Appearance of the Neonate

Preterm infants look very different to term babies. They are smaller and thinner with less body fat and muscle bulk to plump them out. Here are some visible signs of preterm development.


  • 23-24 Weeks: skin is fragile, red, wrinkled and translucent. Soles of the feet are smooth. Requires humidity.
  • 31 Weeks: skin appears thicker and no longer requires humidity.
  • 31-36 Weeks: creases appear on the soles of the feet.
  • Term: creases on soles of feet fully formed. If the infant is overdue the skin may appear dry and scaly.

 Photo of premature child depicting premature skin.



  • 23-24 Weeks: tooth buds are visible in the gums



  • 26 Weeks: visible.
  • 28 Weeks: well formed.
  • 29-32 Weeks: fingernails reach tips of fingers.
  • 36-40 Weeks: toenails reach tips of toes.



  • 23-24 Weeks: eyelids thin and may still be fused. Eyebrows visible.
  • 26 Weeks: opens and closes eyes. Eyes often half open. Eyelids still thin. Pupils do not constrict. A few eyelashes visible.
  • 32 Weeks: the pupil of the eye begins to constrict in light.  Eyebrows and eyelashes more visible.
  • 34-26 Weeks: consistent pupil constriction in light. Lids thicker.

Tears do not usually appear until several months after the due date.



  • 23-24 Weeks: the ears look flat.
  • 32 Weeks: ears look fleshier and springy, but still tend to be flat.



Preterm infants are covered in fine downy hair that disappears as they reach term, last to go on the upper arms and shoulders. Scalp hair is mostly on the back of the head.



  • 23-24 Weeks: testes not visible. Girls clitoris may look prominent.
  • 26-27 Weeks: nipples begin to show.
  • 28 Weeks: testes may be visible under the skin in groin area. Girls’ labia are flat and splayed. Nipples flat and pale.
  • 32 Weeks: girls genitals are filling out and look more normal.
  • 34-39 Weeks: boys testes descend into scrotum.
  • 40 Weeks: breast tissue plump and may leak creamy fluid.




  • 23-30 Weeks: heartbeat is normally fast eg. 140-170 beats per minute.
  • 34 Weeks: 110-155 beats per minute.
  • Term: 90-130 beats per minute.

The heartbeat will exceed these rates when the infant is stressed, unwell, too warm or with some medications.

Collage of two photos showing Vital Signs Monitors and Heartbeat Monitor



Breathing is a big challenge for most preterm infants.  At first you may notice that your infants breathes quickly and irregularly with pauses: they may take big breaths or little shallow breaths.  Variability is normal. Gradually, as the infant gets stronger and more mature, they will breathe more easily and steadily. This will depend on their medical condition; not just on their age.



  • 23 Weeks: no true sleep states. Sleep is referred to as indeterminate sleep.
  • 28 Weeks: little eye movements (REM) seen during periods of light, active sleep.
  • 30-32 Weeks: obvious periods of quiet, deep sleep with slower breathing and little activity.
  • 34-36 Weeks: cycles of active sleep, quiet sleep and waking.
  • 38 Weeks: 40% of sleep is quiet sleep and 60% is active sleep.
  • Term: sleep is 50:50 active and quiet, in cycles that begin with active sleep