Premature birth

Diagnosis

A premature baby in the NICU may need to have many tests. Some tests are ongoing. Other exams may be done only if the NICU staff thinks the baby might have a certain health problem.

Tests your premature baby may need include:

• Breathing and heart rate monitoring. The baby's breathing and heart rate are tracked constantly. Blood pressure readings are done often too.
• Fluid input and output measurement. The NICU team tracks how much fluid your baby takes in through feedings and through a vein. The team also watches how much fluid your baby loses through wet or soiled diapers.

• Blood tests. Blood samples are taken by pricking the heel or placing a needle in a vein. These tests let the NICU staff closely watch the levels of important substances in your baby's blood, such as calcium and blood sugar. A blood sample also may be checked to look for signs of problems such as anemia or illnesses.

  Your baby's health care provider may need the NICU staff to take many blood samples. If so, the staff may insert a thin tube into a vein in the stump of the baby's cut umbilical cord. This way, the staff won't have to stick your baby with a needle each time blood is needed.

• Echocardiography. This imaging test is an ultrasound of the heart. It checks for problems with the way the heart works. It uses sound waves to make moving images on a display screen.
• Ultrasound. This imaging test may be done to check the brain for bleeding or fluid buildup. Or it can be used to check the organs in the stomach area for problems with the digestive tract, liver or kidneys.
• Eye exam. An eye doctor called an ophthalmologist may check your baby's eyes and vision to look for problems with the retina.

More tests may be needed if your baby has other health problems.

Treatment

The neonatal intensive care unit (NICU) or special care nursery closely tracks your premature baby's health.

Supportive care

This type of care for your baby may include:

• Being placed in an incubator. The incubator is an enclosed plastic bassinet that your baby will probably stay in. It's kept warm to help the baby stay at a regular body temperature. Later on, NICU staff may show you a way to hold your baby with direct skin-to-skin contact. This is known as "kangaroo care."
• Tracking of your baby's vital signs. Sensors may be taped to your baby's body to track blood pressure, heart rate, breathing and temperature. A machine called a ventilator or a device called CPAP may be used to help your baby breathe.
• Having a feeding tube. At first your baby may receive fluids and nutrients through a tube in a vein. Breast milk may be given later through a tube passed through your baby's nose and into the baby's stomach. When your baby is strong enough to suck, breastfeeding or bottle-feeding often can be done.
• Getting enough fluids. Your baby needs a certain amount of fluids each day. The exact amount depends on the baby's age and health. The NICU team will closely track fluid, sodium and potassium levels to make sure that your baby's fluid levels stay on target. If fluids are needed, they'll be given through a tube in a vein.
• Spending time under bilirubin lights. To treat infant jaundice, your baby may be placed under a set of special lights. These lights help your baby's system break down extra bilirubin. That's a yellow-colored substance that builds up in the body if the liver can't process it all. Your baby will wear a protective eye mask while under the lights to rest more easily.
• Receiving blood from a donor. Some preterm babies need blood transfusions. This can be due to certain health problems, or because many blood samples have been taken for tests.

Medications

Medicines may be given to your baby for different reasons. For instance, some medicines help the lungs and heart work better. Depending on your baby's health, the medicines they receive may include:

• Surfactant, which is used to treat respiratory distress syndrome.
• Fine-mist or medicines given in a vein to strengthen breathing and heart rate.
• Antibiotics for an illness caused by bacteria, or if there's a risk of such an illness.
• Diuretics, which make the baby pee more to manage excess fluid.
• A shot of medicine into the eye to stop the growth of new blood vessels, which could cause the eye disease retinopathy.
• Medicine that helps close the heart defect called patent ductus arteriosus.

Surgery

Sometimes surgery is needed to treat a premature baby's health problems. Talk with your baby's health care team to understand which complications may lead to surgery. Learn about the types of surgery that might be needed to treat these problems too.

Taking your baby home

The following signs mean your baby is ready to go home:

• Can breathe without support.
• Has a stable body temperature.
• Can breastfeed or bottle-feed.
• Is gaining weight over time.
• Is free of major health problems.

The hospital may let a baby go home before meeting one of these requirements. But the baby's medical team and family first need to set up and agree on a plan for home care and follow-up health care.

Your baby's health care team will help you learn how to care for your baby at home. Before your baby can leave the hospital, your baby's nurse or a hospital discharge planner may ask you questions about:

• Where you live and who you live with.
• Other children in the home.
• Adult relatives and friends who may help you care for your baby.
• Who the baby's primary health care provider will be.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

The thought of bringing your baby home from the hospital might make you feel relieved, excited and nervous. You can do some things ahead of time to prepare for life at home:

• Understand how to care for your baby. Before you leave the hospital, take a course in infant CPR. This can save the lives of babies who stop breathing. Ask your baby's medical team any questions you might have, and take notes.

  Make sure you're comfortable caring for your baby. This is very important if you'll need to use health monitors or give your infant medicines, oxygen or other treatments. Ask what symptoms to call your baby's health care provider about, such as breathing or feeding problems.

