Ask Dr. Marla: What are the milestones for a premature baby in the first few weeks?

By Dr. Marla Shapiro on September 09, 2013
My neighbour’s son was born early at 30 weeks. What are the immediate milestones for this little guy?


This is a diffi cult question because every premature baby will have needs specifi c to him or her. However there are some common concerns and hospital milestones in this degree of prematurity. To answer your question I turned to Dr. Janine Flanagan, a developmental pediatrician at St. Joseph’s Health Centre, and the experts at SickKids Hospital in Toronto. Babies born before the typical 40-week term may need a variety of supports to thrive and be discharged from hospital. They need to meet three key milestones, such as being able to breathe well, feed well and keep their temperatures stable.

Breathing: Because preemies are small in size, they tire out easily. This is why they so often need help with breathing. Many will need oxygen support to keep up their oxygen levels – called saturations – to supply the brain and body with healthy oxygenated blood. While many of us adults kick-start our days with a cup of caffeine, did you know that some premature babies may be given caffeine, too? It helps stimulate them to breathe and to decrease temporary periods of absence of breathing called apnea, as well as low heart rates, called bradycardia. Most babies will reach this milestone of breathing without the aid of technology or medication around what would have been 36 weeks of their previously predicted full-term due date.

Feeding: Preemies learn to suck around 34 weeks. Those born even earlier may need special nutrition given intravenously. When they get a bit older, a feeding tube may be inserted through the nose to feed them until they are strong enough to suck and swallow on their own from the breast or bottle. Often, because the delivery is unexpected, the mother’s milk will not be in yet. Although moms are encouraged to pump breast milk to stimulate milk production, formula may be used to supplement if necessary. Nursing is still encouraged as early as possible to promote bonding and further stimulate milk production. Once they are feeding well and gaining weight steadily, they have reached this very important milestone that we take for granted in term newborns.

Temperature: Babies born early also have diffi culty regulating their temperature so they are placed in an incubator with a controlled temperature setting. Once they are able to stay warm outside an incubator they have reached this milestone.

The incubator also helps protect them from infection and too much stimulation. Premature babies often stay in the NICU – neonatal intensive care unit – until close to their fullterm due date. This time is important for them to feed and grow.

Remember, some babies born early may have a more diffi cult time and need other special care and monitoring. Each case is different and monitored closely by pediatricians specially trained in neonatal care.

Got a health question? Submit it to Dr. Marla.

Originally published in ParentsCanada magazine, October 2013.

By Dr. Marla Shapiro| September 09, 2013

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