Born at 28 Weeks

Where 28 weeks sits

The World Health Organization splits preterm birth into three bands: extremely preterm is under 28 weeks, very preterm is 28 to under 32 weeks, and moderate to late preterm is 32 to 37 weeks. Twenty-eight weeks is the first week of the middle band. Nothing changes overnight in a baby's body at that boundary, but it does change which sentence people use about your baby, and it is worth knowing which one applies so that the statistics you stumble across are at least the right statistics.

The first day

Your baby will be admitted to intensive care. The first hour is about warmth, breathing and lines. Expect a humidified incubator, monitor dots on the chest, an oxygen saturation probe taped to a hand or foot, and either umbilical lines in the cord stump or a fine long line threaded into a larger vein for fluids and nutrition.

NICE guideline NG124 tells teams to stabilise preterm babies with CPAP rather than invasive ventilation where it is clinically appropriate. Plenty of babies born at 28 weeks are managed on CPAP from the outset. Others need a breathing tube and surfactant first and come off it within days.

Breathing support, and why it goes up and down

There is a ladder: ventilator, then CPAP or nasal high flow, then low-flow oxygen through soft prongs, then air. NG124 says that for babies needing non-invasive support, teams should consider nasal CPAP or nasal high-flow therapy as the main mode. After initial stabilisation it says to aim for an oxygen saturation of 91 to 95 per cent, which is why the number on the screen is not being pushed to 100.

Babies do not climb this ladder in a straight line. A baby who moves from CPAP to high flow and back to CPAP after a bad night has not lost ground in any meaningful sense. Infections, a patent ductus arteriosus, a big feed or simple tiredness all move a baby up a rung temporarily.

Caffeine

NG124 says to use caffeine citrate routinely in preterm babies born at or before 30 weeks, starting as early as possible and ideally before three days of age, and to consider stopping it at 33 to 35 weeks corrected gestational age if the baby is clinically stable. Bliss describes it in the same terms: it is the usual treatment for apnoea of prematurity, and most babies grow out of those pauses by around 36 weeks gestation. It is stopped well before discharge, and there is usually a watching period afterwards.

The screening calendar

• Head ultrasound. Bliss notes that very premature babies have a head ultrasound in the first few days to look for bleeding into the ventricles. Repeat scans are routine surveillance.
• Eye screening. Babies born before 31 weeks, or under 1500g, are screened for retinopathy of prematurity, so a baby born at 28 weeks is in that group.
• Hearing. Tested before discharge, with extra tests for babies who were preterm.
• Blood tests. Gases, blood sugar, haemoglobin, platelets and infection markers, taken from a heel prick, a hand or an existing line.

Feeding is the long game

Nutrition starts through a line, moves to tiny tube feeds of your expressed milk, and only later becomes feeding by mouth. Coordinating suck, swallow and breathe is a developmental skill that usually arrives somewhere between 32 and 34 weeks corrected, so a baby born at 28 weeks has roughly a month of tube feeding ahead. This is not a delay. It is the timetable.

Your milk matters more here than at any other gestation, and the unit will help you start expressing within hours of birth. If your supply is difficult — and after a shocking early birth it very often is — say so early rather than late.

How long will this take

Teams often use the original due date as a rough marker, and babies born at 28 weeks frequently go home somewhere in the fortnight either side of it. Some go home weeks earlier. Discharge is not a date; it is a list of behaviours — breathing on their own, holding their temperature in an open cot, and taking all their feeds.

Kangaroo care starts sooner than you expect

Parents assume skin-to-skin has to wait until the wires come off. It does not. Units routinely support kangaroo care for ventilated babies, with two staff to move your baby safely, and it is one of the few things only you can provide. Bliss also encourages comfort holding — a still, cupped hand over your baby's head and feet rather than stroking — for babies who are not yet ready to be lifted out.

NICE NG124 tells staff to explain the benefits of touch, including skin-to-skin, and to recognise parents as partners in their baby's care rather than visitors. If nobody has offered, ask when the first cuddle can happen. The answer is often sooner than the machinery suggests.

On survival figures

You will find survival percentages for 28 weeks with one search, and we are not going to print one. Those figures belong to a named country, a named year and a named denominator, and moving any of the three moves the number. They describe a cohort of thousands of babies; they say nothing about the specific baby in front of you, whose weight, condition, sex, steroid exposure and first-week course all matter. Your consultant can have that conversation properly. Ask for it in a quiet room, and ask for it again a fortnight later, because the honest answer changes as your baby gives them more information.

There is one framing that does help. When a number frightens you — a grade, a stage, a centile — the useful question is not "what does grade two mean" but "what does this change about what happens next for her". That is a question a consultant can answer concretely, and the answer is often "nothing this week".

What to expect of yourself

Twenty-eight weeks usually means two to three months on a unit, and the emotional shape of that is well documented: a frightening first fortnight, a long flat middle where nothing appears to happen, and a sudden rush at the end. The flat middle is the part nobody warns you about, and it is where most parents run out of reserves. Take days off. Sleep at home. Let somebody else sit at the cot side. Bliss offers support by email, Monday to Friday except bank holidays, and most units have a psychologist or family support worker you can be referred to without a crisis.