Born at 32 Weeks

32 weeks is a boundary in the definitions

The World Health Organization's very preterm band runs from 28 to under 32 weeks, so 32+0 is the first day of the moderate to late preterm band. It is a definitional line rather than a biological one, but it shows up in real places: which growth chart your baby is plotted on, which research your baby appears in, and often which level of unit your baby is cared for in.

Which unit, and why it might change

Many babies born at 32 weeks are cared for in a local neonatal unit rather than an intensive care unit, and some who start in intensive care are stepped down within days. Bliss is clear that transfers between units, including moves closer to home when a baby no longer needs a higher level of care, are common. A move is usually good news dressed up as an administrative shock.

Breathing: usually a nudge, not a rescue

Lungs at 32 weeks are often mature enough to work with a little help. CPAP or nasal high flow for a few days is a common pattern, and some babies need nothing at all. A smaller group needs a ventilator and surfactant, particularly if steroids were not given before birth or if there is an infection.

Pauses in breathing with dips in heart rate still happen at this gestation. Bliss notes that apnoea of prematurity usually settles by around 36 weeks gestation and that bradycardias — slowed heart rate — usually stop after about the same point. Both are monitored, and the alarms are set deliberately sensitive.

The real work is feeding

This is where a 32-week admission is spent. Coordinating sucking, swallowing and breathing well enough to take full feeds arrives somewhere around 32 to 34 weeks corrected for most babies, so your baby is arriving at the start of that window rather than after it. Expect tube feeds first, then a mixture of tube and breast or bottle, then full oral feeding.

Progress is not linear. A baby who took three good feeds yesterday and needs the tube for all of them today is tired, not going backwards. Feeding is the single most common reason a baby who looks well is still on the unit.

Jaundice and temperature

Jaundice is more common and treated at lower levels in preterm babies than in term babies, and treatment thresholds below 38 weeks are gestation-specific, so the light your baby is under is not comparable with a term cousin's. Temperature control is the other classic 32-week issue: babies are nursed in an incubator or heated cot until they can hold their own temperature dressed in an open cot.

Which growth chart, and why it looks odd

The Royal College of Paediatrics and Child Health publishes two relevant charts. The neonatal and infant close monitoring chart is designed for very preterm infants from 23 weeks gestation to two years corrected age. The standard UK-WHO 0 to 4 years chart is described by the RCPCH as also suitable for moderately preterm infants born at 32 to 36 weeks. A baby born at exactly 32 weeks may be plotted on either, depending on their course and local practice. Ask which chart is being used; it changes how the centile should be read.

Corrected age runs for two years

NICE guideline NG72 tells clinicians to explain to parents that their child's developmental corrected age, calculated from the original due date rather than the birth date, will be used for the first two years when assessing functional and developmental skills such as walking and talking. The American Academy of Pediatrics gives the same advice on HealthyChildren.org: use corrected age during the first two years.

The exception people forget is immunisations, which run on actual age, not corrected age. If your baby is still an inpatient at eight weeks old, they will normally be vaccinated on the unit.

How long

Babies born at 32 weeks often go home some weeks before their due date, but it depends on feeding more than anything else. The three conditions are the same at every gestation: breathing unaided, holding temperature in an open cot, and taking all feeds. Ask at ward rounds which one is currently holding things up. Bliss notes that you should be involved in discharge planning as your baby gets closer to going home, so it is reasonable to ask what the plan looks like well before it feels imminent.

Follow-up afterwards

Being born at 32 weeks does not automatically mean enhanced developmental follow-up, but it does mean your health visitor and GP should know the gestation, and it means anybody assessing development should be using the corrected age. NG72 is also blunt about the headline that gets lost: the majority of children born preterm have a good developmental outcome and a good quality of life.

The tests your baby will still have

Even a straightforward 32-week admission involves more testing than a term birth. Blood tests may include blood gases, blood sugar, haemoglobin, platelets and infection markers such as C-reactive protein, taken from a heel prick, the back of a hand, or an existing line. Bliss notes that where multiple samples are needed over a short period, a baby may occasionally need a transfusion simply to replace the blood used for testing.

Eye screening for retinopathy of prematurity applies to babies born before 31 weeks or under 1500g, so a baby born at 32 weeks is usually outside that group unless they were small for dates. Hearing is tested before discharge, and Bliss notes that babies born prematurely may have extra hearing tests because they are at higher risk.

What to ask for before you go home

Ask who is coordinating the discharge, what community follow-up has been arranged, and whether feeding support continues afterwards. Ask which growth chart is in the red book and what centile your baby is on with the correction applied. Ask when the next eye or hearing appointment is, if there is one. And ask for the gestation to be written somewhere obvious, because for the next two years every professional who assesses your child needs to know it before they assess anything.