Premature Birth: NICU Care, Causes & Baby Development

What Is Considered a Premature Birth?

A baby born before 37 weeks of pregnancy is considered premature (preterm). Babies can survive if born around 22-23 weeks with specialized neonatal intensive care. The earlier a baby is born, the more medical support they typically need for breathing, feeding, and temperature regulation.

Premature birth, also known as preterm birth, refers to the delivery of a baby before 37 completed weeks of pregnancy. A full-term pregnancy typically lasts 40 weeks, so premature babies miss out on crucial final weeks of development in the womb. This early arrival can affect many organ systems, particularly the lungs, brain, and digestive system, which continue developing right up until the due date.

The degree of prematurity significantly impacts the type and duration of care needed. Medical professionals categorize premature births based on gestational age to help guide treatment decisions and set appropriate expectations for families. Understanding these categories helps parents prepare for what their baby might need and what the NICU stay might look like.

Modern neonatal medicine has made remarkable advances in caring for premature infants. While babies born at the edge of viability (22-23 weeks) face significant challenges, survival rates have improved dramatically over the past few decades. In well-equipped neonatal units, over 90% of babies born at 28 weeks now survive, and outcomes continue to improve with ongoing research and improved care practices.

Categories of Prematurity

Healthcare providers classify premature births into distinct categories based on how early the baby arrives. Each category comes with different typical challenges and care needs, though individual babies may vary significantly in their requirements.

Babies born only slightly early (late preterm at 34-36 weeks) often do well with minimal intervention, though they may need some help with feeding and maintaining body temperature. These babies are sometimes cared for in a special care nursery rather than a full NICU and often go home within days to a few weeks of birth.

In contrast, babies born before 28 weeks (extremely preterm) require intensive medical support. Their lungs lack surfactant, a substance needed for proper breathing; their brains are vulnerable to bleeding; and they cannot coordinate sucking, swallowing, and breathing for feeding. These tiny babies may spend months in the NICU, gradually developing the abilities they need to thrive outside the protective hospital environment.

Why Are Babies Born Prematurely?

In many cases, the exact cause of premature birth is unknown. Common contributing factors include spontaneous preterm labor, premature rupture of membranes (water breaking early), multiple pregnancies (twins, triplets), infections, preeclampsia, and certain maternal health conditions. Sometimes early delivery is medically necessary to protect the health of the mother or baby.

Understanding why premature birth occurs can be frustrating for families, as healthcare providers often cannot pinpoint a single cause. Research shows that premature birth results from complex interactions between genetic, environmental, and health factors. For many families, labor simply begins earlier than expected without any identifiable trigger.

The mechanisms leading to premature birth generally fall into two categories: spontaneous preterm birth, where labor begins on its own before 37 weeks, and indicated (or provider-initiated) preterm birth, where delivery is medically necessary due to complications. Both pathways can lead to different degrees of prematurity, and understanding the cause helps medical teams prepare for the baby's specific needs.

While not all premature births can be prevented, some risk factors are modifiable. Regular prenatal care allows healthcare providers to identify and manage conditions that increase preterm birth risk. When preterm labor seems imminent, medical interventions can sometimes delay delivery long enough to administer treatments that improve the baby's outcomes.

Spontaneous Preterm Birth

Spontaneous preterm birth occurs when labor begins on its own before 37 weeks or when the membranes surrounding the baby rupture prematurely. This type accounts for approximately 70% of all premature births. The triggers can include infections (including urinary tract infections and gum disease), inflammation, stress, and factors that are not yet fully understood.

When the amniotic membranes rupture before labor begins (known as premature rupture of membranes or PROM), delivery often follows within hours to days. While medical teams try to delay delivery when safe to do so, the risk of infection increases once the protective fluid surrounding the baby is lost.

Multiple Pregnancies

Carrying twins, triplets, or more significantly increases the risk of premature birth. The uterus stretches more with multiple babies, which can trigger early labor. Additionally, complications like twin-to-twin transfusion syndrome may require early delivery. Approximately 60% of twins and over 90% of triplets are born before 37 weeks.

Pregnancy Complications

Certain pregnancy complications make early delivery necessary to protect the health of the mother, the baby, or both. Preeclampsia (pregnancy-related high blood pressure) can become dangerous if pregnancy continues, requiring early delivery even if the baby is premature. Placental problems, including placenta previa (low-lying placenta) and placental abruption (placenta separating from the uterine wall), may also necessitate early birth.

