Premature babies and the neonatal unit

A pregnancy normally lasts about 40 weeks. A baby born before 37 weeks is premature.

How much help a premature baby needs depends on how early they were born. A baby born at 35 weeks may need only a little help. A baby born at 26 weeks needs much more, for much longer. Doctors group babies by the week of pregnancy at birth:

• Moderate to late preterm means born from 32 to 37 weeks.
• Very preterm means born from 28 to 32 weeks.
• Extremely preterm means born before 28 weeks.

The earlier the birth, the more the organs still have to mature outside the womb. The lungs, the gut and the brain need the most time.

The neonatal unit is often called the NICU. Nurses and doctors there care for sick and premature newborns day and night. Here is what the main machines do.

• The incubator is a clear, closed bed that keeps your baby warm. Small babies lose heat very fast.
• The monitor uses small stickers on the chest and a soft light on a hand or foot. It tracks the heartbeat, breathing and oxygen level.
• The monitor beeps often. Many alarms come from a loose sticker or a baby who moved. The nurse checks every one. Ask which sounds matter.
• Some babies need a breathing machine through a small tube in the windpipe. Others need gentle air pressure or extra oxygen through small prongs in the nose.
• A drip is a thin tube in a vein, the belly button or the arm. It gives fluids, nutrition and medicines.
• A feeding tube is a soft tube from the nose or mouth to the stomach. It carries milk until your baby can suck, swallow and breathe at the same time. This skill usually comes around 34 weeks.
• Blue lights are phototherapy. They treat jaundice, the yellow color of the skin. Your baby wears soft eye covers under the lights.

Progress in the neonatal unit is rarely a straight line. One day you hear good news. The next day the team turns the oxygen back up or pauses the milk. This is hard to live through.

It helps to know why. The lungs of a premature baby take weeks to heal. The team weans support step by step, through trials. A trial that fails still tells the team where the lungs are. They try again later.

A step back is common in the neonatal unit. It does not mean your baby is losing ground. Ask the team what changed and what the plan is.

As long as your baby is in the neonatal unit, the team watches for early signs of trouble.

You are your baby’s parent, and the team needs you there.

• Hold your baby skin to skin. This is also called kangaroo care. Your baby lies on your bare chest, wearing only a diaper, under a blanket. It keeps your baby warm, steadies breathing and heartbeat, and helps feeding. A few minutes a day count. Fathers can do it too.
• Express your breast milk. Your milk protects your baby’s gut and helps fight infection. Start expressing as soon as you can after birth, and keep going every few hours. Small amounts count too. Ask the nurses to show you how.
• Be there. Talk and sing softly. Your baby knows your voice. Rest a still hand on your baby, without stroking. Small babies tire quickly.
• Join in the care. Change diapers, take the temperature, help with feeds. The nurses will teach you.
• Ask questions. Write them down between visits. Ask what each machine does, what the alarms mean and what the next step is.

Look after yourself too. Eat, sleep when you can, and accept help. Tell the team if you feel overwhelmed. Many parents do.

A whole team looks after your baby. A nurse notes a number at three in the morning. A resident repeats a blood test. A doctor adjusts the plan. Each of them watches your baby closely.

Expect honest news, given in plain words. Sometimes the news is not what you hoped. The team cannot promise that nothing will go wrong. They will tell you the truth and answer your questions.

While your baby is in the neonatal unit, you can call at any time for news. Ask to speak with the nurse caring for your baby, or with the doctor.

Tell the team if you notice anything new about your baby. You may spot it first. Tell them also if you have a fever, a cold or a stomach bug. They will advise you on visits and on your milk.

When your baby is ready to come home, read our guide on going home from the neonatal unit.