

What to Expect When You're
Expecting a Premature Baby.

Article · 7 min readPlain guide

Finding out that your baby may arrive early can be frightening, emotional, and overwhelming. You are not alone, and your NICU team will guide you every step of the way. This article will help you understand what typically happens when a premature baby is born and what you might expect during your NICU journey.

Why Babies Are Born Premature

Babies can arrive early for many reasons, including:

  • Maternal health conditions
  • Infections
  • Placental problems
  • Multiple pregnancies (twins, triplets)
  • Genetic factors
  • Or sometimes no identifiable reason

Who Will Be at the Delivery?

If a premature birth is expected, a specialized team is present usually including:

  • A neonatologist
  • NICU nurses
  • A respiratory therapist
  • Sometimes additional specialists

Your baby will be evaluated on a warmer and admitted to the NICU for close monitoring.

Not all NICUs have the same staffing models, so who attends the delivery may vary.

How Long Will My Baby Stay?

A common estimate is that babies stay until around their due date.

For example:

If your baby is born at 25 weeks, they may stay ~15 weeks until they reach 40 weeks corrected age.

Every baby is unique and can have their own journey which could be longer or shorter depending on their medical needs and growth.

Breathing

Premature babies have lungs that are still developing. They may:

  • Have fewer air sacs (alveoli)
  • Have more fluid in the lungs
  • Lack surfactant, the "slippery" substance that keeps lungs open

Your baby may need:

  • High-flow oxygen
  • CPAP
  • NIPPV
  • Or a breathing tube and ventilator if very premature

Many babies also receive surfactant medication to help their lungs stay open and reduce the effort needed to breathe.

Did you know? Lungs keep growing until about age 4.

Heart and Blood Pressure

Premature babies may have:

  • Immature heart function
  • Low blood pressure
  • PDA (Patent Ductus Arteriosus) - a normal blood vessel that may stay open longer in preemies (will be discussed in detail in its own section later).

Your care team may perform heart ultrasounds (echocardiography), blood pressure monitoring, and medications if needed.

Feeding and Nutrition

Preemies often cannot feed by mouth right away because:

  • The suck-swallow-breath reflex isn't developed until 32–34 weeks
  • Their gut may not be ready for full feedings

They may receive:

  • IV nutrition (TPN)
  • Tube feedings (NG or OG tubes)
  • Slow, gradual increases in feeding

Breast milk is the best option for preterm babies.

Blood Work & Transfusions

Preemies may need blood transfusions because of:

  • Low iron stores
  • Rapid growth
  • Frequent blood sampling for lab tests

This is common and closely monitored.

Immune System/Infection Prevention

Premature babies have immature immune systems, making them more vulnerable to infections. Parents can help by:

  • Washing hands before touching the baby
  • Removing jewelry/watches ("bare below elbows")
  • Asking anyone touching the baby to wash hands

You are your baby's best advocate.

Neurological Development

Premature infants have delicate blood vessels in the brain and are at risk for intraventricular hemorrhage (IVH), especially in the first week.

To protect the brain, the NICU team may:

  • Limit handling
  • Position the head midline
  • Perform serial head ultrasounds

How you can help

  • Speak, sing, or read to your baby
  • Engage in gentle touch

Studies show that early parent involvement supports brain development.

What Parents Can Do

Even if your baby is tiny or on breathing support, you are still their most important person.

You can:

  • Read, sing, or talk to your baby
  • Do kangaroo care (skin-to-skin) when allowed
  • Participate in rounds
  • Help with diaper changes or temperature checks
  • Ask questions, always

Your presence truly matters!