What Happens in the First Hours After a Premature Birth?

The first hours after a premature birth involve stabilizing the baby's breathing, temperature, and circulation. A specialized neonatal team assesses the baby immediately after delivery. Depending on how early the baby was born and their condition, they may need help with breathing, be placed in an incubator for warmth, and have IV lines placed for fluids and medications.

When a premature baby is born, a specialized team of neonatal professionals is typically present in the delivery room, ready to provide immediate care. This team usually includes neonatologists (doctors specializing in newborn care), neonatal nurses, and respiratory therapists. Their primary goals are to help the baby breathe, maintain body temperature, and ensure adequate blood circulation.

The atmosphere in the delivery room during a premature birth can feel intense, with multiple healthcare providers working efficiently around the baby. Parents may feel overwhelmed seeing so many people attending to their newborn. Understanding that each person has a specific role can help reduce anxiety. The medical team is focused on giving the baby the best possible start.

If the baby is stable enough, they may be placed briefly on the mother's chest for skin-to-skin contact before being transferred to the NICU. This early bonding moment, even if brief, can be meaningful for both parent and baby. However, if the baby needs immediate respiratory support or other interventions, they will be taken directly to a specialized resuscitation area.

Breathing Support

Many premature babies need help breathing because their lungs are not fully developed. The lungs are one of the last organs to mature, and premature babies often lack adequate surfactant, a substance that helps the tiny air sacs in the lungs stay open. Medical teams have several tools to support breathing, from gentle to more intensive.

The most common initial support is CPAP (Continuous Positive Airway Pressure), which delivers a steady flow of air through small prongs in the baby's nose to help keep the lungs open. Some babies need additional oxygen mixed with the air. For babies who cannot breathe adequately with CPAP, a breathing tube may be placed into the windpipe connected to a ventilator.

Extremely premature babies often receive surfactant, a medication that mimics the natural substance their lungs lack. This is given directly into the lungs through a tube and can dramatically improve breathing within minutes. The need for breathing support varies widely - some babies need help for just a few days, while others require weeks or months of support as their lungs mature.

Temperature Regulation

Premature babies cannot regulate their body temperature effectively because they have little body fat for insulation and a large surface area relative to their weight. Keeping warm is crucial because cold stress forces the baby to use energy needed for growth and healing. Immediately after birth, babies are often wrapped in plastic wrap or placed in a plastic bag to reduce heat and water loss through their thin, immature skin.

In the NICU, premature babies are kept warm using incubators (enclosed beds with controlled temperature and humidity) or radiant warmers (open beds with an overhead heat source). The most premature babies often stay in incubators initially because the controlled humidity also helps their fragile skin. As babies mature and gain weight, they gradually transition to open cribs.

What Is NICU Care Like for Premature Babies?

NICU (Neonatal Intensive Care Unit) care provides specialized monitoring and treatment for premature babies. Care focuses on supporting breathing, providing nutrition (often through tubes initially), preventing and treating infections, and protecting the developing brain. Parents are encouraged to participate in care, including skin-to-skin contact and eventually feeding, which benefits both baby and family.

The neonatal intensive care unit can feel overwhelming when you first visit. The sounds of monitors, the sight of tiny babies connected to various tubes and wires, and the bustle of medical staff can be intimidating. However, understanding what each piece of equipment does and why it is needed can help parents feel more comfortable and empowered in the NICU environment.

NICU care is designed to recreate, as much as possible, the protective environment of the womb while allowing medical staff to monitor and treat the baby. The goal is to support the baby through the developmental stages they would have completed before birth while minimizing stress and promoting growth. Care is individualized based on each baby's gestational age, weight, and specific medical needs.

Modern NICUs practice "family-centered care," recognizing that parents are essential members of the care team. You are encouraged to visit often, learn about your baby's care, and participate in hands-on caregiving as soon as your baby is stable enough. This involvement helps strengthen the parent-child bond and prepares you for caring for your baby at home.

Environment and Equipment

The NICU environment is carefully controlled to minimize stress on premature babies. Lights are often dimmed, and efforts are made to reduce noise levels. Incubators are covered to protect babies from light and provide a quiet, womb-like environment. Staff members handle babies gently and cluster care activities together to allow for longer rest periods.

