Baby Born at 33 Weeks: What to Expect From the NICU and Beyond

My daughter was born at 33 weeks and 1 day, weighing 4 pounds 2.5 ounces. Until a few days before she was born, I had been having a completely normal pregnancy. At my 32-week appointment on a Monday, my blood pressure was high, and by Friday, I was delivering my daughter by C-section because I had developed severe preeclampsia and HELLP syndrome.

It all happened incredibly fast. If your baby was just born at 33 weeks, or you've been told that you may need to deliver around 33 weeks, you're probably doing exactly what I was doing: trying to figure out what this could actually look like.

Every premature baby and every NICU experience is different, so I can only share ours. But when I was facing an early delivery, hearing stories from other families who had been through it brought me an enormous amount of comfort. So here's what our experience with a baby born at 33 weeks actually looked like, from delivery and respiratory support to feeding, weight gain and finally bringing her home.

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What Happens When a Baby Is Born at 33 Weeks?

A baby born at 33 weeks is premature because any baby born before 37 completed weeks of pregnancy is considered preterm. Depending on the baby, that can mean needing help with breathing, maintaining body temperature, feeding and gaining weight. Premature babies often require care in a neonatal intensive care unit, or NICU.

In our case, the NICU team was already in the operating room when my daughter was born. I couldn't hold her after delivery. I remember hearing the entire team clap when they got her out, but she needed to go directly to the NICU. She needed respiratory support, including CPAP and supplemental oxygen, and was placed in an incubator. I didn't even get to see her for more than 12 hours.

Seeing My 33-Week Preemie for the First Time

My husband went to the NICU before I did because I had just had a C-section, was on a magnesium drip because of my preeclampsia and HELLP syndrome, and couldn't get out of bed yet. Around 1 a.m., approximately 12 or 13 hours after delivery, I tried walking for the first time. I was then put into a wheelchair and wheeled down to the NICU to finally see my daughter.

I'm not going to lie, I was scared. She was so tiny, and it was difficult to even see her face because of the CPAP and everything connected to her. I don't believe I actually held her until the following day. That whole period is honestly a blur.

Before delivery, I was able to receive one antenatal steroid injection. These medications may be given when premature delivery is expected to help accelerate fetal development, particularly the lungs. Sometimes there isn't enough time before an urgent delivery to complete the entire recommended course, and in my case, everything was happening so quickly that I was grateful there was time for even that first dose.

What Does a 33-Week Baby Need in the NICU?

One thing I learned very quickly is that there isn't one standard NICU experience for a baby born at 33 weeks. Some babies need more respiratory support than others, some stay much longer, and some have additional complications. Your baby's medical team is the best source of information about what your individual baby's NICU stay may look like.

Our daughter needed help breathing initially, but she was able to come off respiratory support relatively quickly. She was also in an incubator and initially needed help staying warm. Eventually she moved into an open crib during the last few days of her NICU stay, which felt like a huge milestone.

Every time we visited, one of the first things we did was take her temperature under her arm. There were a few readings that seemed off and made us nervous, but the nurses would recheck them and weren't concerned. Maintaining her temperature ultimately wasn't something that prolonged her stay. For us, the biggest hurdle was feeding.

Feeding a Baby Born at 33 Weeks

I had no idea before having a premature baby how much of the NICU experience could revolve around feeding. Premature babies may not yet have the coordination to suck, swallow and breathe simultaneously, which is one reason feeding can take time to develop.

My daughter initially received donor milk as well as the colostrum I was able to provide. I wasn't planning to breastfeed, so she later transitioned to premature infant formula. She had a feeding tube through her nose, but the NICU nurses also started introducing a bottle surprisingly quickly.

Watching them teach her how to eat was incredible. They knew exactly how to position her, pace the bottle and help her learn the coordination she needed. Eventually I could come in during feeding times and give her bottles myself. As she became stronger, more and more of each feeding came from her bottle rather than her feeding tube, and that became the last big thing standing between us and home.

Why Feeding Can Keep a Preemie in the NICU

Toward the end of our NICU stay, it felt strange because she looked so good. She was breathing on her own, maintaining her temperature and gaining strength, but she still needed to consistently take enough of her feeds by bottle rather than through her feeding tube.

This is something I had never thought about before having a preemie. Eating is work for a premature baby because they have to develop the ability to coordinate sucking, swallowing and breathing before they can successfully feed by mouth.

Once my daughter was consistently taking enough of her feeds by bottle, her feeding tube could finally come out. Then she needed to demonstrate that she could continue doing well without it before discharge. She started with an Ultra-Preemie nipple and worked her way through several flows as she got stronger. I share our full timeline in how long babies use preemie nipples.

