Discharge Instructions: Going Out, Visitors, and Your Premature Infant

The immune system defends the body against germs and infection. An adult's immune system constantly protects the body from germs. And babies who get breast milk have extra immune protection. But your preemie's immune system needs time to develop. During this time, germs that don't make you sick at all could make the baby very sick. So, you need to give your baby extra protection. For the first 3 months after birth, keep your baby away from places where germs are easily spread and from people who may pass germs to the baby.

It's okay to take the baby for short outings. A walk around the block or visit to the park is fine. But to avoid germs, stay out of crowds and confined, crowded spaces. This means places like malls, movie theaters, or airplanes. You should also not take the baby to places where there are a lot of other children, such as a school or daycare center. Don't be afraid to ask strangers not to touch your baby. You can always say something like, "Our doctor told us the baby could get really sick from any germs, so we can't let you touch them." Remember, your baby's health is more important than a stranger's hurt feelings.

It's okay for the baby to have some visitors. Just make sure your guests aren't sick. Before having someone over to visit, don't be afraid to ask if they have a cold or other infection. Also, ask visitors to wash their hands before holding or playing with the baby. You might want to keep a bottle of hand sanitizer near the front door (out of reach of small children). This makes it easier for guests to clean their hands before touching the baby.

Most germs spread on hands. Washing your hands well and often is the best way to prevent passing germs to your baby. People who have contact with the baby should follow the steps below. If there are other kids in the family, you may need to help them wash their hands, but they may enjoy being in charge of telling visitors to wash.

• Remove any rings, bracelets, or watches you're wearing. It can be hard to clean under these. (You may want to stop wearing jewelry and false nails until your baby is a little older.)
• Use clean, running water and plenty of soap to work up a good lather.
• Clean your whole hand, under your nails, between your fingers, and up your wrists. Don't just wipe—rub well.
• Wash for at least 20 seconds. You may be surprised how long this takes, so be sure to count.
• Rinse, and let the water run down your fingertips, not up your wrists.

Your baby won't always need this extra protection. As they get older, their immune system will get stronger. After about 3 months, it will probably be OK to take your baby to more places and have more visitors. Talk to the baby's doctor to make sure. Also, take extra care during your baby's first winter or two. Flu and cold germs that often spread during the winter can make babies very sick. You and any others who will be close to the baby should be sure to have the flu shot and the Tdap shot (for whooping cough) as soon as possible.

Respiratory syncytial virus (RSV) is a common virus. It infects the airways. In adults and older children, it tends to cause mild symptoms like a cold. Most people recover in a week or two. But RSV can be serious. Babies are more likely to get severe RSV and need hospital care.

The CDC advises an RSV vaccine for babies called nirsevimab. This vaccine is used to prevent severe RSV disease in babies. It has an RSV monoclonal antibody. It's given as a shot (injection). It's for babies who are:

1. Age 8 months or less.
2. Born in or before their first RSV season.
3. Born to someone who did not have the RSV vaccine in pregnancy.

The vaccine is also advised if:

• The mother's RSV vaccine status is not known.
• The baby was born within 14 days of the mother's RSV vaccine.

Most babies born to those who got the RSV vaccine don't need to get nirsevimab too.

Nirsevimab may also be advised for some high-risk babies and children ages 8 months to 19 months.