You will see various monitors and equipment around your baby's bedspace. Monitors track heart rate, breathing rate, and oxygen levels continuously, alerting staff to any concerns. IV pumps deliver precise amounts of fluids, nutrition, and medications. Do not be alarmed by the occasional alarms - many are minor and quickly resolved. The nursing staff will explain what the equipment does and what different sounds mean.

Kangaroo Care (Skin-to-Skin Contact)

Kangaroo care, or skin-to-skin contact, is one of the most powerful interventions for premature babies. The baby, wearing only a diaper and perhaps a hat, is placed upright on the parent's bare chest and covered with a blanket. This simple practice has profound benefits backed by extensive research.

Studies show kangaroo care stabilizes the baby's heart rate and breathing, helps maintain body temperature (parents' bodies naturally adjust to warm or cool the baby as needed), promotes better sleep, supports breastfeeding, and reduces stress for both parent and baby. WHO research demonstrates that kangaroo mother care can reduce mortality in low birth weight babies by up to 40%.

Even babies on breathing support or with IV lines can often receive kangaroo care with help from the nursing staff. Parents are encouraged to hold their baby skin-to-skin for extended periods, ideally an hour or more at a time. Both mothers and fathers (or other caregivers) can provide kangaroo care, and the benefits are similar regardless of who is holding the baby.

Pain Management

Even the most premature babies feel pain, though they cannot express it as older children do. Untreated pain and stress are harmful, particularly for the rapidly developing brain. NICU teams prioritize pain prevention and management as part of comprehensive care.

Non-pharmacological approaches include giving the baby a few drops of sweet solution (sucrose) before painful procedures, swaddling, providing something for the baby to suck on, and having parents provide comfort through touch and voice. When necessary, medications are used for pain relief, carefully dosed for tiny bodies.

What Treatments Might My Premature Baby Need?

Common treatments for premature babies include respiratory support (CPAP or ventilator), surfactant therapy for lung development, phototherapy for jaundice, antibiotics for infections, and nutritional support through IV fluids and tube feeding. The specific treatments depend on gestational age and individual medical needs. Most complications of prematurity are manageable with modern neonatal care.

The treatments your baby needs depend on how early they were born and their individual condition. Some babies require minimal intervention, while others need intensive support across multiple body systems. Understanding the common challenges and treatments helps parents feel more informed and engaged in their baby's care.

Medical teams take a proactive approach, monitoring for potential problems and intervening early when needed. Many conditions that were once life-threatening are now routinely managed in NICUs worldwide. While hearing about potential complications can be frightening, knowing what to watch for helps parents understand the monitoring and treatments their baby receives.

Respiratory Distress Syndrome (RDS)

Respiratory distress syndrome occurs when premature lungs lack adequate surfactant, the substance that keeps the tiny air sacs (alveoli) from collapsing. Without surfactant, breathing is extremely difficult. RDS is common in babies born before 34 weeks and is the most frequent reason premature babies need breathing support.

Treatment includes surfactant replacement therapy (medication given directly into the lungs) and breathing support ranging from CPAP to mechanical ventilation. Most babies with RDS gradually improve as their lungs mature and they begin producing their own surfactant. Some very premature babies develop a chronic lung condition called bronchopulmonary dysplasia (BPD), which may require ongoing oxygen or breathing support even after discharge.

Apnea of Prematurity

Apnea refers to pauses in breathing lasting more than 20 seconds, often accompanied by a drop in heart rate. The breathing control center in the brain is immature in premature babies, leading to these episodes. Apnea is common and usually resolves as the baby matures.

Treatment typically involves caffeine medication, which stimulates the breathing center in the brain. Monitors alert staff to apnea episodes, and gentle stimulation (such as rubbing the baby's back) usually prompts the baby to resume breathing. Severe or frequent episodes may require additional breathing support.

Jaundice and Phototherapy

Jaundice (yellowing of the skin and eyes) is extremely common in premature babies because their immature livers cannot efficiently process bilirubin, a byproduct of red blood cell breakdown. While mild jaundice is normal, high bilirubin levels can be harmful to the developing brain.

Treatment involves phototherapy - placing the baby under special blue lights that help break down bilirubin in the skin. The baby wears eye protection during treatment. Phototherapy is very effective and may be needed for several days. Premature babies often require multiple courses of phototherapy as they continue processing bilirubin.