The feeding tube coming out felt enormous because we knew we were getting close.

The Two Steps Forward, One Step Back Part of the NICU

Someone described the NICU experience to me as "two steps forward, one step back," and that was definitely true for us. Our daughter was doing really well, and then she started losing more weight than her team wanted to see.

She was born at 4 pounds 2.5 ounces and lost a significant amount of weight after birth. When her weight became a concern, her medical team increased the calories in her formula from 22 calories per ounce to 24. Thankfully, she turned a corner pretty quickly, began gaining weight again, eventually went back to 22-calorie formula and surpassed her birth weight before coming home.

Premature babies can have different nutritional needs than full-term babies. Some need additional calories, protein, vitamins or minerals to support growth, so feeding plans should always be determined with your NICU and pediatrician.

What Were Our Requirements for Leaving the NICU?

Our daughter spent just under two and a half weeks in the NICU and came home at just under 35 and a half weeks gestational age. Generally, premature babies need to be able to breathe independently, maintain their body temperature, feed by breast or bottle and gain weight steadily before discharge.

For us, feeding was the final major milestone. Then there was one more test I hadn't known about before having a preemie: the car seat test.

Our 90-Minute Car Seat Test

Before our daughter could leave the NICU, we brought in our infant car seat, which was the Doona. She completed a 90-minute car seat test in the middle of the night while the NICU team positioned her in the seat and monitored her to make sure she could remain safely positioned and maintain stable breathing.

When she passed, it felt like one of the final boxes had been checked. After just under two and a half weeks, we were finally getting ready to bring her home.

What Our NICU Routine Looked Like

I stayed in the hospital for six days after my C-section because I was also recovering from severe preeclampsia and HELLP syndrome. I needed repeated blood work, blood pressure monitoring and medication while my own health stabilized. During those first six days, my husband would wheel me down to the NICU multiple times a day.

Once I was discharged, we were incredibly fortunate to live only about five minutes from the hospital. Rather than sitting next to her incubator all day while she slept, we generally planned our visits around her feeding and awake times. We could feed her, hold her and do skin-to-skin, then go home while she slept and grew. At night, we'd call the NICU to check on her.

I recognize what a privilege our proximity to the hospital was because there were families around us who lived much farther away and couldn't easily come and go. There was also a complicated reality to my own recovery. Of course I desperately wanted my daughter home, but at the same time, I had just undergone a C-section and was recovering from a serious pregnancy complication. Knowing that she was receiving around-the-clock care from an incredible NICU team gave me the space to physically recover at home between visits.

Those feelings can exist at the same time. The NICU nurses and doctors are a very special group of people, and they cared for my daughter with so much love that I felt comfortable leaving the hospital each night knowing she was in excellent hands.

The Hard Parts I Didn't Expect

There were so many little moments I hadn't anticipated. My son came to the hospital wearing his big brother shirt and carrying balloons, but he couldn't meet his baby sister. He didn't know any differently and was excited about the whole idea, but it was still hard for us.

I also hadn't bought preemie clothes because I had absolutely no reason to expect I would need them. My aunt sent us some, and I quickly discovered that we could actually bring our own clothes into the NICU.

The Magnetic Me preemie sleepers were especially helpful because they were easy to get on and off around everything going on in the NICU. I kept about two outfits there at a time, which was plenty for us. If something got spit-up or poop on it, or she was bathed and changed, the NICU would send the dirty clothes home with us and I'd bring clean ones back.

She eventually moved from preemie to newborn and then 0–3 month clothes, which took much longer than it did with my full-term baby.

Bringing Our 33-Week Preemie Home

Bringing home a baby who was still technically weeks away from her due date was exciting and scary because she was still so tiny. Our NICU team reminded us of something that gave me a lot of reassurance: they weren't going to send her home until they believed she was ready to be there.

Before discharge, they had watched her breathing, feeding, temperature and weight. They had seen her around the clock in a way that I hadn't, and that gave me confidence that she really was ready to come home.

Our team actually discouraged us from using additional breathing-monitoring devices at home because they were concerned that inaccurate readings could create unnecessary alarm. That's something every parent should discuss with their own baby's medical team rather than making the decision based on someone else's NICU experience.

At home, we continued using the 22-calorie premature infant formula and initially woke her approximately every three hours to eat. She was drinking around two ounces at a time. We started with just four 4-ounce bottles at home, which was plenty for us initially. We saw our pediatrician within a couple of days of discharge and continued monitoring her growth and development at her regular appointments.

What Is Corrected Age for a 33-Week Preemie?

