Bringing Home a Baby From the NICU: A Guide For Parents and Caregivers

Premature babies, those with health problems, or those that have had a difficult birth typically go to the neonatal intensive care unit (NICU). There, babies can get around-the-clock care from expert nurses and doctors. Depending on their condition, they can stay for either a few days, weeks, or months. Conditions that commonly land babies in the NICU include:

• Premature births;
• Breathing problems;
• Failure to gain weight or grow properly;
• Immature organ systems;
• Neurological problems;
• Surgical needs.

While many parents find the NICU overwhelming, it can be equally as stressful to bring the baby home afterward. Although it may be exciting to bring your baby home, you may also be afraid they will get sick again, or you may feel guilty that your baby was in the NICU. However, learning how to care for them at home is an effective way for both you and the baby to feel safe and comfortable. 

Discuss a Care Plan With the Medical Team

Before leaving the NICU, it’s important to go over a care plan with the baby’s medical team. These care plans will depend largely on the condition the baby has. For instance, if your baby is born prematurely, the care plan is relatively straightforward:

• Ensure your baby is kept at a safe and comfortable temperature;
• Develop a night routine to ensure both you and the baby get to sleep;
• Use only plain water for bath time;
• Use moisturizing products provided by your healthcare team;
• Stay in contact with the hospital team in case of emergencies.

However, some conditions require more care. For instance, babies with infant respiratory distress syndrome (IRDS) need extra oxygen and may need to be on a ventilator. Caring for your baby at home may look like the following:

• Ensure you know how and when to give oxygen to your baby;
• Learn how to do rescue breathing;
• Do not smoke or allow anyone else to smoke in the house;
• Wash your hands before holding the baby;
• Keep your baby away from crowds or people who are sick;
• Immunize your baby and ensure people who come around your baby are immunized;
• Take advantage of follow-up appointments with your doctor. 

It is also important to note that babies born with prenatal conditions are more at risk for sudden infant death syndrome (SIDS). While the cause of SIDS is not known, there are some ways to help prevent it:

• Lie the baby on their back unless your healthcare team has instructed otherwise;
• Use lightweight blankets, like swaddles;
• Keep bedding away from the baby’s face;
• Make sure no one smokes in the house;
• Keep the baby in your room for the first six months;
• Never fall asleep with your baby on the sofa or the bed;
• Keep your baby away from radiators, heaters, and direct sunlight;
• Keep the room at 64 degrees Fahrenheit. 

Know Unusual Behaviors To Watch For

Depending on the condition your baby has, there are some unusual behaviors that parents or caregivers should watch out for. These signs can alert you to emergencies or new illnesses that may take you back to the NICU. For instance, babies with IRDS should go to the hospital if:

• They are using belly muscles to breathe;
• Their chest is sinking in or their nostrils flare;
• The baby has a cough that will not go away;
• The baby has a fever;
• The baby vomits repeatedly;
• The baby is not eating.

Additionally, if your baby was born prematurely, they may exhibit signs that may call for additional medical treatment. These signs include:

• Impaired vision;
• Hearing problems;
• Dental problems;
• Behavioral problems;
• Chronic health issues.

Understanding and watching out for these signs can help your baby lead a healthier life and help avoid a medical emergency.

Learn Infant CPR

Infant CPR is a life-saving process and varies differently from the CPR you would perform on an adult. Since an infant’s bones are softer and their organs are still developing, CPR must be administered more gently. To administer CPR to an infant, follow these steps:

• Check if the infant is unconscious by tapping or flicking the bottom of their feet;
• Open the airway by tilting the head back slightly and lifting the chin;
• Check for sounds of breathing;
• Use your mouth to make a complete seal over the infant’s mouth and nose and blow for one second. These are called rescue breaths;
• Use two fingers to deliver 30 quick compressions that are about 1.5 inches deep.
• Give two rescue breaths;
• Repeat the breaths and compressions until you see obvious signs of life. 

Often, people stop to call emergency services before administering CPR. While this is true for adults, infants are more likely to survive following immediate CPR. Be sure to perform CPR on an infant first, and have a bystander call emergency services for you.