Infections

Premature babies are highly vulnerable to infections because their immune systems are immature. Additionally, they require invasive medical devices (IV lines, breathing tubes) that can serve as entry points for bacteria. NICU staff take extensive precautions to prevent infections, including careful hand hygiene.

If infection is suspected or confirmed, antibiotics are administered through the IV. Signs of infection in newborns can be subtle and different from those in older children, so medical teams maintain a high level of vigilance. Early breast milk feeding helps protect against infections by providing antibodies and beneficial bacteria.

Necrotizing Enterocolitis (NEC)

NEC is a serious intestinal condition that primarily affects premature babies. Parts of the intestinal wall become inflamed and may die, requiring medical or sometimes surgical treatment. NEC can range from mild to severe and life-threatening.

Treatment involves stopping feedings to rest the intestine, providing nutrition through IV, and giving antibiotics. Severe cases may require surgery to remove damaged portions of the intestine. Breast milk significantly reduces NEC risk, which is one reason NICU staff strongly encourage breast milk feeding for premature babies.

Retinopathy of Prematurity (ROP)

ROP is an eye condition where abnormal blood vessels grow in the retina of premature babies. The blood vessels that supply the retina normally finish developing near the end of pregnancy. When babies are born early, this development can go awry, potentially leading to vision problems or blindness in severe cases.

All babies born before 30 weeks (or very low birth weight) are screened for ROP by an eye specialist. Many mild cases resolve without treatment as the baby matures. More severe ROP may require laser treatment or medication injected into the eye to stop abnormal vessel growth.

How Are Premature Babies Fed?

Premature babies cannot coordinate sucking, swallowing, and breathing until about 34-36 weeks gestational age. Before this, they receive nutrition through IV (parenteral nutrition) and/or through a feeding tube to the stomach. Breast milk is strongly recommended as it provides unique benefits for premature babies. The transition to bottle or breast feeding is gradual and supported by the NICU team.

Feeding premature babies presents unique challenges because the ability to suck, swallow, and breathe in a coordinated way develops relatively late in pregnancy, around 34-36 weeks. Babies born earlier cannot safely feed by mouth and need alternative methods of receiving nutrition. The NICU team works carefully to ensure your baby receives adequate nutrition for growth and development.

Nutrition is critical for premature babies, who need calories and nutrients not only for maintenance but for the rapid growth and development that should be occurring. The brain, in particular, is growing rapidly during the third trimester, and adequate nutrition supports this crucial development. Medical teams monitor weight gain, growth, and nutritional status closely.

The goal is always to transition to full oral feeding, whether breast or bottle, when the baby is developmentally ready. This transition happens gradually, with the NICU team assessing feeding readiness and advancing feeds as the baby tolerates them. Parents play an important role in feeding, learning to read their baby's cues and eventually taking over feeding entirely.

Intravenous Nutrition

In the first days after birth, many premature babies receive nutrition directly into their bloodstream through an IV line. This parenteral nutrition contains a carefully calculated mixture of glucose, amino acids (protein building blocks), lipids (fats), vitamins, and minerals. It provides complete nutrition when the baby cannot yet tolerate feeding into the stomach.

As babies begin tolerating milk feeds, IV nutrition is gradually reduced and eventually stopped. The transition is guided by how well the baby digests and absorbs the milk feeds. Very premature babies may need IV nutrition for several weeks before they can receive all their nutrition through milk.

Tube Feeding

Before babies can feed by mouth, they receive milk through a feeding tube. A thin, soft tube is passed through the nose or mouth into the stomach, and small amounts of milk are given at regular intervals. The baby does not need to coordinate sucking and swallowing - the milk goes directly to the stomach for digestion.

Tube feeds usually start with very small amounts that are increased as the baby tolerates them. The feeds consist of breast milk (from the mother or a donor) or special premature infant formula. The NICU team monitors for signs of feeding intolerance and adjusts accordingly.

The Importance of Breast Milk

Breast milk provides unique benefits for premature babies that cannot be replicated by formula. It contains antibodies and other immune factors that protect against infections, including the serious intestinal condition NEC. The proteins in breast milk are easier for immature digestive systems to process. Breast milk also contains growth factors that support gut development.

