In this World Prematurity Day special of The Care Circle powered by Motherhood Hospitals, host Sahiba is joined by Dr. Santosh Kumar K, Senior Consultant and Lead – Paediatrics & Neonatology at Motherhood Hospitals, Banashankari, Bengaluru. With over 15 years of experience and hundreds of NICU admissions each year, Dr. Santosh offers a compassionate and expert-led understanding of premature birth.

Together, they explore what prematurity truly means, why babies are sometimes born early, and how the NICU supports these tiny fighters through their most critical days. Dr. Santosh explains the stages of prematurity, modern neonatal advancements that have improved survival, and the essential role of practices such as colostrum swabbing and kangaroo care. The episode also highlights the emotional journey of parents, growth expectations, long-term follow-up needs, and the myths that often create unnecessary fear. This conversation offers clarity, comfort, and confidence to every parent navigating the world of premature birth.

Key Takeaways:
Here are the key points you shouldn’t miss from this episode:

• Prematurity refers to birth before 37 completed weeks
• Premature birth is often unavoidable and not the parents’ fault
• Neonatal advancements have improved survival and long-term outcomes
• NICU provides specialised support for breathing, temperature, feeding and infection control
• Colostrum swabbing helps prime gut immunity in early days
• Kangaroo care skin-to-skin contact stabilises temperature, breathing and heart rate
• Premature babies may initially struggle with feeding due to immature coordination
• Many premature babies achieve catch-up growth with proper nutrition
• Parents should watch for red flags like poor feeding, lethargy or breathing issues
• Common myths, such as that premature babies cannot be touched or breastfed, are incorrect
• Emotional support for parents is crucial during and after the NICU stay

Dr. Santosh Kumar K
Senior Consultant and Lead – Paediatrics & Neonatology

0:06 – Global prematurity overview & episode introduction
1:10 – Introduction of Dr Santosh Kumar: credentials & NICU expertise
2:07 – Guest welcome
2:24 – What prematurity means & why babies are born early
3:27 – Reassurance for parents: “It is not your fault”
3:36 – How premature baby outcomes have improved over 10–15 years
4:39 – Why survival rates have risen: research, care, NICU systems
5:00 – What the NICU is & why premature babies need it
5:49 – The role of parents in NICU bonding & kangaroo care
6:20 – Can premature babies breastfeed? Feeding protocols explained
8:15 – The power of colostrum in preterm survival
8:24 – Tracking growth: weight, head circumference & length
9:52 – Post-NICU concerns: infections, jaundice, feeding issues
10:09 – Corrected gestational age & structured follow-ups
11:15 – Red, Yellow & Green flag babies: how risk levels are tracked
12:45 – Milestones needed before NICU discharge
12:59 – Preparing for home care: hygiene, follow-ups, environment
14:28 – Myth-busting segment introduction
14:50 – Myth 1: “Preterm babies cannot be touched”
15:34 – Myth 2: “Preterm babies always stay smaller”
15:49 – Myth 3: “A few drops of colostrum don’t matter”
16:08 – Myth 4: “Prematurity happens due to negligence”
16:25 – Myth 5: “Premature babies can’t breastfeed”
17:03 – Myth 6: “Premature babies will always face challenges”
17:30 – Supporting parents emotionally during the NICU journey
18:16 – Advice for coping: rest, support groups, shared parenting
18:25 – One golden message for parents of premature babies
18:37 – Host closing & appreciation
18:50 – Guest closing remark
18:51 – Outro: appointment booking & following The Care Circle

Sahiba: (0:06) Globally, nearly 1 in 10 babies is born prematurely before completing 37 weeks of pregnancy. It remains one of the leading causes of newborn deaths worldwide, though advances in neonatal  care are helping more of these tiny fighters survive and thrive. In India alone, over 3.5 million babies are born pre-term each year.

