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Do All Premature Babies Go To The NICU? A Pediatrician Explains

It’ll depend on many factors.

One in ten babies are born prematurely every year, according to the Centers for Disease Control and Prevention (CDC). In fact, I was a super preemie, myself. Even though it’s common for babies to be born prematurely — defined as a baby born before the 37th week of pregnancy — it’s not talked about all that much, and that can lead to a sense of confusion and isolation for parents of preemies. It can be nerve-wracking to find out that you’re likely to have a premature baby, or that you are in labor and are going to deliver a baby that is technically considered premature. At the very top of the list of things that parents-to-be of premature babies are likely wondering about is if all premature babies go to the NICU, which is the acronym commonly used to describe the neonatal intensive care unit? So, do all premature babies go to the NICU automatically, or do some premature babies get to go home immediately?

What defines a premature baby?

“Prematurity is defined as less than 37 weeks of gestation,” says board-certified pediatrician Dr. Leann Poston. Before we explore whether or not all babies that are premature go to the NICU, though, it is worth knowing that there are several levels of NICU. Level 1 is basic infant care, or a “well-baby nursery” for healthy babies getting ready to be transferred or to go home. Level 2, or “special care” is more advanced care, generally for babies born between 32 and 34 weeks, or babies who might need more intense care and monitoring. Level 3 is a NICU that has the capacity for subspecialty care, meaning that this is a place where physicians who specialize in cardiac or pulmonary care generally for babies born before 32 weeks are very available. Level 4 is the highest level of NICU care, and it’s for the tiniest and youngest of preemies. It’s the ‘all-hands-on-deck’ NICU.

Do all premature babies go to the NICU?

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For the most part, yes, though which level of NICU they will be sent to will depend on your baby’s age and needs. As a matter of course, “all babies born at 34 weeks or less go to the NICU” explains Poston. However, though the specific level of NICU will depend on each baby’s needs. “Babies that are 35 to 36 weeks old typically go to the NICU until it is clear that their breathing, feeding, and temperature regulation are satisfactory.” And, as far as when premature babies will get to go home, there is usually a weight requirement, and it’s generally four pounds.

What causes premature birth?

Premature birth can be caused by many things. Every year, more and more studies are being completed to determine what causes premature birth, and how they can possibly be prevented. The research is transforming how premature babies who go to the NICU are being cared for, which has led to fewer adverse outcomes, and for health care provider’s ability to care for babies born as early as 23 weeks.

But the science isn’t perfect, nor is how the science is applied. We know that Black babies are more likely to be born prematurely than white babies, and science is starting to understand why that is, and yet little is being done to correct the problems. A study published in Frontiers of Reproduction posited that systemic problems — like racism, housing disparities, quality of care, rates of C-sections — other “downstream” issues contribute to the level of premature births in the Black community. Because of this, Black premature babies are more likely to spend time in the the NICU.

Disparities in care, hospital guidelines, and other factors play a huge role in whether or not your premature baby will go to the NICU. Not all preemies need the extra care, and not all full-term babies are ready to go home immediately.

Studies Referenced :

Braveman, P., Dominguez, T. P., Burke, W., Dolan, S. M., Stevenson, D. K., Jackson, F. M., Collins, J. W., Driscoll, D. A., Haley, T., Acker, J., Shaw, G. M., McCabe, E. R., Hay, W. W., Thornburg, K., Acevedo-Garcia, D., Cordero, J. F., Wise, P. H., Legaz, G., Rashied-Henry, K., … Waddell, L. (2021). Explaining the black-white disparity in preterm birth: A consensus statement from a multi-disciplinary scientific work group convened by the March of Dimes. Frontiers in Reproductive Health, 3. https://doi.org/10.3389/frph.2021.684207Centers for Disease Control and Prevention. (2021, November 1). Premature birth. Centers for Disease Control and Prevention. Retrieved July 24, 2022, from https://www.cdc.gov/reproductivehealth/features/premature-birth/index.html

Hallman, M., Haapalainen, A., Huusko, J. M., Karjalainen, M. K., Zhang, G., Muglia, L. J., & Rämet, M. (2018). Spontaneous premature birth as a target of Genomic Research. Pediatric Research, 85(4), 422–431. https://doi.org/10.1038/s41390-018-0180-z

Richter, R. (2022, February 23). Premature babies' survival rate is climbing, study says. Healthier, Happy Lives Blog. Retrieved July 20, 2022, from https://healthier.stanfordchildrens.org/en/premature-babies-survival-rate-is-climbing/#:~:text=Two%20percent%20may%20not%20sound,23%20weeks%2C%2055%25%20survived.

Experts:

Dr. Leann Poston M.D., M.B.A., M.Ed., pediatrician and specialist for Invigor Medical