If the baby's mother is unable to provide breast milk, many NICUs offer donor breast milk from screened, pasteurized sources. Donor milk provides many (though not all) of the benefits of the mother's own milk and is generally preferred over formula for very premature babies.

For mothers of premature babies, establishing milk supply requires pumping with a breast pump because the baby cannot yet breastfeed. This can be challenging, but NICU staff and lactation consultants provide support and guidance. Even small amounts of breast milk are valuable - every drop counts for premature babies.

Transitioning to Oral Feeding

As babies approach 34-36 weeks corrected gestational age, they begin developing the coordination needed for oral feeding. The transition from tube feeds to breast or bottle feeding is gradual. Babies often start with "non-nutritive sucking" - sucking on an empty breast or pacifier to practice the motion without the demand of actually getting nutrition.

Breastfeeding directly is encouraged when the baby shows readiness signs, and many premature babies learn to breastfeed successfully. Some babies transition to bottle feeding instead or in addition to breastfeeding. The NICU team assesses feeding progress and supports the transition according to each baby's abilities and the family's goals.

When Can My Premature Baby Go Home?

Premature babies generally go home when they can maintain body temperature in an open crib, feed entirely by mouth (breast or bottle), breathe without support (or are stable on home oxygen if needed), and are gaining weight consistently. This is often close to the original due date but may be earlier or later depending on the baby's progress. The NICU team prepares parents thoroughly before discharge.

The question "when can my baby come home?" is one of the first things parents ask, and the answer depends on how well the baby is meeting certain milestones. There is no set number of weeks or specific weight required for discharge - each baby is evaluated individually. The focus is on the baby's abilities rather than their size or age.

The discharge process typically begins well before the actual going-home day. Parents learn infant CPR, receive training on any special care their baby needs, and have opportunities to "room in" with their baby for a day or two before discharge. This preparation helps parents feel confident in caring for their baby independently.

Leaving the NICU is a major milestone, but it can also feel daunting. After weeks or months of having monitors and medical staff available around the clock, going home with just yourselves and your baby can trigger anxiety. This is completely normal. Support from the NICU team, early pediatrician follow-up, and sometimes home nursing visits help ease the transition.

Discharge Criteria

Most NICUs require babies to meet several criteria before discharge. First, the baby must maintain normal body temperature in an open crib without the help of an incubator or warmer. This typically requires weighing at least 1,800-2,000 grams (about 4 pounds) and having adequate body fat.

Second, the baby must be able to take all nutrition by mouth, whether from breast, bottle, or a combination. The baby should complete feeds without excessive fatigue and gain weight consistently, usually at least 15-30 grams (about 0.5-1 ounce) per day.

Third, the baby must be breathing without assistance (or be stable on home oxygen if needed) and be free of significant apnea episodes for a period determined by the NICU (often 5-7 days without events requiring intervention). Some babies go home with apnea monitors if monitoring is needed.

Home Care Support

Some babies go home with continued support from the hospital. This might include home nursing visits, especially for babies who need specialized care such as tube feeding or oxygen. Parents receive training on any equipment or procedures before discharge and have contact numbers for questions or concerns.

Regular pediatrician visits are especially important for premature babies. Your baby will have frequent weight checks and developmental assessments in the first months after discharge. Premature babies also require adjusted vaccination schedules and may need additional protective measures, such as RSV (respiratory syncytial virus) prevention during cold and flu season.

How Do Premature Babies Grow and Develop?

Most premature babies develop normally and catch up with their full-term peers. Development is assessed using "corrected age" (age calculated from the original due date rather than birth date) until about age 2. While some preterm babies may have developmental challenges, early intervention and follow-up care help optimize outcomes. The vast majority of premature babies lead healthy, normal lives.

Parents naturally worry about whether their premature baby will develop normally. The reassuring answer is that most premature babies, especially those born after 28 weeks, grow up without significant long-term problems. Modern neonatal care has dramatically improved outcomes, and the majority of premature children perform well in school and lead independent adult lives.

Development in premature babies is assessed differently than in full-term babies. Medical teams use "corrected age" or "adjusted age," which is calculated from the original due date rather than the actual birth date. This makes sense because a baby born two months early has had two fewer months to develop. By corrected age, most premature babies reach developmental milestones on schedule.

Developmental follow-up is an important part of care for premature babies. Specialized clinics monitor growth, movement, vision, hearing, and cognitive development over the first few years. Early identification of any delays allows for prompt intervention, which can significantly improve outcomes. Most children "graduate" from specialty follow-up by age 2-3 if they are developing well.

