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The top question NICU parents ask is: when can my preemie come home? No matter whether your baby is in the NICU for days, weeks, or months – discharge day is a huge deal. Many preemies are ready to go home around their original due date, but that timeline varies widely. Some babies will be discharged home with only a few extra follow-up visits, while others will require extensive medications, devices, and therapies at home. In this post, we discuss the milestones your preemie must meet in order to be ready for discharge from the NICU.
Breathing Room Air
Some preemies, especially those born very preterm, require extensive respiratory support. Others may only need minimal supplemental oxygen or simple monitoring of independent breathing. In order to be discharged home, most preemies need to be breathing room air without oxygen. Some preemies who develop long term respiratory issues such as chronic lung disease (CLD) may be sent home with supplemental oxygen via nasal cannula.
Stable Breathing and Heart Rate
Preemie parents quickly learn the NICU term “A’s and B’s,” which refers to apnea and bradycardia. Apnea is a period of 20 or more seconds when a baby ceases breathing. Bradycardia refers to abnormally low heart rate that occurs as a result of lowered oxygen saturation levels from a period of apnea. These “spells” are common among preemies and often resolve on their own as the baby matures. Outgrowing the “A’s and B’s” is a necessary milestone for NICU discharge. However, if a baby has occasional mild spells and is otherwise doing well, they may be discharged home with a portable heart and breathing monitor.
Many preemies require the help of an incubator in order to maintain their body temperature. Without the ability to maintain their body temperature, babies can quickly become distressed. Preemies are kept warm in an incubator with a heated platform or via skin-to-skin contact during kangaroo care. Babies can usually maintain their body temperature fairly well by the time they weigh around 4 pounds.
Preemies typically cannot coordinate sucking and swallowing until the 32nd-34th gestational week. As a result many preemies require supplemental tube feedings, and they will need to be weaned off of them before discharge. In order to be discharged, most preemies need to be taking all feedings by mouth. While a small number of preemies are sent home with an NG tube or G-tube, this is not the norm. Most babies need to be successfully taking bottles and/or breastfeeding in order to be discharged home.
Babies need to be steadily gaining weight in order to be discharged home. Usually, the NICU team will want to see that your baby is gaining weight on scheduled feedings as well as on-demand feedings. This ensures that your baby is ready for more relaxed home life vs. the rigor of the NICU schedule. Most babies reach this milestone around 37 weeks, but it can take longer.
Preemies must pass several tests to demonstrate they are healthy enough to go home and if they may require additional therapy. This includes:
- A carseat test to ensure they maintain healthy vitals while in a car seat
- A bilirubin test to ensure their levels are healthy
- A PKU test to screen for metabolic disorders
- A hearing screen to identify any hearing issues
- A heart test to screen for heart disease
Parents must be ready for NICU discharge, too!
When all the focus is on your preemie, it can be easy to forget your own needs as a parent. The question, “When can my preemie come home?” should always be followed up with, “How can I prepare for life after the NICU?” As your baby gets closer to their discharge date, make sure you’re feeling as physically and mentally prepared for their arrival home as possible. Learn the essentials of caring for your baby like feeding, diapering, bathing, and nail care. Ask your NICU care team for newborn care tips, like swaddling. Make sure you have a plan for meals and household logistics once you’re home – you won’t want to be staring into an empty fridge with a baby in one arm! Hire professional support to ease your transition from NICU to home. Our team of expert Newborn Care Specialists and Postpartum Doulas has extensive experience with preemie families. As your baby grows stronger and healthier in the NICU, feel the excitement of their quickly approaching discharge day without the nerves of having to go it alone. We’re here to help!