• Discuss feedings. Ask the medical team about your baby's need for extra nutrition. The team might suggest that you use products such as breast milk fortifier supplements or preterm infant formula. Keep in mind that premature babies often eat less and may need to be fed more often than full-term babies. Find out how much and how often your baby should eat.
• Limit contact with other people. Premature babies are more likely to get serious illnesses than are other newborns. Try to keep your baby away from crowded places as much as you can. And make sure everyone who comes into contact with your baby washes their hands first. Ask people who are ill to put off their visit until they are well.

• Protect your baby from RSV. Premature babies have a higher risk of getting a serious illness called RSV infection. This disease is caused by a virus. It affects the lungs and other organs involved in breathing.

  There are a few options to protect premature babies from severe RSV infection. One is an RSV vaccine for pregnant people that helps protect babies from birth through 6 months of age. The other is an antibody product given to the infant. This product is called nirsevimab (Beyfortus). Rarely, when nirsevimab is not available or a child is not eligible for it, another antibody product called palivizumab may be given.

• Follow a suggested schedule for checkups. Discuss your baby's need for future health checkups with your baby's care provider and any specialists. At first, your baby may need to see a primary care provider every week or two. That way the baby's growth, health needs and care can be watched closely.

• Get your baby vaccinated. Vaccines help protect people from dangerous diseases. It's suggested that vaccines be given to premature babies who are in stable health based on their age. Your baby's care team may talk to you about a schedule for when your baby should receive each vaccine. Delays in this schedule are common. Work with your baby's care provider to make sure your baby gets every vaccine on the schedule.

  Also make sure that other family members in your home are up to date on their vaccines, including shots for the flu and COVID-19. Family members and adult caregivers also should check with their health care providers to find out if they're up to date on their pertussis vaccine for whooping cough. If you're pregnant, make sure you're up to date on this vaccine too.

• Note any delays in development. Over the coming months, your baby's care provider may watch for any signs that the baby is taking longer than usual to reach key milestones. Babies who are at risk of such delays or disabilities may need more tests. You may be referred to services and support systems that can help, called early intervention services. The rules that determine who gets to use these services vary based on where you live.

Coping and support

Caring for a premature baby can be very tiring. You may be anxious about your baby's health. You also might feel angry, guilty or overwhelmed.

Some of these tips may help during this hard time:

• Learn everything you can about your baby's health. Talk to your baby's health care providers. Ask for pamphlets, books and trusted websites to get more information about taking care of your preterm baby.
• Take care of yourself. Get as much rest as you can. Eat healthy foods too. You'll feel stronger and better able to care for your baby.
• Build up your milk supply. Use a breast pump until your baby is able to breastfeed. Ask the hospital staff for help. They can show you how to use a breast pump and find the supplies you'll need to store milk.
• Accept help from others. Let friends and family help you. They could care for your other children, prepare food, clean the home or run errands. This helps you save your energy for your baby.
• Keep a journal. Write down the details of your baby's progress, along with your own thoughts and feelings. You may want to include pictures of your baby. That way you can see how much your child changes from week to week.
• Find good listeners for support. Talk to your partner or spouse, friends, family, or your baby's caregivers. The NICU social worker often can be helpful. If you're interested, your baby's caregivers may be able to suggest a support group in your area or online. Many parents find it very helpful to talk to other parents who take care of a preterm infant.

Caring for a premature baby is a great challenge. Take it one day at a time. Despite the worries and setbacks, celebrate your preemie's strength and ability to adapt. Cherish the time you can spend getting to know your child.

Preparing for your appointment

As the parent of a premature baby in the neonatal intensive care unit (NICU), you'll talk with many care providers for your baby. Members of the NICU team caring for your infant may include:

• Neonatal nurse — A registered nurse who has special training in caring for premature and high-risk newborns.
• Neonatal nurse practitioner — An experienced neonatal nurse who has completed extra training to assist doctors called neonatologists in caring for newborns.
• Pediatrician — A doctor who treats children from birth through the end of childhood.
• Neonatologist — A pediatrician who is trained to treat health problems in newborns.
• Pediatric resident — A doctor who is being trained to treat children.
• Respiratory therapist — A provider who helps care for newborns with breathing-related problems.
• Pediatric surgeon — A surgeon who is trained to do surgery for newborns and children.

You also might meet with a pediatric social worker. This professional can help you find services that might be useful during and after your baby's hospital stay.

Ideally, you'll work together with your baby's care providers. Over time, they can show you how to hold, feed and care for your baby.

What you can do

It's OK to ask the NICU care team any questions you have about your baby's condition. Or you can write down your questions and get answers when you're ready.

For instance, you could ask:

• How is my baby's health? Has anything changed?
• How does this equipment help my baby?
• Why are you giving my baby medicine?
• What types of tests does my baby need?

You also can ask how to help care for your baby:

• When can I hold my baby? Will you show me how?
• When can I try to breastfeed or bottle-feed my baby?
• Who should I contact if I have questions about my baby's care?
• Can I bring in a blanket or family photos to personalize my baby's incubator?

You may have questions about taking your baby home too:

• When will my baby be able to come home?
• What do I need to know about caring for my baby once we're home?
• How often do we need to come back to the hospital for follow-up visits?

During your baby's time in the NICU, feel free to ask the staff how you can become more involved in your baby's care. It can give you confidence as a new parent. It also can make life easier once you bring your child home.