Premature Babies – What to Expect in The NICU

New babies bring excitement. However, that excitement can quickly turn to worry when you realize you're facing a premature birth. What to expect with premature babies can be unknown to many of us. While the worry remains, we can find a bit of relief in knowing we live in a time where modern medicine allows even the earliest preemies to have a chance of survival. More than just survive, modern medicine also means many preemies thrive exceptionally well.

Premature Babies – What To Expect Week By Week

Each day of pregnancy impacts your baby's development. Every baby born before 37 weeks is premature. However, a 25-week baby is very different than a 29- or 35-week baby. Their breathing, feeding and growth patterns will vary based on their gestation at birth.

What Is A 23–24 Weeker NICU Stay Like?

We now live in a time where more than half of babies born at 23–24 weeks survive. A baby born at this gestation will weigh a bit over 500 grams (one pound).

Babies at 23–24 weeks gestation typically have a breathing tube and are supported by a ventilator. Eventually, some will graduate to continuous positive airway pressure therapy (CPAP mask). A CPAP machine increases air pressure in your baby's throat so that their airways don't collapse when they breathe in. A nasal cannula would follow as your baby's breathing becomes more stable.

Some babies will remain on a ventilator and eventually require a tracheotomy for long-term respiratory support at home. Some may go home on oxygen with a nasal cannula. This is common for micro preemies — babies born weighing less than 800 grams (1.75 pounds) or prior to 26 weeks gestation.

Babies born at this gestation can't safely eat by mouth yet. They will have IV lines placed to provide medicine, nutrition, and hydration. Depending on how a baby is doing, they will eventually begin feeds via a feeding tube placed in their nose (NG) or mouth (OG). Breast milk remains a biologically normal food as a mother's milk is different than had she given birth to a full-term baby.

What Is A 25–26 Weeker's NICU Stay Like?

A baby born at 25–26 weeks gestation weighs approximately 680–900 grams (1.5–2 pounds). At this gestation there is a survival rate of up to 80–90%.

Babies born at this gestation often require a breathing tube and ventilator. Some are quick to transition to a CPAP mask and then nasal cannula. They're unable to take feeds by mouth at this gestation. Breast milk, whether yours or donor milk, is often fortified for babies at this gestation. An exclusive human milk diet reduces the risk of necrotizing enterocolitis (NEC), a serious infection.

Exclusively pumping until baby can feed at the breast can be very time consuming and quite challenging. However, every drop you're able to provide is important as it's helpful for their development and extremely helpful for preventing infection.

How Long Are 27–28 Weekers in The NICU?

Babies born around 27–28 weeks need a good bit of support still. However, their respiratory system is more developed than at 23–26 weeks. A baby born at this gestation should expect a NICU stay close to their original due date.

A 27–28 weeker may or may not need support from a ventilator. They will need some respiratory support, however — it may be a ventilator, CPAP or nasal cannula. Many facilities don't start oral feedings (breast or bottle) until 32 to 34 weeks gestational age. This is because preemies aren't yet able to safely suckle, swallow, and breathe properly.

Skin-to-skin care: Skin to skin, also known as kangaroo care, is extremely beneficial for preemies. Depending on your baby's level of life support, you may be able to hold them immediately. Sometimes you will need to wait a few days to a few weeks. Your baby's nurse can help you get comfortable navigating all the wires and tubes.

What Is The NICU Like For 29–30 Weekers?

Babies born at 29–30 weeks gestation are still very premature and in need of a lot of medical support. However, their respiratory system, and other systems, are a bit more developed than their earlier preemie peers.

A baby born around this time is about 1 kg or 2.5 pounds. Babies born at this gestation may or may not require a breathing tube and ventilator. They will not be ready for oral feeding for a few weeks and will require an NG or OG tube.

Preemies will have frequent blood sugar tests until the NICU team is sure they can maintain their blood sugar levels. They will also have heel sticks to check for jaundice. If their bilirubin levels are high, they will receive phototherapy for jaundice — a non-invasive treatment. If you come in one day and see your baby's bed looking blue, it's simply phototherapy.

What To Expect With A 31–32 Weeker

A 31–32-week baby weighs around 1.5–2 kgs (3–4.5 lbs). Their NICU experience is often similar to 27–30 weekers but they may go through each stage a little faster. They are likely to have less time on breathing support, less time with IVs, less time with a feeding tube, etc.

Some of these babies will even be ready to go home around 35–37 weeks. However, many will still need more time in the NICU to get their feeding skills down, reach a certain weight, outgrow apnea of prematurity, and maintain their body temperature.

What To Expect With A 33–34 Weeker

Most hospitals require every baby born under 35 weeks to at least be evaluated, if not admitted to the NICU. A 33 weeker will almost definitely require some time in the NICU. They are unlikely able to successfully breast or bottle feed full feedings at 33 weeks and may need time to learn to maintain their body temperature.

Some 33–34 weekers can breathe room air right away, but many will also need some respiratory support. For many 33–34 weekers, the biggest challenges are oral feeding, jaundice and maintaining body temperature. These babies are more likely to be discharged prior to their original due date, though it's still a good idea to be prepared for a 6–7 week stay.

Do 35–36 Weekers Go To The NICU?

Many babies at this gestation will need some monitoring while in the hospital to be sure they're transitioning and feeding well. Some 35–36 weekers will need some time in the NICU to learn to feed and maintain their body temperature. Some are discharged with their mother; others will need a few days to a few weeks.

The near-term preemies are more likely to have some feeding difficulties as they're less alert than their full-term peers. They're also more likely to need phototherapy for jaundice, and they may require blood sugar monitoring.

---

Having a preemie can be scary and overwhelming. It's rarely expected and it's certainly not the desired outcome for a pregnancy. Fortunately, with modern neonatology and many early intervention specialists, preemies today not only survive, but most also thrive quite well!

Many premature babies catch up in growth and development around 2–3 years of age. The earlier they're born, the longer this can take. Of course, just as with full-term babies, every baby develops at their own unique pace. If you are expecting or already have a preemie, please reach out for support.