A baby born at 28 weeks gestation is classified as “very preterm” or “extremely preterm.” These infants face medical challenges because their organ systems have not completed the final stages of development. Survival for babies born at this stage is high, but they require specialized care in a Neonatal Intensive Care Unit (NICU). This overview describes the physical appearance and medical context of an infant arriving at this early gestational age.
Visual Appearance and Measurements
The appearance of a baby born at 28 weeks is primarily due to their size and immature skin structure. The average weight for an infant at this gestational age is typically between 1 pound, 12 ounces and 2 pounds, 7 ounces (0.8 kg to 1.1 kg), with a length of approximately 13 to 14.4 inches (33 to 36.5 cm). Their head appears disproportionately large compared to the rest of their body, reflecting the rapid brain growth that has already occurred.
The skin is thin, delicate, and often has a translucent quality because the protective layers have not fully formed. This transparency allows the underlying blood vessels to be clearly visible, giving the baby a reddish-purple or pinkish hue. There is no subcutaneous fat, which contributes to the wrinkled, fragile look of the skin.
A fine, downy layer of hair known as lanugo covers much of the body, particularly the back, shoulders, and face. This hair is normally at its most abundant around 28 weeks gestation. Other external features, such as the ears, may lack cartilage and appear soft and flat, and the genitals remain small and underdeveloped.
Critical Care Needs Due to Organ Immaturity
The primary medical needs for a 28-week infant stem from the underdeveloped state of their internal organs. The respiratory system is the most immediate concern, as the lungs lack sufficient surfactant that prevents the air sacs from collapsing. This deficiency causes Respiratory Distress Syndrome (RDS), necessitating breathing support that ranges from continuous positive airway pressure (CPAP) to mechanical ventilation, often paired with the administration of artificial surfactant.
Thermoregulation is another challenge because the baby lacks the body fat. Their relatively large surface area compared to their body mass causes rapid heat loss, which must be counteracted by placing the infant in a double-walled incubator. The incubator provides an environment to keep the baby’s core temperature within the target range of 97.7°F to 99.5°F (36.5°C to 37.5°C).
The gastrointestinal tract is also immature, meaning the baby cannot digest food or feed orally. Peristalsis, the coordinated muscle movement that pushes food through the gut, is disorganized, and the suck-swallow-breathe reflex has not developed. Initially, the baby receives nutrition intravenously through parenteral nutrition, with introduction of breast milk through a feeding tube to prepare the gut for later feeding.
Early Neurological State and Reflexes
The neurological state of a 28-week infant reflects an immature central nervous system. The brain surface is beginning to form the characteristic folds and grooves. This immaturity means the infant’s behavior is often disorganized, and they have difficulty regulating their own systems.
Primitive reflexes are only partially functional. The sucking reflex is present and can be elicited, but the necessary coordination with swallowing and breathing typically does not mature until closer to 32 to 34 weeks. The rooting reflex, which helps a baby locate a food source, is also present.
The sensory system is exposed to stimuli for which it is not yet prepared, making the infant sensitive to the NICU environment. Bright lights, loud sounds, and frequent handling can easily overwhelm the baby’s immature nervous system. Care is therefore focused on minimizing sensory input and supporting the baby’s ability to maintain a calm, stable state.
Expected NICU Journey and Short-Term Outlook
The survival rate for a baby born at 28 weeks is high, typically ranging from 80% to over 90%. The short-term outlook is generally positive, although the baby faces an extended stay in the NICU to allow for growth and maturation. The median length of stay for an infant born at this stage is around 2 to 3 months, often until near the original due date.
The first few weeks are important as the baby stabilizes on life support and manages the complications associated with prematurity. Before discharge, the baby must achieve several milestones. These milestones are often referred to as the “Big Three” and include temperature stability, breathing independence, and successful oral feeding.
The infant must consistently maintain a normal body temperature in an open crib, and be free from significant episodes of apnea and bradycardia for several days. The baby must be able to take all of their nutrition by bottle or breast and demonstrate steady weight gain. Once these benchmarks are met, the medical team can begin the final discharge planning process.