Limit Their Exposure and Keep Your Home Clean

Many babies that are in the NICU are more susceptible to illnesses because of their weak immune systems, so it’s important to limit their exposure to others and keep your home clean. You’ll want to make sure that most of the cleaning is done before your baby comes home. To keep your home clean, consider the following:

• Dust regularly;
• Establish a no-shoes rule inside the house;
• Wash baby clothes with a doctor-approved laundry detergent;
• Clean all surfaces and furniture with disposable wipes;
• Vacuum all carpets and rugs;
• Consider air filters to get rid of pollutants;
• Keep animals away from the baby and their room until their immune system grows;
• Sterilize your home with alcohol spray or bleach;
• Sterilize baby bottles and utensils;
• Ensure everyone washes their hands before holding the baby;

By practicing good hygiene and cleaning practices, you can allow your baby’s immune system to grow stronger as the weeks go by. As the baby gets older, they will need to develop a resistance to germs, which means the sterile environment is not going to last forever. Your doctor can give you a timeline of how long it might take for your baby to catch up.

Understand That Developmental Milestones May Look Different

Doctors measure a baby’s progress by milestones. These milestones include reaching benchmark weight, height, performing motor skills, and showing social skills at a certain age. Common developmental milestones include:

• Smiling at people;
• Briefly calming themselves;
• Looking for their parents;
• Making gurgling sounds;
• Turning head toward sounds;
• Paying attention to people;
• Following objects with their eyes;
• Holding their head up;
• Smiling spontaneously;
• Playing with people;
• Copying movement and facial expression;
• Babbling;
• Copying sounds;
• Responding to affection;
• Reaching for toys;
• Bringing their hands to their mouth.

However, if you have a baby that has prenatal conditions, they may develop at a slower pace than what is considered normal. Many premature babies are more likely to have medical issues that cause their development to slow, and need extra time to build up their strength. Your doctor should come up with an alternative timeline for milestones to track your baby’s progress.

Find a Pediatrician and Make a List of Specialists

Pediatricians are vital to the health of your baby, especially if they spent time in the NICU. Typically, pediatricians are trained to:

• Help determine a healthy lifestyle for your baby;
• Offer advice to prevent illness;
• Provide appropriate care for illnesses;
• Treat life-threatening childhood conditions.

Pediatricians also start treating your child at the infant stage, which is highly beneficial for babies with prenatal conditions. The more the doctor knows about the child, the better they can treat their conditions. Additionally, it may also be prudent to find pediatric specialists in case of emergencies or to ask questions. These specialists may practice in fields such as:

• Developmental and Behavioral Pediatrics;
• Pediatric Cardiology;
• Pediatric Emergency Medicine and Critical Care;
• Pediatric Endocrinology;
• Pediatric Gastroenterology;
• Pediatric Pulmonology.

While this is not an exhaustive list of pediatric specialties, these specialties are congruent with conditions commonly experienced by NICU babies. Although it may seem overwhelming, your team of healthcare professionals can provide recommendations for any specialist you need.

Coordinate With Insurance to Pay for Any Special Equipment Needed

While babies will need some general baby gear such as diapers, pacifiers, baby powder, and caddy organizers, they may also need some specialized equipment. This equipment can include:

• Apnea monitors;
• Oxygen tanks;
• Feeding tubes;
• Syringes.

Fortunately, your insurance may be able to cover the costs of your baby’s NICU stay and their equipment. When you call your insurance to add your baby to your plan, keep these questions in mind:

• Does my plan cover all of my baby’s NICU expenses?
• Are there services the plan does not pay for?
• How can we pay the remaining costs?

Be sure to start a folder of letters and bills related to your baby’s medical care. This can help the insurance company make more informed decisions about what is covered, as well as give you peace of mind. If your insurance does not cover all of your baby’s care, you can talk to a social worker in the NICU. Social workers help families find resources and services to help parents care for their babies. Additionally, you can also apply for financial aid to help cover the costs. 

Babies that have been in the NICU may need a bit more time to catch up to typical growth milestones. By understanding your baby’s condition, keeping your home clean, and making regular pediatric appointments, you and your baby can develop a routine that will help them grow stronger.