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Milestones a NICU Baby Must Reach Before Discharge

When Can I Take My Baby Home?

By

Updated July 17, 2014

'Newborn premature baby girl, just two days old, resting on her mother's breast.'
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While they’re in the NICU, premature babies have several milestones to meet before they can go home with their parents. Before NICU discharge, premature babies need to be able to breathe, eat, and keep their temperatures stable.

Breathe without oxygen: One of the first milestones that many premature babies meet is being able to keep their oxygen saturation high without needing extra oxygen or other respiratory support. Many preemies need some kind of respiratory support soon after birth. Some babies may only need extra oxygen for a short time, but others need it for longer. Babies who are very small or very early at birth are at risk for a chronic condition called BPD and may need extra oxygen even after they’re ready to go home.

Outgrow 'As and Bs': Apnea of prematurity, commonly referred to as the 'As and Bs,' is a common condition among premature babies. While babies are in the NICU, their heart rate and breathing pattern are carefully monitored, and periods of apnea and bradycardia are caught quickly. By about 34 to 36 weeks gestational age, though, most babies have outgrown As and Bs. Those who haven’t may be sent home with an apnea monitor.

Take all feedings by mouth: Premature babies are not as strong as full-term babies and aren’t able to coordinate sucking and swallowing until about 32 to 34 weeks gestational age. Most premature babies are nourished with TPN at first, and they are fed through a feeding tube until they’re strong enough to drink from the breast or from a bottle. Before babies can be discharged from the NICU, they should be eating from a bottle well enough that they are gaining weight steadily on an ad lib feeding schedule, although this is not absolute. This usually happens around 37 weeks gestational age, although some babies -- especially those who have had severe respiratory problems -- may take longer.

Maintain a stable temperature: Most premature babies need to sleep in an incubator to stay warm. Premature babies aren’t able to keep themselves warm as well as full term babies and will get too cold if they are not skin-to-skin in kangaroo care or kept in an incubator. Being able to stay warm outside of an incubator is a big milestone that preemies need to meet before they can leave the NICU. It is a milestone that is based on weight more than gestational age, and most babies are able to keep themselves warm by the time they weigh about 4 pounds.

Sources:

Leslie Law-Morstatt MHS, Debra M Judd PhD, Patricia Snyder PhD, R John Baier MD and Ramasubbareddy Dhanireddy MD. “Pacing as a Treatment Technique for Transitional Sucking Patterns” Journal of Perinatology (2003) 23, 483–488.

Macwan, K; Shareef, M; Albert, V; Drenckpohl, D. “Initiation of Oral Feedings in Infants Less Than 34 Weeks to Facilitate Early Discharge from NICU” Pediatric Research October 2004; 56, p. 672.

New, K, Flenady, V, and Davies, MW. “Transfer of Preterm Infants from Incubator to Open Cot at Lower Versus Higher Body Weight.” Cochrane Database Syst. Rev. 2008: 2, CD004214.

Stokowski, RN, MS, Laura. “A Primer on Apnea of Prematurity.” Advances in Neonatal Care June 2005. 5; 155-170

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