Behind these numbers are stories of resilience, parents who never give up, and the NICU, i.e., Neonatal Intensive Care Unit, team who work around the clock to give these babies a fighting chance. Every year on November 17th, we observe World Prematurity Day, a global initiative to raise awareness about premature birth, its challenges, and its heroes – the babies, parents, and caregivers who make survival stories possible. Hello and welcome back to the Care Circle, a podcast series by Motherhood Hospitals, your trusted space for conversations around pregnancy, newborn care, parenting, and fertility.

And in this special World Prematurity Day episode, we are uncovering the facts, the myths, and the care every premature baby deserves. I am Sahiba, your host for this episode, and joining me today is Dr Santosh Kumar, Senior Consultant and Lead – Paediatrics & Neonatology at Motherhood Hospitals, Banashankari, Bengaluru with over 15 years of experience.  He handles 450-600 NICU admissions each year, including babies born as early as 24 weeks and weighing as little as 500 grams.

 He has a special interest in neonatal emergencies, high-risk premature care, and neurodevelopmental follow-ups, and has even established a neonatal transport system to bring critical newborns safely from rural areas to advanced NICU centres.  Dr. Santosh, thank you so much for joining us on the Care Circle today. 

Dr Santosh Kumar: (2:04) Thank you, Sahiba.

It’s been wonderful to be here today.  

Sahiba: (2:07) So, doctor, for many first-time parents, the word premature can sound frightening. Could you start by explaining what prematurity means, why babies are sometimes born early, and how you and your team guide parents through the first moment of shock and uncertainty? 

Dr Santosh Kumar: (2:24) So, by definition, a preterm baby means those babies who are born before 37 weeks of pregnancy.

There are several reasons; there could be maternal factors, and there could be foetal factors.  Maternal factors, for example, there could be hypertension, there could be diabetes in pregnancy, or there could be some infections or there could be multiple pregnancies. Similarly, foetal factors can be of the congenital deformities, etc, something like that.

So, when you classify further in detail about the prematurity, those babies who are born between 34 to 36 weeks of gestation are called late preterm. Babies who are born 32 to 34 weeks of gestation are called moderate preterm. Babies are called very preterm when they are born between 28 to 32 weeks of gestation.

And extremely premature babies are those babies who are born before 28 weeks of gestation. But what is important is for the parents to know that it is not their fault and the good news is that with advanced neonatal care, even extremely premature babies could have a very high chance of survival and normal growth. 

Sahiba: (3:27) That’s quite reassuring to know, doctor.

So, doctor, if we look back 10 or even 15 years from now, how have outcomes improved for premature babies? 

Dr Santosh Kumar: (3:36) Yeah, that’s a very good question to answer. Now, when you take the development of neonatal intensive care over the last two decades, the neonatal mortality rate, which we call it as babies who had the death rate before 28 days of their birth, the numbers were around 37 per every 1000 live births in 2005. Today, when you take it in 2025, it is approximately around 17.3 per every 1000 live births.

And when you take it in cities like Kerala, country states like Kerala, Tamil Nadu, and all, they’re now reaching close to a single-digit mortality rates. So the reason for this good improvement in the mortality rate could be one, the access and infrastructure, the ongoing research, lot of research work on the respiratory support for newborn babies, the neuro protection that has come into existence, the nutrition and growth has been a very viable, important factor for these newborn babies, and infection control practises in the NICU and an excellent in antenatal care during the pregnancy. 

Sahiba: (4:39) That’s actually amazing to know, doctor, that we are progressing at such a good rate.

This brings me to my next question. NICU can look intimidating to parents, with all the machines, wires, and alarms. Can you explain what the NICU really is, basically the entire setup, why babies need it, and what parents can expect? 

Dr Santosh Kumar: (5:00) The neonatal intensive care unit is a specialised environment for premature or critically ill newborns.

Matching the in utero experience of the babies in the external environment is what it takes in the neonatal intensive care unit. So babies might need help with breathing, maintaining the temperature, requiring some sort of nutritional support, and various forms of feeding, and all these things. So there are a lot of monitors and machines in and around the baby, which try to track all these vital signs and respond instantly if needed.

