When Can My Preemie Come Home From the NICU?

Milestones Before a Premies Can Be Discharged From the NICU

Parents may be anxious to bring their baby home from the NICU.
When can you take your baby home from the NICU?. Image by Diane Macdonald / Getty Images

If your baby is in the neonatal intensive care unit (NICU) you're probably wondering when she can come home. Since this is a question that is on so many parents mind's, it's good that there are some specific criteria you can watch for.

When Can Your Baby Be Discharged From the NICU?

Almost as soon as your baby enters the NICU you may be questioning how long she will be there. How long do babies need to stay?

What milestones must be met before she's discharged?

In general, there's not a "rule" which states how long your baby will have to stay in the NICU. Many babies go home from the NICU about the time they were originally due to be born, but this can vary widely. Some babies may be discharged from the NICU well before they were expected to be born, while others will need to stay well beyond their due dates.

While there is not a rule about gestational age at discharge, there are several NICU milestones which must be met before a premie can come home. Let's take a look at each of these individually.

Staying Warm

Before being sent home, a baby needs to be able to maintain her body temperature outside of an incubator. The time at which your baby is able to stay warm in an open crib will depend more on her weight than her gestational age. In general, premies gain the ability to control their body temperature outside of an incubator when they are about 4 pounds.

Certainly, this can vary considerably, and other factors need to be considered as well.

If your baby has reached this milestone, check out these answers to questions parents often have about temperature when going home with a premature baby.

Take All Feedings By Mouth

In general, babies are not discharged from the NICU until they are able to take all of their feedings by mouth.

In other words, they are able to coordinate sucking and swallowing and take their feedings from a bottle or breast. This is not a hard and fast rule, however, and some babies are sent home with an NG tube or a G-tube.

Until the age of 32 to 34 weeks gestational age, most babies are unable to feed by bottle or breast alone, and even when they no longer require total parenteral nutrition or a feeding tube, many require scheduled regular feedings until the age of 37 weeks gestation age. Many NICU's want to see a baby not only gaining weight on scheduled feedings, but able to do so on ad lib schedules (feeding when the baby is hungry rather than by the clock.)

Breathe Without Oxygen

Most of the time, babies should be able to breathe room air without oxygen before they are sent home from the NICU. There are exceptions to this general rule, however, and some babies are allowed to go home with the use of oxygen via a nasal cannula. Your baby's doctors will make sure that she is able to maintain her oxygen saturation on room air well before you go home.

Outgrow As and Bs

As and Bs stand for apnea and bradycardia and are hallmarks of prematurity.  Apnea refers to periods in which a baby stops breathing for awhile (more than 20 seconds.) This lack of breathing results in falling oxygen saturation levels, which in turn results in a lowering of the heart rate (bradycardia.) These "spells" are very common in premature infants, occurring in half of babies born around 30 weeks gestation and dropping to around 7 percent when a baby reaches 34 to 35 weeks gestation.

It is usually caused by immaturity of the nervous system.

Most of the time babies are kept in the NICU until their A and B spells have resolved. Sometimes, if a baby is doing well and has met all of the other milestones for discharge, but continues to have mild As and Bs, she may go home with a portable heart and breathing monitor.

Keep in mind that you won't be sent home if your child is at risk, or if it's thought that her spells could be dangerous. Your baby's doctor may give you the choice to keep your baby in the NICU a little longer or go home with a monitor. In that case, it will be up to you and how comfortable you are with monitoring your baby.

Screening Before Discharge

In addition to achieving the milestones noted above, specific screening tests will likely be required before you take your baby home. These may include a hearing test (either the otoacoustic emission or the automated auditory brainstem response tests,) car seat safety check, testing for an hyperbilirubinemia, and screening for heart disease.

In addition, normal education as done with full-term infants will include instruction on feeding, elimination, weight gain, and more.

Bottom Line on Bringing Your Baby Home From the NICU

Deciding when your baby may go home from the NICU is usually based on her attainment of the milestones listed above. The NICU staff will not send you home before you are comfortable managing any extra cares beyond those of caring for a healthy full-term newborn. Babies can vary tremendously when it comes to the time they may be discharged. It's hard to predict a time based on gestational age or weight when she will be ready, and rather it depends on many different factors.

Before your baby goes home, make sure to get your own support system in place. Bringing home a premature infant is stressful. Many parents feel a bit overwhelmed as they suddenly find themselves alone with their baby after the constant activity of a NICU. If the time is getting close, check out this guide to bringing your premie home. It's also a good idea to be aware of car seat safety for premature infants.

Sources:

Aagaard, H., Uhrenfeldt, L., Spliid, M., and L. Fegran. Parents’ Experiences of Transition When Their Infants are Discharged from the Neonatal Intensive Care Unit: A Systematic Review Protocol. JBI Database of Systemic Reviews and Implementation Reports. 2015. 13(10):123-32.

Kliegman, Robert M., Bonita Stanton, St Geme III Joseph W., Nina Felice. Schor, Richard E. Behrman, and Waldo E. Nelson. Nelson Textbook of Pediatrics. 20th Edition. Philadelphia, PA: Elsevier, 2015. Print.

Quinn, J., Sparks, M., and S. Gephart. Discharge Criteria for the Late Preterm Infant: A Review of the Literature. Advances in Neonatal Care. 2017 Apr 24. (Epub ahead of print).

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