Premature Baby: The NICU, Skin-to-Skin Care and Coming Home

You pictured the birth at the end of the ninth month, the bag packed, the cot assembled. And then baby arrived early. In place of a quiet first cuddle, there is an incubator, wires, screens that beep and a team talking about "weeks of amenorrhoea" and "saturation". Having a premature baby is often a shock, even when everything goes well.

You are not alone: worldwide, more than one baby in ten is born too soon, according to the World Health Organization (WHO). Here is what to expect in the neonatal unit, how you can take part in care from the very first days, and what changes once you are home.

What is a premature baby?

A baby is premature when born alive before 37 completed weeks of pregnancy. The WHO distinguishes three degrees:

About 13.4 million babies were born prematurely worldwide in 2020 (WHO). The earlier the birth, the higher the risk of serious complications and of a long hospital stay (HUG). In high-income countries, most babies born from 28 weeks survive, the WHO notes, and it stresses that three quarters of prematurity-related deaths could be prevented with simple, low-cost care.

If the premature birth was preceded by contractions, hospital stays or corticosteroids, our article on threatened premature labour explains those steps. The Moroccan health record, for its part, keeps track of the birth: gestation, weight, length, head circumference, Apgar score and care received.

The neonatal unit: what to expect

The neonatal unit looks after babies who need closer monitoring or specific care. Depending on gestation and condition, your baby may need:

• an incubator to keep warm, since a premature baby regulates temperature poorly;
• breathing support, from oxygen to more substantial assistance;
• sensors that continuously monitor heart, breathing and oxygen, hence the frequent alarms, which the team will teach you to understand;
• a fine feeding tube, through the nose or mouth, to receive milk until they can suck and swallow in coordination;
• sometimes a drip and phototherapy for jaundice.

Ask every question, even the ones that seem naive: what does this alarm mean, whom can I call at night, when can I hold him? In Morocco, also ask about visiting hours, whether both parents can come together, and what you may bring (clothes, expressed milk, a small comforter to leave near him).

Skin-to-skin and kangaroo care

This is probably the most powerful care you can give yourself. Kangaroo care means placing baby undressed, in a nappy and sometimes a hat, directly on a parent's chest, back covered.

Since 2022, the WHO recommends starting it immediately after birth, with no prior period in an incubator, and practising it for as many hours as possible. Previously, mother and baby were separated for three to seven days on average. According to the WHO, this early contact saves many more lives and reduces infections and hypothermia.

According to Naître et grandir, skin-to-skin brings the premature baby:

• better regulation of temperature;
• steadier breathing and heart rate;
• better weight gain and more restorative sleep;
• fewer signs of stress and pain during procedures;
• easier breastfeeding, as the mother produces more milk.

Parents benefit too: less stress and anxiety, more confidence, a bond that grows. Dad can perfectly well take over. For safety, baby's face stays visible, nose and mouth clear, chin slightly raised; if you feel sleep creeping up, lay baby down or hand them to someone awake.

Breast milk, a treatment in its own right

For a premature baby, their mother's milk is much more than a meal. The WHO strongly recommends breastfeeding for premature and low-birth-weight babies, because it lowers the risk of infection. When the mother's milk is not available, donor milk is the best alternative; failing that, the team prescribes a milk suited to premature babies.

If baby is too small to suckle, you can express your milk as soon as possible after the birth, then regularly, day and night, to start and sustain lactation. The team will give it by tube, then help baby move gradually to the breast. Our article on expressing your milk explains the rhythm and the technique, and the one on storing breast milk the rules for bringing it to the unit. To equip yourself, our guide to choosing a breast pump compares manual and electric models, available in our breast pump section.

What is corrected age?

It is the age your baby would be if born at 40 weeks. You calculate it by subtracting the number of weeks of prematurity from the actual age. The American Academy of Pediatrics gives this example: a baby born at 32 weeks is 8 weeks early; at 4 months of life, their corrected age is 2 months.

That is the age at which you compare their progress: smiling, head control, sitting, first steps. During the first two years, corrected age gives a better idea of when they should reach these milestones. Keep it in mind when faced with remarks from relatives ("he's not holding his head up yet?") and when reading their growth chart with the paediatrician. For vaccines, follow the schedule set by the doctor and our reference article on the vaccination schedule in Morocco.

Coming home

Discharge is decided with the neonatal team, once baby is stable and feeding enough. Prepare for it together: ask for a demonstration of care, the hospital report, follow-up appointments and the number to call if in doubt.

At home, a few rules matter even more for a former premature baby:

• sleeping on the back, in their own bed, on a firm mattress with nothing around them: no pillow, no bumper, no nest. The full rules are in our article on safe sleeping;
• skin-to-skin, to continue every day;
• infection prevention: hand washing, no visits from people with colds, no tobacco in the house or car, and limited family visits in the first weeks;
• regular follow-up with the paediatrician, who judges growth and development by corrected age.

As for clothes, "newborn" bodysuits are often too big at first: premature sizes exist, and a few simple outfits, easy to put on without handling baby too much, are enough.

Taking care of yourself

A premature birth turns everything upside down: the end of the pregnancy, the birth plan, the nfissa (the postpartum period) surrounded by family. Parents often go through fear, guilt, exhaustion and endless trips to the hospital. These emotions are common and legitimate. The WHO also asks that families receive emotional, financial and professional support, and that parents and baby be treated as one unit.

Talk about how you feel with the team, with your doctor, with a psychologist if the unit has one. Accept practical help from relatives with meals and older children. And if sadness settles in for more than two weeks, read our article on baby blues and postpartum depression and seek help.