Parents are encouraged to be part of the care, talking softly, gentle touch, or even kangaroo care, which is the most important part of the neonatal intensive care unit, that means skin to skin contact, can make a big difference in the baby’s recovery, it stabilises heart rate, improves weight gain, and strengthens emotional bonding. 

Sahiba: (5:49) That’s beautiful to know, doctor, so even inside that clinical space, love and touch are still part of healing. 

If your baby is currently in the NICU, remember, you’re not alone; help and guidance are just a click away.

Visit our website or the Motherhood app to learn more about our NICU and the way the brand has extended its presence across India. Moving on, doctor, one of the biggest concerns for new parents is feeding. Can premature babies breastfeed? How do you ensure they get enough nutrition to grow well? 

Dr Santosh Kumar: (6:20) Feeding premature babies requires patience and a step-by-step approach.

Each neonatal intensive care unit will have a protocol to follow. Now, since these babies are born premature, they’ll have coordinated feeding protocols. For example, there’s something called tube feedings.

Once the baby outgrows, the tube feeding is done. Once the baby does well in palada feeds, it goes to what they call non-nutritive sucking. And from non-nutritive sucking, the baby attains to reach to have bad breastfeeding.

So tube feeding is something where we deliver the milk directly into the baby’s stomach. So there’s no point in sucking, swallowing, or breathing coordination. Once the baby grows to a certain gestational age, the baby is tried with palada feeds where the milk is given through the mouth.

The baby tries to hold the milk in the mouth, tries to breathe, and then swallows the milk. And once the baby attains a good amount of palada feeds, we start something called non-nutritive sucking. What is non-nutritive sucking is to make the mother empty her breast, try to give an empty breast feeding, and see how good the sucking efforts of the baby are and how it coordinates with its breathing.

If the coordinated efforts in a non-nutritive sucking with breathing are good, then we have something called direct breast  feeding. In the direct breastfeeding initially for five minutes and gradually increasing the duration of breastfeeding for breastfeeding baby starts gaining a good amount of weight and improves its gestational age. But at the time of birth, colostrum is very important for the baby’s thriving, which is very rich in natural antibiotics and has a lot of immunological factors.

So initially, as the baby is born extremely premature, we start something called mouth painting. We apply this colostrum to the baby’s oral cavity, thereby helping the baby get a good amount of natural antibiotics and enhancing logical factors. 

Sahiba: (8:15) That’s so powerful that something so natural can be life-saving. Once babies grow stronger, how do you track their progress? 

Dr Santosh Kumar: (8:24) Normally, in this, premature babies normally they will have the maternal factors. So all babies will lose some amount of weight in the initial few days of birth. But what we try to achieve in the intermediate and intermediate care units is to minimise this weight loss, wait for babies to stabilise.

Once they start stabilising, the most important factors are weight, head growth, and the length of the baby. So these three are tracked throughout the stay in the NICU. Make sure that they gain a certain amount of weight; there’s a certain limit of weight gain that the baby can achieve during their prematurity, based on the gestational age of the baby.

For example, if a baby is born less than 28 weeks of gestation, we expect them to gain at least 10 to 15 grams per day and gain around 0.5 centimetres of head growth. And similarly, certain expectations of length. So, as the baby grows 32 weeks, we expect the baby to gain around 20 to 25 grams per day, and when the baby grows beyond 3 weeks, we expect them to gain around 30 to 40 grams.

So we continuously monitor their tracking throughout their stay in the NICU. Once they are out of the NICU, at regular follow-ups, the growth of this progression is monitored. What is important here is the certain guidelines for the premature babies when they achieve catch-up growth.

For example, head circumference, normally a premature baby is achieved by 3 to 4 months of age. For example, length by 6 to 7 months or 6 to 8 months of age, weight by 1 to 2 years of age. So we track them throughout their post follow-up care from the NICU.

Sahiba: (9:52) That’s so reassuring to know, doctor. So, doctor, I have also heard that premature babies often need extra care even after leaving the NICU. What are some common health issues parents should be aware of, and how do you track development fairly when they are born early? 

