Too Cool for the NICU

By: Dr. Marietta Sperry, DNP, MSN, RNC-IBCLC, IBCLC

When your baby is born early,
but too good for the NICU...

"Do all babies born early need to go to the NICU?"

Some babies born between 34-37 weeks might need to go to the neonatal intensive care unit (NICU) after birth, but not all do! Many now can be cared for with mom in the regular Mother/Baby unit.

Some “transition” to life outside the womb good enough to be with you in the regular mother-baby unit. Even though they are early, and their counterparts might need a few days or even weeks before they are ready to go home, your baby may not need to go to the NICU.^1,2

"Great Pretenders"

Some babies born too early may look just like a full-term baby (born between 38-40+ weeks), but do not always act like them. They may look like they are eating well and are making great efforts. However they may lack the strength to feed well or sleep too much, which could result in weight loss. They might still have breathing problems such as not knowing how to such, swallow, and breathe in a coordinated way. Sometimes they may even get jaundiced (yellow skin) because they are not eating enough. Some of these might happen after you go home. Some may be readmitted for problems that are continuing

Characteristics of Late Preterm/Early Term Infants³

"So what should I do if my baby is born early and too good for the NICU?"

Some things you can do⁵:

1. Follow up- Check with your pediatrician at regular intervals to make sure your baby is gaining weight adequately after discharge. Notify them if something just doesn’t feel right! Typically you may be asked to return to your pediatrician within 1-2 days after discharge.
2. Don’t let your baby sleep too long, even while still in the hospital. The old adage about never waking a sleeping baby does not apply to babies born too early! Newborns should eat 8-12 times in 24 hours. Wake them up to eat if they are sleeping longer than 3-4 hours. Ask for guidance on a feeding plan tailored to your baby.
3. Follow Safe Sleep Guidelines
   https://www.nichd.nih.gov/sites/default/files/publications/pubs/Documents/NICHD_Safe_to_Sleep_brochure.pdf
4. Review with your provider the signs of adequate intake: 8-10 wet diapers a day and 2 poops a day by the end of their 1^st week. Their pee should be pale yellow and not dark or concentrated.
5. Ask questions-“Is there anything else I should know?” to your healthcare provider before hospital discharge with your "too cool to go to NICU? baby.

Want more info about early or late pre-term infants?

Follow the links below for more resources.

For more about late preterm (babies born between 34-36 weeks, and early term infants (babies born between 37-38 6/7) see the following:

"What Parents of Late Preterm (Near-Term) Infants Need to know"
https://my.awhonn.org/productdetails?id=a1B2E000008LOXeUAO

Brigham and Women’s Hospital Letter for parents of babies born between 35-37 weeks
https://www.brighamandwomens.org/assets/BWH/pediatric-newborn-medicine/pdfs/caring-for-late-preterm-infant-letter-inf-bwh-hms.pdf

Late Preterm Infants Brochure-CHI health
https://www.chihealth.com/content/dam/chi-health/website/documents/continuinged/LatePretermInfantsBrochure.pdf

Or check out these videos!

March of Dimes-Developmental milestones for premature babies
https://youtu.be/k-MrCxDLAZo

For more in-depth information geared towards healthcare providers see
Dr. Valencia Walker, MD. Late Preterm Infants
https://youtu.be/G-OlH9PfTxA

Marietta Sperry, DNP, MSN, RNC-MNN, IBCLC

Dr. Sperry is a nurse with a Doctor of Nursing Practice degree. She has over 40 years of experience in Maternal-Newborn nursing with a National Certification. She is an International Board-Certified Lactation Consultant. She obtained her DNP and Master of Nursing Education degrees from Indiana State University and is currently pursuing a Ph.D. in Nursing at the University of Utah. Her passion is improving outcomes for the Maternal Newborn population. She loves spending her spare time with her grandchildren.

References

1. Engle, W. A., Tomashek, K. M., & Wallman, C. (2007). “Late-preterm” infants: A population at risk. Pediatrics, 120(6), 1390–1401. https://doi.org/10.1542/peds.2007-2952
2. Mefford, L. C., & Alligood, M. R. (2011). Evaluating nurse staffing patterns and neonatal intensive care unit outcomes using Levine’s conservation model of nursing. Journal of Nursing Management, 19(8), 998–1011. https://doi.org/10.1111/j.1365- 2834.2011.01319.x
3. Young, P. C., Korgenski, K., & Buchi, K. F. (2013). Early readmission of newborns in a large health care system. Pediatrics, 131(5), e1538–e1544. https://doi.org/10.1542/peds.2012-2634
4. Brigham and Women's Hospital. (2016). Caring for late preterm infant [PDF]. Women's and Brigham's Hospital. https://www.brighamandwomens.org/assets/BWH/pediatric-newborn- medicine/pdfs/caring-for-late-preterm-infant-letter-inf-bwh-hms.pdf
5. Cox, Wendy-Author’s photos https://www.wendycoxphotography.com/#MTop