As you and your infant adjust to being at home, you will gradually establish a routine together. You also may find that your premature infant is truly different from what you'd expect of a full-term infant. During the first weeks at home, consider these important points:

• Sleeping and wakefulness. Because their brain functions aren't as fully developed at birth as full-term newborns, premature infants:
  • Sleep more per 24-hour period than full-term infants do but for shorter periods of time. Expect that you may be awakened frequently at night until 6 months after your due date.
  • Are seldom awake for more than brief periods until about 2 months after their due date. It may seem like a long time before your infant is responsive to your presence.
• Fussiness and hypersensitivity. It is normal for full-term infants to cry for up to 3 hours per day by 6 weeks after their due date. Most premature infants will do the same and then some. Your premature infant may be easily overstimulated by too much light, sound, touch, or movement or by too much quiet after living in the noisy NICU. If so, gradually create a more calming environment, swaddle your infant in a blanket, and hold him or her as much as possible.
• Sleeping position. Laying your infant on his or her back reduces the risk of sudden infant death syndrome (SIDS), which is more common among premature infants than full-term infants. (Your infant's risk of SIDS is in no way affected by a history of apnea of prematurity; the conditions are considered to be unrelated.)
• Feedings. Your infant probably will come home on a hospital feeding schedule, which will tell you how often to nurse or bottle-feed at home. To avoid infant dehydration, never go longer than 4 hours between feedings. Small feedings may help reduce spitting up. If you see signs of reflux during or after feedings, talk to your infant's doctor.
• Nutrition. Your infant's doctor may recommend adding iron, vitamins, or supplemental formula to a breast-fed diet. Iron supplementation is typical treatment for all premature infants (preemies), because they lack the iron stores that full-term infants have at birth. Some preemies simply need extra energy and vitamins from supplemental formula to keep up their growth.
• Exposure to communicable disease and smoke. Your premature infant is more vulnerable than a full-term infant, particularly due to immature lungs at birth.
  • Keep your infant away from sick family members and friends as well as from enclosed public places during his or her first two winter seasons.
  • Don't allow tobacco smoke near your infant.
• Protection from serious illness (immunizations, influenza vaccine, and RSV antibody). With the exception of the hepatitis B vaccine, the preemie's schedule for childhood immunizations is the same as for a full-term infant, figured from the date of birth (chronological age). Your infant may also need protection from influenza and respiratory syncytial virus (RSV).
• Hearing and vision screening. Premature infants are at greater risk of hearing loss. Those born at or before 30 weeks' gestation or weighing less than 1500g are more likely to develop a vision problem called retinopathy of prematurity.
  • Your infant's hearing will have been assessed in the NICU, but be alert to new or increased hearing problems during your child's first 5 years of life.
  • Vision screening is recommended for infants born at or before 30 weeks, whose birth weight was below 1500g, or who have serious medical conditions. The first screening is recommended between 4 and 7 weeks after birth.²