Dr. Santosh Kumar: (10:09) So once premature babies get discharged from the neonatal intensive  Care Unit, the most common thing is acquiring infections, second thing following with jaundice, third is about feeding difficulties, and various other viral or bacterial infections that the baby can get in.

We use something called a correlative gestational concept. So when the baby is normally discharged between 34 to 35 weeks of gestation, we ask the parents what precautionary measures they have to take, in terms of taking care of the baby at home environment and we tell them when they have to regularly follow up with us. Once the baby gets discharged from prematurity, the follow-ups will be cycled accordingly with the follow-up within the first three, four days.

Following the tracking from there, we will be having follow-ups at one week, two weeks, three weeks, or one-month follow-ups. During these follow-ups, we classify these babies into red flags, yellow flags, and green flags based on the gestational age they are born and the risk factors of the stomach course they would have gone through in the Intensive Care Unit. So based on that, if the baby is falling into a red flag, these babies require extensive follow-up care with a multidisciplinary approach.

For example, babies require a complete high-risk neonatal follow-up, they require a developmental assessments, they require an eye screening at regular intervals, they require hearing screening of both screening tests as well as diagnostic tests and at three months or four months of corrective age, when the development assessment happens, from there we track them and put them into developmental follow-ups and physiotherapies and multiple developmental specialists will be involved into the care of the babies and as per the protocol, it will be followed up. Now similarly, a baby is born at, born with a green flag, was required a neonatal intensive care, but did not have a course and had a good gestational age, those babies require normal follow-up with the neonatologist, and the neonatologist will do a follow-up and do a direct observation card, something called direct observation of the babies. If there is any factor that is delaying or any factor that is hindrance to the overall development of the baby, those babies again will be put into the developmental follow-up programme and they will be tracked from there and again the babies who are following yellow flag will be again, they will have a certain other test which will track till the age of two years.

So, all these three stages of flags, red, yellow, and green, are monitored for the overall multidisciplinary approach till they grow up to reach around two to three years of age. 

Sahiba: (12:45) This brings me to my next question: going home from the NICU is emotional, relief mixed with anxiety. What milestones must a baby reach before discharge, and how can parents prepare for home care? 

Dr. Santosh Kumar: (12:59) Yes, as we discussed, Sahiba, before discharge, what we do is the support that the baby would require at the time of admission to the NICU and gradually, as the baby shows some amount of progress, tries to adjust to the external environment, we try to reduce the support, once we start reducing the support, it could be in terms of respiratory support, it could be in terms of temperature support or it could be in terms of feeding difficulties or it could be in terms of the infections. So, one by one all this is weaned off and baby should become absolutely stable where it can sustain with his own energy to maintain the temperature, does not lose much weight, gaining good adequate weight on daily basis and breathes well on its own, does not require any sort of support, not undergoing any sort of breathing difficulties and once these are achieved by the baby, the baby is fit for discharge at a certain gestational age as well as certain weight. Once the baby gets discharged, at home the parents are advised to always maintain a clean and calm environment, minimise the attenders, wash hands before handling the baby, follow up your visits with the doctor at regular intervals as advised by the neonatologist or the paediatrician, following what are the protocol that has been set by the doctor at the time of discharge and these are some of the instructions that the parents should follow when they are going back home and taking care of the baby.

Sahiba: (14:28) That is such helpful guidance, doctor. Those first few days at home can feel overwhelming, but knowing what to watch for really gives parents that confidence. Doctor, there are many myths about premature babies; let’s clear a few.

Are you ready, doctor? 

Dr. Santosh Kumar: (14:42) Yes, please, sure. 

Sahiba: (14:43) So the first statement is that premature babies can’t be touched or held, is it a myth or a fact? 