This was another concept that was completely new to me. Because my daughter was born approximately seven weeks early, we use her corrected age when thinking about development.

For example, when she is six months old based on her actual birthday, her corrected age is closer to four months. So when I'm looking at developmental milestones, I'm not expecting her to necessarily do everything a full-term six-month-old would be doing.

Corrected age is generally considered when tracking a premature baby's development during the first two years. At every pediatrician appointment, I've asked whether we should be doing anything additional, including early intervention, and so far our pediatrician has been happy with her development.

That doesn't mean every premature baby will follow the same path, which is why I think it's worth continuing to ask those questions at well visits and discussing your individual baby's development with your pediatrician.

What I Wish I Had Known Before Having a Baby at 33 Weeks

The thing that helped me most happened before my daughter was even born. I found out I had preeclampsia on a Monday and delivered her that Friday, so there was virtually no time to process what was happening.

My sisters immediately started reaching out to people they knew, including friends of friends, people who had experienced premature deliveries themselves and families whose babies had arrived in their late 20s or early 30s in terms of gestational weeks. They shared stories about how their children were doing, and I needed those stories.

They couldn't guarantee what would happen with my baby, and neither can I guarantee what will happen with yours. Every pregnancy, premature baby and NICU course is different, but those stories gave me hope during a terrifying few days.

They helped me understand that delivering my daughter early was not automatically the outcome I had imagined when I first heard the words "33 weeks." They also helped me focus on something else that mattered: I needed to be okay, too.

My daughter needed to be delivered because I was very sick. Keeping her inside longer wasn't necessarily the safest option simply because 33 weeks sounded impossibly early to me. Once she arrived, we took things one milestone at a time: breathing, temperature, feeding, weight, moving to an open crib, getting the feeding tube out, passing the car seat test and finally coming home.

If Your Baby Was Just Born at 33 Weeks

If you're reading this from a hospital room or next to an incubator, I know how overwhelming all of this information can feel. I also know how tempting it is to compare your baby to every other 33-week baby you find online, but try to remember that gestational age is only one part of the story.

My daughter's NICU stay was relatively short, and I know how fortunate we were. Other families we met were facing much longer stays and very different medical circumstances. What brought me comfort was learning to focus on the baby in front of me and the next milestone rather than trying to predict the entire NICU stay.

Ask the nurses questions and let them teach you how to change that impossibly tiny diaper, take a temperature, hold your baby around all of those wires and eventually give a bottle. Let them care for your baby while you take care of yourself, too.

The NICU nurses and doctors caring for my daughter became the people I trusted with the most important person in my world at a time when I couldn't care for her entirely on my own. That's something I'll never forget.

Frequently Asked Questions About Babies Born at 33 Weeks

Is a baby born at 33 weeks premature?

Yes. A baby born before 37 completed weeks of pregnancy is considered premature, or preterm. Babies born at 33 weeks may need additional medical observation and NICU care depending on their individual needs.

How long does a baby born at 33 weeks stay in the NICU?

There isn't a set length of stay based solely on gestational age. Our daughter was born at 33 weeks and 1 day and spent just under two and a half weeks in the NICU, coming home at just under 35 and a half weeks gestational age. Another 33-week baby may have a shorter or much longer stay depending on breathing, feeding, temperature regulation, growth and other medical needs.

Does a 33-week baby need help breathing?

Some do. Our daughter needed respiratory support after birth, including CPAP and supplemental oxygen, before eventually breathing independently. The amount and duration of respiratory support can vary considerably from baby to baby.

Can a baby born at 33 weeks bottle-feed?

Yes, but feeding can take time to learn because premature babies need to coordinate sucking, swallowing and breathing. Our daughter initially received nutrition through a feeding tube while learning to take a bottle, and increasing the amount she could consistently take by bottle was ultimately one of the final milestones she needed to reach before coming home.

When can a 33-week preemie go home?

There isn't one specific gestational age or weight that guarantees discharge. Generally, the medical team will want to see that a premature baby can breathe independently, maintain body temperature, feed successfully and gain weight appropriately, along with resolving or managing any other medical issues. Our daughter came home before her original due date, at just under 35 and a half weeks gestational age.

Do you use corrected age for a baby born at 33 weeks?

Generally, yes. Corrected age accounts for the number of weeks a premature baby was born before their due date and can provide a more appropriate reference point for developmental milestones during the first two years.

A Note From Me

This article describes my family's personal experience with premature birth and a NICU stay. A baby born at the same gestational age can have a very different medical course, so this should not replace guidance from your baby's medical team.

Always talk to your NICU team and pediatrician about your baby's specific needs, feeding, development and discharge plan.