A birth before thirty seven weeks is preterm, and India has among the highest numbers of preterm births in the world. For parents, the neonatal unit is an overwhelming environment of alarms, tubes and terminology.
Understanding what is happening and what your role is makes an enormous difference, and parents are not visitors in this process.
Degrees of Prematurity
The outlook varies enormously across the preterm range, and the categories matter.
- Late preterm, 34 to 36 weeks: most do well, often needing feeding support and temperature regulation
- Moderate preterm, 32 to 34 weeks: commonly need breathing support and tube feeding for a period
- Very preterm, 28 to 32 weeks: require intensive support and a stay of several weeks
- Extremely preterm, under 28 weeks: the most complex, with a stay often extending to the original due date
Late preterm babies are frequently underestimated. They look like small term babies but have immature feeding, temperature control and jaundice handling, and they need more support than their appearance suggests.
What the NICU Equipment Does
The machinery is less alarming once you know what each item is for.
- Incubator: maintains temperature and humidity, since preterm babies lose heat rapidly
- CPAP: delivers continuous pressure through soft nasal prongs to keep the lungs open
- Ventilator: breathes for the baby when they cannot do so adequately
- Monitor leads: track heart rate, breathing and oxygen saturation
- Nasogastric tube: delivers milk, since coordinated sucking develops only around thirty four weeks
- Intravenous lines: fluids and medication
- Phototherapy lights: for jaundice, which is more common in preterm babies
Alarms sound frequently and most are not emergencies. They often reflect a leg movement dislodging a sensor. The nursing team will tell you which ones matter.
Common Complications of Prematurity
Knowing what is being watched for helps you understand the daily conversations.
- Respiratory distress syndrome: immature lungs lacking surfactant, treated with surfactant and breathing support
- Apnoea of prematurity: pauses in breathing, which resolve as the brain matures
- Jaundice: more frequent and treated at lower thresholds
- Infection: preterm babies are highly susceptible, hence strict hand hygiene
- Necrotising enterocolitis: a serious bowel condition, less common in babies fed breast milk
- Retinopathy of prematurity: abnormal retinal vessel growth, screened for by an eye specialist
- Anaemia and low blood sugar
Breast milk substantially reduces the risk of necrotising enterocolitis and infection, which is why expressing is encouraged from the first day even when the baby cannot yet feed.
Kangaroo Mother Care
Skin to skin contact between parent and baby is one of the most effective interventions in neonatal care, and the evidence is strong.
The baby, wearing only a nappy and cap, is held upright against the parent's bare chest and covered. Benefits include better temperature stability, more stable heart rate and breathing, improved weight gain, better breastfeeding success, reduced infection and shorter hospital stay.
Both parents can provide it. Aim for sessions of at least an hour, since shorter periods disturb the baby more than they help. Ask the nursing team when you can start, which is often earlier than parents assume.
Feeding a Preterm Baby
Feeding progresses in stages as the baby matures, and it is often the last thing holding up discharge.
Initially nutrition is intravenous, then small volumes of milk are introduced through a tube. Coordinated suck, swallow and breathe develops around thirty four weeks, so breastfeeding or bottle feeding begins around then.
Expressed breast milk is strongly preferred and is often fortified with additional protein and minerals for very preterm babies, since their requirements exceed what breast milk alone provides.
Express eight to ten times daily including once at night to establish supply. Many mothers find supply difficult under the stress of a NICU stay, and this is common rather than a failing. Our feeding support service works with mothers throughout the admission.
Understanding Corrected Age
This concept is essential and frequently not explained clearly.
Corrected age is the age the baby would be if born on the due date. A baby born at thirty weeks, now four months old, has a corrected age of two months.
Development and growth should be assessed against corrected age, not actual age, until around two years. A preterm baby who is not sitting at seven months actual age but is at the level expected for four months corrected is developing appropriately.
The one exception is vaccination, which follows actual age from birth without correction. Preterm babies should not have immunisation delayed.
Going Home
Discharge criteria are practical rather than based on a set weight.
- Maintaining temperature in an open cot
- Feeding fully by breast or bottle without tube support
- Gaining weight consistently
- No episodes of apnoea for a defined period
- Screening tests completed, including eye and hearing checks
- Parents confident in feeding, and trained in basic resuscitation
Going home is often accompanied by anxiety after weeks of continuous monitoring. That is normal. Keep the unit's contact number and use it.
Follow Up After Discharge
Preterm babies need structured follow up, and this is where late problems are identified and treated.
- Growth monitoring using corrected age
- Developmental assessment at regular intervals through the first two years
- Eye examination for retinopathy, on the schedule set before discharge
- Hearing assessment
- Iron and vitamin D supplementation, usually for several months
- Immunisation on schedule by actual age
- Physiotherapy where muscle tone is abnormal
At home, minimise visitors in the early weeks, insist on hand washing, avoid anyone with respiratory infection, and keep the baby away from crowds during the first winter. Preterm lungs handle respiratory infections poorly.
The Parents Need Care Too
A NICU admission is traumatic. Rates of anxiety, depression and post traumatic stress in parents of preterm babies are high, and are rarely addressed.
Feeling detached from the baby, guilt about the preterm birth, and difficulty bonding are all common and do not reflect on you as a parent. Kangaroo care helps considerably with bonding.
Ask staff to explain things repeatedly if needed. Keep a notebook of questions. And seek support if the distress persists after discharge, which our psychiatry department provides.
Most preterm babies, particularly those born after thirty two weeks, go on to develop entirely normally. The stay is long and frightening, and the parts you contribute, expressing milk and kangaroo care, are genuinely among the most effective treatments available.
Our neonatology department and NICU at T. Nagar provide care from stabilisation through to structured follow up.
Related Topics