Understanding Corrected Age

Corrected age adjusts for prematurity by calculating the baby's age as if they had been born on their due date. For example, a baby born 2 months early would have a corrected age of 4 months when they reach 6 months chronological (actual) age. This correction is used for developmental assessment until about age 2, after which any remaining differences typically become less significant.

Using corrected age prevents unfair comparison with full-term peers. A baby born at 28 weeks is expected to reach milestones like rolling over, sitting, and walking according to their corrected age, not their actual age. Most premature babies catch up to their peers in the first two years when assessed by corrected age.

Potential Developmental Concerns

While most premature babies develop normally, some face challenges that benefit from early intervention. The risk of developmental issues increases with greater prematurity and with certain complications during the NICU stay. Potential areas of concern include motor skills, language development, attention and behavior, and learning differences.

Early intervention services, available in most regions, provide therapy and support for children identified with developmental delays. Physical therapy, occupational therapy, and speech therapy can help children reach their potential. The earlier intervention begins, the more effective it tends to be, which is why developmental monitoring is so important.

It's important to remember that many developmental concerns identified in early childhood resolve or become minimal over time. Children are remarkably adaptable, and with appropriate support, most premature children thrive. Focus on celebrating your child's achievements and providing a loving, stimulating environment.

Long-Term Health Considerations

Some premature babies have ongoing health considerations. Those who developed bronchopulmonary dysplasia (chronic lung disease) may be more prone to respiratory illnesses in early childhood. Premature babies may also have higher rates of asthma and other respiratory conditions.

Vision and hearing should be monitored, especially in very premature babies who were at risk for retinopathy of prematurity. Some children need glasses or other visual aids. Most premature babies pass their hearing screening, but some may develop hearing issues that benefit from early intervention.

What Support Is Available for Families?

Having a baby in the NICU is emotionally challenging, and support is available. Social workers and psychologists in most NICUs provide counseling. Parent support groups, both in-person and online, connect families with others who understand. Practical support includes information about parental leave, financial assistance, and resources for siblings. Taking care of yourself is essential for caring for your baby.

Having a premature baby is one of the most stressful experiences a parent can face. The fear, uncertainty, and sense of helplessness are completely normal reactions to an abnormal situation. Acknowledging these feelings and seeking support is not a sign of weakness - it's an essential part of coping with the NICU experience.

Parents of premature babies often experience a range of emotions including guilt ("Did I do something wrong?"), grief (for the pregnancy and birth experience they imagined), anxiety (about their baby's health and future), and sometimes even depression. These feelings are common and usually improve over time, especially with support. However, if emotions become overwhelming, professional help is available and encouraged.

Taking care of your own physical and emotional needs is not selfish - it's necessary for being able to care for your baby. Try to eat well, rest when possible, and accept help from others. The NICU marathon requires endurance, and pacing yourself is important. Your baby needs you healthy and present.

NICU Social Workers and Psychologists

Most NICUs have social workers and sometimes psychologists available to support families. Social workers can help with practical matters such as navigating insurance, understanding parental leave options, arranging accommodations if you live far from the hospital, and connecting you with community resources.

Psychologists or counselors can provide emotional support and coping strategies. They can help with anxiety, depression, and trauma related to the NICU experience. Individual or couples counseling is often available. Don't hesitate to ask the NICU staff to connect you with these resources.

Parent Support Groups

Connecting with other NICU parents can be tremendously helpful. Other parents understand the unique challenges of the NICU experience in a way that friends and family may not. Many hospitals offer NICU parent support groups, and online communities connect parents worldwide.

Organizations dedicated to premature babies and NICU families provide information, support, and advocacy. These groups often organize events, provide educational resources, and can connect you with local support services. Many parents find that connecting with others who have "been there" provides comfort and practical advice.

Caring for Siblings

If you have other children at home, balancing their needs with time in the NICU can be challenging. Siblings may feel confused, jealous, scared, or all of these at once. Age-appropriate explanations about why the baby needs to be in the hospital and when they might come home can help.

Many NICUs allow sibling visits, which can help children understand the situation and feel included. Books about premature babies and NICU experiences written for children can also help siblings process their feelings. Try to carve out some special one-on-one time with your other children when possible.