A baby born at 27 weeks gestation is classified as extremely premature, arriving in the late second trimester of pregnancy. This early birth instantly places the infant in the Neonatal Intensive Care Unit (NICU). Understanding the journey ahead is important for families coping with this unexpected beginning. This article provides realistic expectations about the length of the NICU stay and the medical milestones a 27-week baby must reach before going home.
Understanding the Length of Stay
The amount of time a 27-week baby remains in the NICU is highly variable, but a common guideline is that the baby will stay until close to their original estimated due date. Since a full-term pregnancy is around 40 weeks, a baby born at 27 weeks will typically spend an additional 13 weeks, or roughly 90 to 105 days, in the hospital setting. This duration is an average, and some babies may be ready for discharge sooner, while others require a longer stay due to complications.
The NICU journey is generally divided into phases: initial stabilization, a period of growth and development, and finally, preparation for the transition home. The initial weeks are focused on supporting immature body systems. Once stable, the baby enters a “feeder and grower” phase, concentrating on gaining weight and developing the functional skills needed for life outside the incubator. The ultimate timing of discharge depends entirely on the baby achieving a specific set of medical and developmental milestones, not simply reaching a certain age.
Immediate Medical Concerns
A 27-week gestation means that the infant’s organ systems are profoundly immature, necessitating immediate, intensive medical support. The most common and immediate challenge is Respiratory Distress Syndrome (RDS), caused by a lack of surfactant, the substance that keeps the lung’s air sacs open. Babies this age almost always require respiratory support, ranging from mechanical ventilation to less invasive pressure support, and may be given synthetic surfactant. Extended need for breathing support can lead to a condition known as Bronchopulmonary Dysplasia (BPD), a chronic lung condition that may require oxygen support for months.
The fragile, developing brain is also at risk for Intraventricular Hemorrhage (IVH), which is bleeding into the fluid-filled spaces of the brain. While mild IVH often resolves without long-term issues, severe bleeds can result in permanent neurological injury. Digestive immaturity is another serious concern, making the baby vulnerable to Necrotizing Enterocolitis (NEC), a potentially life-threatening condition where tissue in the intestine becomes inflamed and dies. Feeding typically starts slowly with small amounts of milk given through a tube to encourage gut development while the baby receives primary nutrition intravenously.
Meeting the Criteria for Going Home
Discharge from the NICU is determined by the baby’s ability to demonstrate consistent physiological maturity, independent of their chronological age.
Thermoregulation
The baby must be able to consistently maintain a stable body temperature in an open crib without the aid of an incubator for at least 24 to 48 hours. This proves they have enough subcutaneous fat and a mature nervous system to manage their own heat.
Full Oral Feeding
Another important milestone is achieving full oral feeding, either by breast or bottle, eliminating the need for a feeding tube. The baby must coordinate the complex actions of sucking, swallowing, and breathing to take in enough calories for steady weight gain.
Respiratory Stability
Finally, the baby must demonstrate respiratory stability by being free from episodes of apnea (pauses in breathing) and bradycardia (slow heart rate) for a specified period, typically five to seven days. Before final discharge, many NICUs require the infant to successfully complete a car seat challenge, a monitored test to ensure breathing remains stable while positioned in the car seat.
Support After the NICU
Bringing an extremely premature baby home marks the beginning of specialized care, focused on continued growth and monitoring. The concept of “corrected age” becomes central, which is the baby’s chronological age minus the number of weeks they were born early. Developmental milestones are measured against this corrected age, offering a more accurate benchmark for expectations.
Post-discharge support often includes regular visits to specialized NICU Follow-Up Clinics, where a multidisciplinary team monitors growth and neurodevelopment. These clinics help identify potential delays early, which can lead to early intervention services like physical, occupational, or speech therapy. Parents will also need to manage a detailed discharge plan, including specific feeding instructions, fortified milk or formula, and possibly specialized monitoring or medication.