Caring for Your Premature Baby at Home

Your baby is finally coming home from the hospital after a stay in the NICU. Before you leave, learn all you can from the care team about caring for your baby so that you can feel confident at home.

Here’s what you need to know about keeping your baby safe and healthy over the next few weeks.

How Soon Should My Baby Visit the Doctor?

Your baby should see the pediatrician within 2–4 days of discharge from the hospital (unless your pediatrician was already caring for your baby while your little one was in the hospital). Your hospital care team can let you know when your child needs to be seen.

At your discharge meeting, you should have learned about any needed tests, including blood, hearing, and vision tests. Make sure you know what tests your baby needs, and schedule them if you haven’t already.

If your baby needs home nursing or visits with medical specialists, schedule those too. Many former preemies continue to see specialists — including early-intervention specialists, neurologists, ophthalmologists, and physical therapists — for several years to measure their vision, hearing, speech, and motor skills. Follow up with these specialists to make sure your child gets the best possible care.

What Should I Know About Feeding My Baby?

Your baby will be discharged with a custom feeding plan and might need extra calories to grow well. Premature babies need more nourishment because they have to catch up to the growth of full-term babies.

Some premature babies can drink from a breast or bottle. Others have problems coordinating sucking, swallowing, and breathing during feeding by mouth. These babies temporarily are fed through:

• an NG tube: A nasogastric tube passes milk or nutrition through the nose and into the baby's stomach.
  or
• a G-tube: A gastrostomy tube is surgically inserted through the skin and goes directly into the baby's stomach.

In some cases, premature babies who cannot be fed through the stomach are on total parenteral nutrition (TPN), a solution that contains all the nutrition a baby needs. TPN is given through an IV catheter in the vein. Talk to your care team about what’s best for your child.

How Can I Keep My Baby Safe During Sleep?

Expect your preemie to sleep more than a full-term baby, but for shorter periods. All babies, including preemies, should sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS).

How Can I Protect My Baby From Infections?

Because their immune systems are still developing, preemies are at risk for infections. Here are ways to keep your baby safe:

• Limit outings. Limit trips outside the home to medical visits for the first several weeks, especially during the winter months. Because doctors' offices commonly have many kids with viral infections, try scheduling your visit for first thing in the morning or ask to wait in an exam room instead of the main waiting area.
• Avoid public places and some visitors. Most doctors recommend not visiting public places with preemies. And limit visitors to your home: anyone who is ill should not visit, nobody should smoke in your home, and all visitors should wash their hands before touching your baby. Talk to your doctor about specific recommendations — some family visits may need to be postponed until your little one's immune system gets stronger.
• Keep your baby up to date on vaccines, as recommended by the pediatrician. Also, all household members and people who are in close contact with your baby should be up to date on the pertussis immunization (through the Tdap vaccination shot) and have had the seasonal flu vaccine.
• Ask about a shot to prevent RSV. RSV (respiratory syncytial virus) is a common viral infection that's often mistaken for a cold or the flu. RSV causes few problems in adults and older kids, but in preemies it can lead to severe illness, breathing problems, or even death. It is now recommended that all pregnant women get an RSV vaccine at 32–36 weeks of their pregnancy if the baby will be born during RSV season (usually fall to spring in the U.S.). This can protect the newborn from severe RSV illness. If the mother did not get this vaccine, or if the baby was born less than 2 weeks after she did, doctors can give the baby a new type of shot that contains antibodies against RSV as another way to protect the baby from RSV. Babies younger than 8 months old get this shot during or right before RSV season. Babies born in the fall will get the shot before they leave the hospital, and its effect should last throughout the RSV season. Preemies who go home from the hospital at other times of the year also may need the shot when winter arrives. Preemies and other children at higher risk for getting very sick from an RSV infection can get a second shot when they enter their second RSV season, up to 19 months of age.
  
  In the past, preemies under age 2 could get a different type of RSV antibody preventive shot monthly throughout RSV season. Children who got some doses of this shot, either in the previous year or the current year, can still get the newer one. Ask your doctor which preventive shot is best for your child. Some doctors will give the older shot, and others might give the newer one. They are equally safe and effective.

Should I Be Concerned About My Baby’s Breathing?

Premature infants commonly have periods of apnea, or pauses in breathing. These usually end by the time most preemies go home. Babies won't be sent home if apnea causes a slow heart rate or a change in color. In some cases, if the doctor thinks it's needed, a baby goes home from the NICU with an apnea monitor. If your baby needs a monitor, anyone who will be alone with your infant at home should get trained to use it and know how to do infant CPR.

Some babies develop a longer-lasting lung condition called bronchopulmonary dysplasia (BPD) (also called chronic lung disease of prematurity), which involves scarring and irritation in the lungs. After they go home, babies with BPD may need extra oxygen and medicines to help their lungs work better. If your baby will need oxygen, equipment for giving it and monitoring your baby at home and during travel will be arranged before discharge. Talk to the care team if you have questions about using this equipment or are concerned about your child's breathing.

What if I Feel Overwhelmed?

It’s common for parents to have a wide range of emotions during these first months. If your child has serious health problems, you may feel angry or sad. While recovering from childbirth, mothers of preemies may experience the hormonal shifts of baby blues or more serious postpartum depression.

It’s best to have 6–8 weeks to rest and recover after giving birth, but a baby's premature birth may reduce that recovery time. Also, those long days in the NICU take a physical and emotional toll. But there are things you can do to make the adjustment of living with your new baby easier:

• Accept offers of help from family and friends. They can babysit your other children, run errands, or clean the house so you have time to care for the baby or rest.
• Get enough rest, eat well, and exercise moderately. Find support and encouragement from doctors, nurses, other parents, support groups, or online communities.
• Get professional help, if needed. If you're overwhelmed or depressed, do not hesitate to get professional help for yourself so you can fully enjoy your new baby.

What Else Should I Know?

Take advantage of these quiet weeks together to enjoy skin-to-skin contact, also known as kangaroo care. In a warm room at home, dress your preemie in only a diaper, then place the baby on your chest and turn their head to one side so that their ear is against your heart.

Research shows that kangaroo care can enhance parent–child bonding, promote breastfeeding, and improve a preemie's health.