Bringing your baby home from the NICU, and the follow-up that matters

A premature baby is ready to go home when they can keep warm, feed well and gain weight, and breathe steadily without monitors, and when the family feels ready. Going home is the start of a new stage of care, not the end. Corrected age, vaccines on time, hearing and eye checks and regular follow-up visits all matter in the months ahead.

When can my premature baby come home from the NICU?

When your baby is mature enough, not when they reach a magic weight. The American Academy of Pediatrics stresses planning each discharge around the individual baby and family.¹ In practice, Dr Dutta looks for these things:

• Keeps a normal temperature in an open cot or in kangaroo care.
• Feeds well by breast, cup or paladai, without a tube.
• Gains weight steadily over several days.
• Has no worrying breathing pauses or drops in heart rate for some days.
• Any remaining problems, such as medicines or oxygen, are stable and can be managed at home.
• You feel confident with feeding, warmth, medicines and danger signs.

Does my baby need to reach a certain weight to go home?

No. There is no single discharge weight. Weight is only a rough guide, and it does not decide on its own.

A small baby who feeds well and keeps warm may go home before a bigger baby who still needs a tube. Ask your doctor what your baby still needs to achieve, rather than "what weight". The answer tells you what to work on.

What should we take home from the NICU?

A clear discharge summary, written feeding and medicine instructions, and dates for the next visits. WHO recommends that families of small babies get education, counselling and discharge preparation before going home.²

• Discharge summary with birth weight, weeks of pregnancy at birth, main illnesses, treatments and any blood transfusions.
• Feeding plan: how much, how often, and whether fortifier continues.
• Medicines and doses, usually vitamin D and iron.
• Vaccination record.
• Dates for the follow-up clinic, ROP eye check and hearing test.
• A phone number for when you are worried.

If your unit allows it, stay in for a night or two before discharge and do all the care yourself, with nurses close by.

What is corrected age for a premature baby?

Corrected age is your baby's age counted from the due date, not the birth date. It tells you which milestones to expect.³

A baby born at 30 weeks is 10 weeks early. At 6 months after birth, the corrected age is about three and a half months. So when you compare smiles, head control or sitting with a cousin, use the corrected age. A baby born 10 weeks early who is not yet sitting at 7 months may be right on track. Doctors use corrected age for growth and development for the first couple of years.

Should vaccines be given by corrected age?

No. Vaccines are given by actual age from birth, on the normal schedule, in full doses.⁴

Premature babies are more at risk from infections such as whooping cough, so delaying vaccines puts them in danger. The American Academy of Pediatrics says stable preterm and low birth weight babies should get vaccines at the same age from birth as full term babies, and that these vaccines are safe for them. The timing of hepatitis B vaccine may differ in babies under 2000 g, depending on the mother's hepatitis B status.⁴ Follow the IAP or government (UIP) schedule and your doctor's advice.

Does my premature baby need vitamin D and iron drops?

Usually yes. Preterm babies miss the iron and vitamin stores laid down late in pregnancy.

WHO strongly recommends iron for breastfed preterm or low birth weight babies who are not getting iron from another source, and says vitamin D may be considered.² The American Academy of Pediatrics recommends at least 400 IU of vitamin D a day for all infants, starting soon after birth.⁵ Do not stop these drops early without asking.

How often does a premature baby need check-ups after the NICU?

Often, especially in the first months. The first visit is usually within a few days of going home, then at regular intervals set by your doctor.

WHO strongly recommends home visits by trained health workers to support families caring for small babies.² Many Indian teaching hospitals also run a high risk newborn follow-up clinic. At these visits we check growth, feeding, development, anaemia, bone health, hernias and breathing. Babies born very early or very small, or who were very ill, should attend this clinic.

Why does my NICU baby need a hearing test?

Babies who were in a NICU have a higher chance of hearing loss, and early hearing aids or therapy help speech develop.

The CDC advises that all babies have a hearing screen by 1 month of age, a full hearing test by 3 months if they do not pass, and early intervention by 6 months if hearing loss is found.⁶ Ask before discharge whether your baby's test was done and what type it was. If it was missed, book it straight away.

What eye checks does my premature baby need after discharge?

If your baby needs ROP screening, every eye check must happen on time, even after going home.⁷

ROP is an eye disease of premature babies that can cause blindness if missed. Keep going until the eye doctor says the retina is fully mature. Bring the last eye report to each visit. Later, have your child's eyes checked again as your doctor advises, because children born very early can have other vision problems too.

Will my premature baby develop normally?

Most babies born early do well, but they have a higher chance of delays than full term babies. Early help makes a real difference.

A review of babies born before 32 weeks or under 1500 g found that about 17 percent had cognitive delay and about 21 percent had motor delay in early childhood, mostly mild. About 7 percent had cerebral palsy. Risks were higher in babies born earliest and smallest.⁸ Play, talk and read to your baby every day, and keep every developmental check. Physiotherapy and early stimulation work best when started early.

How should my premature baby sleep at home?

Always on the back, on a firm flat surface, in your room but not in your bed. Keep pillows, bolsters and soft toys out of the cot.⁹

The American Academy of Pediatrics also advises against overheating and against exposure to smoke.⁹ It advises room sharing without bed sharing, and keeping babies away from smoke, alcohol and drugs.⁹ Many Indian families share beds. If you do, never bed share after anyone has smoked, drunk alcohol or taken sedating medicines. A cot or separate mattress next to your bed is safer.

How do I keep my premature baby warm but not too hot?

Feel the back of the neck or the tummy. Warm and dry is right. Cold hands and feet alone do not mean the baby is cold.

In winter or in an air conditioned room, a cap, socks and one more layer than you wear are enough. In a Kolkata summer, a thin cotton layer is often plenty, and too many wraps can cause overheating.⁹ Skin to skin care at home keeps a small baby at the right temperature, and WHO recommends continuing it at home.²

Why do premature babies go back into hospital?

Common reasons are infections, feeding problems, jaundice and breathing trouble. In babies born a few weeks early, jaundice and infection cause most readmissions.¹⁰

Kangaroo care is linked to fewer readmissions in low birth weight babies.¹¹ Keep visitors few in the first weeks, especially in monsoon and winter when coughs and colds spread. Anyone who holds the baby should wash hands first, and nobody should smoke in the house. Preterm babies benefit from flu vaccine from 6 months of age.⁴ It also helps if adults at home are up to date with their own vaccines.

When should I call the doctor or go back to hospital?

Go the same day, or to the nearest emergency, if your baby shows any of these signs. Premature babies can become sick quickly. Many of these signs predict serious illness in young infants:¹²

• Feeding poorly or too sleepy to feed.
• Breathing 60 times a minute or more, chest drawing in, grunting or pauses in breathing.
• Blue or grey lips.
• Temperature of 37.5 degrees C or more, or below 35.5 degrees C.
• Fits, stiffening or jerking.
• Repeated or green vomiting, or a swollen tummy.
• Few wet nappies, or yellow colour spreading to the legs or palms.
• Your baby simply seems unwell to you.