Caring for premature babies

All newborns need gentle and nurturing care. However, when a baby has been born prematurely, they have extra needs when planning for their care. The average gestation period, or full-term pregnancy for humans, is between 37- 42 weeks. In Australia, around 8% of babies are born prematurely – before 37 weeks gestation.  

Caring for premature babies

Most premature babies are born between 32-36 weeks gestation, though almost all of them grow up to be healthy and well children.  The chances of survival depend on how premature a baby is.  Babies who are born premature, also known as ‘prem’ are generally smaller, lighter and less robust than babies who are born when they are due. It’s common for premature babies to be classified according to their Corrected Age (CA) rather than their actual age. A corrected age is the baby’s actual age minus the number of weeks or months they were born. 

Special Care Units (SCU) or Neonatal Intensive Care Units (NICU) have specialist equipment and trained staff to manage premature and sick babies’ care.  

As your baby becomes more stable and there are plans for discharge home, you will become more involved in their care.  Feeding, bathing, changing nappies, giving medications (if needed) and monitoring their oxygen levels are all skills for parents which improve with practice. 

You will also have the opportunity to ‘room in’ with your baby at the hospital and be guided by the staff in your little one’s care. If your baby is still on oxygen or needs other equipment, you’ll be shown how to use this so you become more confident. 

It’s normal if you’re feeling some anxiety about going home with your premature baby, though it may help you to know that you won’t be discharged until both you and the hospital staff are confident you are ready. 

10 Common issues with premature babies

  1. Breathing problems. Depending on the baby’s gestation, they may need to be ventilated or have breathing support until their lungs mature and they can breathe on their own. 
  2. Feeding difficulties – caused by a delay in being able to suck.  Often, premature babies need to be fed via a tube into their stomach until their sucking and swallowing reflexes have developed. 
  3. Temperature control issues – because of immaturity of the portion of the baby’s brain which controls their temperature.   This is why prem babies are often cared for in humidicribs which are temperature controlled. 
  4. Apnoea – this is a condition when the baby stops breathing for a short period.  This is due to the baby’s brain immaturity in the section which controls their breathing. 
  5. Bradycardia – slow heart beat which is caused by the apnoea episodes. 
  6. Jaundice – this is when the skin becomes yellow and is due to the liver breaking down red blood cells. Often, premature babies need phototherapy treatment to help their body process the bilirubin which causes their skin to have a yellow/orange tinge.  
  7. Low blood sugar – this is often monitored closely and is managed by frequent feeding or Intravenous fluids.
  8. Slow weight gain, until their feeding improves. Expressed breast milk, donor milk or premature baby formula are often used, in the right amounts, to support the baby’s growth. 
  9. Very premature babies are also at risk of having other conditions with their heart, eyes and gut. 
  10.  They are also more vulnerable to developing infections and are commonly on antibiotics. 

Oh, you’re so tiny…

It can be scary for parents to care for their premature baby, especially if their early birth was a surprise. Some (very) premature babies spend a long time in hospital and it’s common for parents to feel a combination of excitement and fear about how they’ll manage once they are home.  

Most NICUs have discharge coordinators who help new parents to prepare for going home.

Do you want to talk?

Think about talking with someone about your baby’s birth if you’re struggling. The circumstances around premature birth can be challenging to deal with.  It can be very helpful for new parents to have the opportunity to debrief and speak with a counsellor about what they have experienced. Remember, you need to be okay so you can look after your baby well. 

Expect your premature baby to become easily tired and need to sleep a lot. Gentle handling, feeding and changing can be exhausting for small babies. During sleep, babies conserve energy and release growth hormones.  They also spend a lot of their time in Rapid Eye Movement (REM) sleep which is essential for their learning and memory, as well as brain development.  

What to expect in the early weeks after coming home with your prem baby

  • Frequent appointments with the team who supported you in hospital. Use phone apps, calendars and reminders to help keep you on track with your baby’s appointments. 
  • If you have the energy, it may help to be open to new developments and research findings which are constantly being updated to improve the outcome for premature babies. 
  • Aim for simple and quiet life at home in the first few weeks after coming home with your premature baby. Managing their feeds and general cares will take lots of time and energy, so choose carefully what else you take on.
  • Always follow the safe sleeping guidelines when settling your baby for sleeps. Even if your baby was settled to sleep on their tummy in hospital, it’s important you always place them on their back for sleeps. 
  • Make sure your baby is dressed warmly. Premature babies have very little body fat – which acts as a natural insulator against the cold. 
  • Swaddle your baby in a cotton or muslin wrap. This will help them to feel secure and warm and will help to contain their ‘startle’ reflex so they don’t wake up as easily. 
  • Be mindful of good hygiene and wash your hands after nappy changing, before feeding and handling your baby. Encourage other people to do the same. This will help to reduce the risk of your baby becoming sick. Limit visitors in the early weeks, until you’ve settled in at home and your baby isn’t so little. 
  • Make sure your baby receives the routine vaccinations recommended for their age. As long as your baby is well and stable, they need to receive their vaccines according to their actual age, not their corrected age. This is important because premature babies need the protection of immunisations as they’re especially vulnerable to some infections.  Check here of more information. 
  • Feed your baby as frequently as you’ve been advised to by the hospital. You may need to offer your baby expressed breast milk (EBM) if they are too immature to suck at your breast.  Many mothers of premature babies buy or rent a dual electric breast pump which makes the job of expressing easier and less time intensive.  Check here for information on expressing and storage of breast milk.
  • Have a list of numbers to call and people to ask if you have any concerns with your premature baby once you’re home.  Never hesitate to check or seek reassurance if you’re unsure about any aspect of your baby’s care.  

One final thing

Make sure you take the time to simply enjoy your baby each day. All new babies need lots of love and attention, but premature babies can absorb even more time and energy. It’s important to try and make the most of each day, no matter how mature your baby was when they were born. 

Written for Sudocrem by Jane Barry, Midwife and Child Health Nurse, July 2022.