What to Expect with a Premature Baby | NICU & Preemie Parent Guide
While some parents can prepare for premature birth, most enter the NICU unexpectedly. Here are nine key insights to help you navigate the preemie experience.
What to Expect with a Premature Baby
Most babies arrive between 37 and 42 weeks of pregnancy. A premature baby, or preemie, is born before 37 weeks. Thanks to advances in neonatal medicine, some micro preemies born as early as 22 to 23 weeks can survive with intensive care, though every additional week in the womb greatly increases survival rates and reduces complications. Babies born at 28 weeks often have a survival rate of over 90% in advanced NICUs, but they may still need weeks or months of specialized support.
Nothing Can Fully Prepare You for Having a Premature Baby
Even if you have been told your baby might arrive early, the reality of what to expect with a premature baby is something you can only truly understand once you are living it. The experience can be isolating, overwhelming, emotional, and sometimes terrifying, but also deeply rewarding.
You will quickly get a crash course in medical terminology and NICU acronyms. It can feel overwhelming at first, and that is OK.
The NICU is a Community All Its Own
The neonatal intensive care unit (NICU) is more than just a hospital ward. It is a mini-community. Alongside neonatologists and nurses, you will meet respiratory specialists, occupational therapists, receptionists, lactation consultants, social workers, x-ray techs, and more. You will also see parents just like you, some there for a single night, others for months.
The NICU is busy and often noisy, with beeps, alarms, and breathing machines sounding regularly. It may feel overwhelming at first, but in time, those sounds become background noise, each with a specific meaning the staff understands instantly.
Premature Baby Appearance: What to Expect
Depending on how early your preemie is, their appearance may be different from what you imagined:
Eyes may be fused shut
Skin can be very fragile, red, and wrinkled
Fine unpigmented hair (lanugo) may cover the body
Sex organs may not yet look fully developed
Some micro preemies born extremely early may also have:
Ears without fully formed cartilage (soft and folded)
No visible nipples yet
Skin so delicate it can tear like wet paper
These differences are completely normal for premature babies at various stages of development. Over time, most physical characteristics begin to resemble those of full-term newborns.
Holding and Bonding with Your Preemie
You may not be able to hold your baby right away. Once you can, make the most of it and hold them as often as your preemie will allow. Skin-to-skin contact, also called kangaroo care, is powerful for bonding and for your baby’s development. Your touch, voice, and presence are more important than you may realize.
Every Preemie’s Journey is Unique
Not all preemies are the same, so avoid comparing your baby to someone else’s. Each preemie has their own set of challenges, setbacks, and victories, and they will reach milestones on their own schedule.
Many parents describe NICU life as a rollercoaster. You will have days where nothing seems to change, and others where your baby struggles. Sometimes those highs and lows happen in the same hour. The best advice is to take a deep breath and remember that what is true in this moment could change quickly.
Your Role in Caring for a Premature Baby
You are the most important member of your baby’s medical team. Get involved in their care when you can:
Change diapers
Help with baths
Feed your baby (bottle, breast, or through a feeding tube)
Comfort them with your voice and touch
These moments not only support bonding but also boost your baby’s growth and stability.
Frequently Asked Questions About Premature Babies
Q: How early can a baby be born and live?
A: Some babies have survived being born as early as 22 weeks, though survival rates improve greatly after 24 to 25 weeks.
Q: Can a baby survive at 28 weeks?
A: Yes. Babies born at 28 weeks have a high survival rate, often over 90% in advanced NICUs, but they may still require weeks of hospital care.
Q: What is considered premature?
A: Any baby born before 37 weeks of pregnancy is considered premature. This includes late preterm (34 to 36 weeks), very preterm (less than 32 weeks), and extremely preterm (less than 28 weeks).
Q: Is there a crash course in medical terminology/acronyms?
A: Yes, here is a glossary to help guide you, it can be overwhelming - and that is OK.
A Final Word of Encouragement
Having a premature baby can feel like stepping into a world you never expected, but you are not alone. The NICU is a place of both challenges and miracles. With time, care, and love, many preemies go on to live full, healthy lives. Celebrate every milestone, no matter how small, and know that your role in your baby’s journey is powerful.
