M.D., a board-certified pediatrician at Cedars-Sinai Medical Center in Los Angeles, California, and a member of the What to Expect Medical Review Board.

"For example, babies' lungs are developed at 36 weeks. This baby would not be expected to need as much respiratory support as a more premature baby," explains Dr. Monk. "The nervous system and brain are becoming more complex at 28 weeks, so we might anticipate a baby this age requiring more support regulating many of their organs."

Premature babies aren't only categorized by gestational age. A preterm baby's health and treatment in the NICU also has a lot to do with size at birth — usually the smaller the baby, the greater the chances for a longer hospital stay and possibility for complications. Here are the weight categories:

• Low birth weight: Less than 5 pounds, 8 ounces
• Very low birth weight: Less than 3 pounds, 5 ounces
• Extremely low birth weight: Less than 2 pounds, 3 ounces
• Micro preemies: Less than 1 pound, 12 ounces (800 grams), or born before 26-weeks' gestation

Going home with your baby

No matter your baby's gestational age at birth, he must meet a few requirements before his doctors will determine it's safe to take him home. See general time spans for each age below, but in general a baby will need to stay in the NICU for monitoring and care until he can:

• Breathe on his own
• Maintain a stable temperature
• Feed by breast or bottle
• Reach a certain weight and be gaining weight steadily
• Have no unresolved acute medical concerns such as apnea (when preemies stop breathing for short periods of time while they're sleeping)

“NICU time feels like an eternity, even when it's a relatively short stay like ours,” says What to Expect Community mom Flannel-Hedgehog, whose baby was born at 32 weeks. “Looking back, those 29 days simultaneously feel like a tiny blip and also like forever. My daughter is 8.5 months now, healthy, and an absolute joy.”

Get more preemie expert advice and tips from parents who have been there in the What to Expect app.

Babies born before 28 weeks

The outlook for extremely preterm babies born before 28 weeks has improved significantly over the years thanks to medical advances. Studies show that survival rates improve with each week: more than 50% at 23 weeks, 75% at 25 weeks, and over 90% at 26 weeks.

One advance has been the steroid betamethasone, which is given to mothers at risk for preterm delivery. The steroid boosts your baby's development in the womb, helping prevent respiratory distress, necrotizing enterocolitis (severe infection in the gut), and brain hemorrhage. “It has greatly affected neonatal outcomes and has decreased rates of morbidity and mortality associated with preterm delivery,” says Dr. Monk.

The recommendation for women to take folic acid beginning in early pregnancy has also improved outcomes for preterm babies. “Folic acid helps develop baby's neural tube and spine,” Dr. Monk explains. Many foods are now fortified with it.

What happens in the NICU?

Because their respiratory systems aren't fully developed, these tiny babies need help breathing.

And since the ability to coordinate reflexes like sucking and swallowing doesn't kick in until around 34 weeks' gestation, they aren't able to eat on their own. Most receive nutrition and fluids intravenously (through an IV) or feeding tube. Because of their extremely low birth weight, they'll need to gain a few pounds.

Additionally, extreme preemies are at an increased risk of complications, including respiratory distress syndrome (RDS, a lung disorder), hypoglycemia (low blood sugar), hypothermia (difficulty staying warm), jaundice, urinary tract infections, and pneumonia. All of these can increase the amount of time a baby needs to stay in the hospital.

How long before your baby can go home?

Extreme preemies without complications are typically ready for discharge two to three weeks before their due date. But babies who have endured health complications as a result of their preterm status, such as breathing problems or difficulty gaining weight, may have to stay in the NICU well after their anticipated birth date.

Generally speaking, the earlier the baby is born, the more likely he'll have to stay past his due date. Try not to get your hopes dashed if your baby has to stay a little longer than you expected. It's important that he meet each important NICU milestone so that he'll be safe at home and healthy in the long run.

What to Expect Community mom MissNai088 says her 24-week baby spent five months at the hospital, “but he is perfect. He just started preschool and did not have any developmental assistance. He is healthy, strong, and happy. He speaks 2 languages and is a tough, adventurous guy.”

Babies born between 28 and 32 weeks

According to a study of more than 10,000 preterm infants, babies born after 28 weeks of pregnancy have almost a full (94%) chance of survival. These babies do tend to have more complications and require intensive treatment in the NICU than babies born later, though, according to the American Academy of Pediatrics (AAP).

Babies born after week 30 tend to have little to no long-term health or developmental problems. Most babies born before 32 weeks, however, tend to have breathing difficulties at birth.

What happens in the NICU?

Babies who have breathing difficulties will likely need to use a respirator (ventilator) for a while.

Some have trouble feeding and may initially receive their meals through a tube that's inserted into the nose or mouth and passed down to the stomach. This is called gavage feeding.

Because their immune systems are still developing, they're also at a greater risk of infection, and they're more prone to hypoglycemia and hypothermia.

Even though your baby is under guarded care, she can still receive touch. “Most babies in the NICU can be held by their parents close to their bassinet or incubator,” says Dr. Monk. “Many babies can receive oxygen support by prongs placed in the nose, so they are able to be moved and held and enjoy skin to skin with their parents.”

How long before your baby can go home?

Babies born at this age usually go home a couple of weeks before or right around their original due date, as long as they don't experience any serious complications or illnesses.

Babies born between 32 and 36 weeks

Moderate and late-term (or near-term) preemies have spent quite a bit of time in Mom's womb, so they have nearly full odds of survival.

What happens in the NICU?

Most babies in this category are less likely to have severe breathing problems, but they may need a little help with breathing for a few hours or days.

Some may require gavage feeding, but most will be able to nipple-feed. As with any preterm baby, they're still at risk for infections and problems like jaundice, hypoglycemia and hypothermia.

How long before your baby can go home?

It may be anywhere from just after birth to a few days or a few weeks. If all checks out with your baby, he may be able to go home right away. But if there are any issues, your baby will have to stay for a while.

What to Expect Community mom ColoredPencils had her little one at 32 weeks 3 days, and discharge was at 36 weeks 2 days. “I want to say it took 10 days to get feeding down,” she says.

Babies born between 37 and 39 weeks

For decades, “full-term” described any pregnancy that lasted until 37 weeks up to 42 weeks. The American College of Obstetricians and Gynecologists (ACOG) now defines a full-term pregnancy as between 39 weeks of pregnancy through 40 weeks, 6 days.

That means a delivery that occurs between 37 weeks and 38 weeks, 6 days, is referred to as an “early-term” delivery. These early-term babies still have a risk of infections and other problems, but the odds of serious complications are very low.

What happens in the NICU?

At this point, babies are usually right on track developmentally, so any treatment will be minimal.

How long before your baby can go home?

Many babies in this category don't have to spend any time at all in the NICU. At most, it will likely be a couple of weeks tops.

The bottom line: No matter how early your baby arrived, every day in the NICU brings new progress. The monitors, tubes, and long hours can be challenging, but your little one is growing stronger with every milestone. Before long, you'll be leaving the NICU together, ready to start the next chapter at home.