Dr. Santosh Kumar: (14:50) Gentle touch and kangaroo care are not only  safe but essential for bonding and growth. Now in terms whenever you, whenever the baby is born admitted to the neonatal intensive care unit, we ask the mother and father to spend good amount of time near the baby, try gently touch the baby, try to talking to them and the mother to stay with the baby because the sound, the touch and the smell of the mother are the key factors to make sure that the baby understands that the mother is still experiencing the in utero environment because the smell of the mother is something that the baby is always feeling to make sure that they are in safe environment, this is one of the important factors so definitely the touch are much important, much required for a neonatal baby in the NICU.

Sahiba: (15:34) The Second one would be that premature babies always stay smaller or weaker. 

Dr. Santosh Kumar: (15:39) Again, a myth, with proper nutrition and follow-up, most catch up in height, weight by 2 years of age, length by 1 year of age, and weight by 3 years. 

Sahiba: (15:49) Next one, even a few drops of colostrum can make a big difference.

Dr. Santosh Kumar: (15:52) Absolutely, it’s a liquid gold packed with natural antibiotics that protect the preterm babies from infections and also has immunoglobulin factors that help in their thriving during the neonatal care.

Sahiba: (16:08) Moving on, prematurity can happen to anyone. 

Dr. Santosh Kumar: (16:11) Exactly, it is not caused by negligence; it can occur due to medical, genetic, or various unexplained reasons.

Most often,the cause for the prematurity could not be identified, but there is no one at fault. 

Sahiba: (16:25) Next one would be the doctor, the premature babies can’t breastfeed.

Santosh Kumar: (16:30) Not true, not true, it’s just that a matter of time that the baby learns how to grow up to start having breast feeding from the mothers, there is certain protocol that the NICU will follow and gradually over a period of time the baby will be definitely be able to start having direct breast feeding from the mother, only that the baby requires some amount of energy to have a sustained sucking efforts and you should also have a good coordination for breathing and sucking and swallowing, so that develops over a period of time and definitely these babies will end up with direct  breast feeding from the mothers.

Sahiba: (17:03) The last one will be a doctor. Premature babies will always face challenges in life. 

Dr. Santosh Kumar: (17:08) Again, it’s a myth, with proper care, love, and medical follow-ups, these little fighters often grow up stronger than we can imagine. So this needs extra care, regular follow-ups with the paediatrician or the neurologist, that’s all it requires, and it’s a myth that they require lifelong care on follow-ups. 

Sahiba: (17:30) That’s such a heartwarming reminder that strength really does come in the tiniest packages. Moving on, doctor, the NICU journey is not just tough on babies; it’s emotionally and physically draining for parents. What advice do you have for families coping with fear, guilt, or financial and emotional stress? 

Dr. Santosh Kumar: (17:48) It’s again completely normal to feel overwhelmed, anxious, or even guilty, but none of this is your fault.

Talk to the care team openly, join NICU parent support groups, prioritise  rest, good quality of sleep, nutritional and emotional health, father should also take part equally in terms of care and bonding, which helps both parents feel more in control. Remember, caring for yourself allows you to care better for your baby. 

Sahiba: (18:16) You explained it so beautifully, doctor.

So, finally, Dr. Santosh, if you can give parents one golden piece of advice about premature babies, what would it be? 

Dr. Santosh Kumar: (18:25) Trust your baby’s resilience and your care team; these little ones are stronger than they look. With love, patience, and proper medical support, premature babies don’t just survive, they thrive. 

Sahiba: (18:37) Premature babies truly are little warriors and , and with the right care, love, and guidance, they go on to live happy, healthy lives. A big thank you to Dr. Santosh Kumar for sharing such valuable insights today.

Dr. Santosh Kumar: (18:50) Thank you. 

Sahiba: (18:51) To our listeners, if your pregnancy feels high-risk, complicated, or you simply want expert guidance from our Neonatalogist, help is just a call or click away. There are several ways to book an appointment: visit motherhoodindia.com or the motherhood app to book an appointment, or call 96203 96203.

If you are listening to this podcast, use the appointment link on the landing page to connect directly with our specialist. Don’t forget to follow the care circle on Spotify for more conversations that matter to your family’s health. Until next time, take care and celebrate every little milestone.