7 Things to Know About Bringing Your Baby Home From the NICU

Becoming a parent can be overwhelming — and even more so if your infant spent time in the neonatal intensive care unit, or NICU. Whether your premature baby spent a few days or a few months in the NICU, they may have more complex needs than babies born at term.

“In the NICU, we offer a lot of education and support for parents. But once they go home, they feel they are on their own,” says neonatologist Anirudha Das, MD. “Babies who started life in the NICU are often fragile, and the parents are anxious. So it’s helpful to know what to expect.”

How do we keep our neonate babies safe from SIDS?

Preemies are more prone to sudden infant death syndrome (SIDS) than term babies. Dr. Das encourages all parents to follow the sleep safety guidelines from the American Academy of Pediatrics, including:

• Back to sleep: Place your child on their back to sleep or nap, but encourage supervised playtime on the tummy.
• Share your room: Have your baby sleep in the same room as you but not in the same bed.
• Stay firm: Choose a firm, flat sleep surface and make sure no bedding or soft items remain in the crib when your baby sleeps.
• Immunize: Pertussis, or whooping cough, is a preventable respiratory disease that is linked to SIDS. Protect your baby by making sure caregivers are vaccinated.
• Don’t smoke: Breathing in smoke could cause apnea in babies and lead to SIDS. For your baby’s protection (and your own), quit smoking.

Dr. Das also recommends not using store-bought movement or oxygen monitors. They are unreliable and often give a false sense of security that everything is fine, he says.

Is my preemie more susceptible to germs?

“A premature baby’s immune system is not fully developed, so be extra cautious,” Dr. Das says. “Breast milk gives antibodies, which provide the baby with an extra measure of protection. Whenever possible, we encourage moms to nurse their babies or pump and feed breast milk in a bottle.”

Dr. Das also recommends:

• Vaccination: Most of the time, babies receive their first immunizations before they leave the NICU. You and any visitor who comes in contact with your preemie need to receive the flu and DTaP (diphtheria, tetanus and pertussis) vaccines. A baby cannot get the flu vaccine until they are 6 months old, so their health depends on siblings, visitors and caregivers being immunized.
• Handwashing: Make sure you and anyone who comes in contact with your baby washes their hands or uses hand sanitizer.
• Minimize contact when ill: If you breastfeed and become sick, you can breastfeed wearing a mask to avoid giving the infection to the baby, or ask a family member to feed the baby using a bottle.

Is it safe to bathe a premature baby who was in the NICU?

“Parents can bathe their baby every day, as long as they keep the room temperature higher, so the baby doesn’t get cold in the bath or immediately after,” says Dr. Das. “And since babies tend to have dry skin, I recommend putting moisturizer on the skin within 5 to 10 minutes after their bath.”

What steps should I take when feeding my preemie baby?

Dr. Das says all preterm babies have reflux and may vomit two to three times a day, which is normal. He recommends parents receive CPR training, because there is a risk of choking with reflux.

Other important feeding-related advice includes:

• Stooling: Breastfed babies will poop several times a day. Formula-fed babies may poop once every four days, since formula causes decreased bowel movements. A hard stool, however, is abnormal for preemies.
• Water: You can use tap water to mix formula, but bring it to a boil for two to three minutes first, and then let it cool. Boiling kills the organisms that could affect preemies in their first few months.
• Equipment: If you are using a bottle to feed your baby, choose nipples as recommended by the NICU staff. Other than that, you can use the same materials as you would for a term baby.

Will I need any special equipment for my NICU baby?

“These days, few babies go home with an apnea monitor, and most don’t go home on oxygen,” says Dr. Das. “If your baby does need an apnea monitor or oxygen for a short time, you’ll be given instructions before you leave the NICU.”

Before the neonatologist discharges your baby, they’ll do a car seat challenge test. Your baby will stay in a car seat for two hours to make sure they can breathe in the seat. Car seats could result in the neck position blocking the airway, so this is an important test to make sure your baby is safe.

How do I choose a pediatrician, and if I have questions, who do I ask?

Any pediatrician is qualified to care for a premature infant. If possible, stay within the same health system as the neonatologist to ensure seamless transition of care.

If you have questions in the period shortly after discharge, you can reach out to the neonatologist, but your baby’s pediatrician will be their primary care provider. For babies with complex issues, the outpatient neonatology team will follow your baby’s developmental milestones along with the pediatrician for the first two years of life.

Is postpartum depression common among parents of preemies?

“The mental health of parents is vital,” says Dr. Das. “They experience a lot of anxiety when their baby is in the NICU, so postpartum depression is a very real thing.”

Happy, healthy parents are key to healthy babies, Dr. Das says. He urges parents to get screened and find support if they feel anxious or depressed.