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GOING HOME from NICU
Planning for Discharge
As the day finally approaches for you to take your baby home, don't
be surprised if you have mixed emotions. Happiness and joy are often
mixed with anxiety over the responsibility of caring for your baby.
Your baby's nurses will be able to assist you by teaching you the
necessary things from how to feed and bathe your baby to how to
take your baby's temperature. You will also be able to have a "dress
rehearsal" with your baby, where you can stay overnight in
the hospital (rooming in) providing all of your baby's care while
having the nursing staff just on the other side of the door to assist
you if needed.
Commonly Asked Questions About Discharge
1. When will my baby be ready to go home?
There is not a specific weight requirement for discharge from NICU.
Your baby must also meet the following criteria:
- Be able to maintain his/her body temperature in an open crib.
- Be actively gaining weight on breast/bottle feedings.
- Not have any apneas (pauses in breathing) causing bradycardias (slowing
of the heart rate) for several days to be sure that the "apnea
of prematurity" has resolved.
- While most babies do not require oxygen when they are discharged, some will need to be sent home on oxygen.
Most babies meet these criteria between two weeks before to two weeks after their original due date.
2. Will my baby need medications at home?
Preemies are commonly treated with medications for apnea (pauses
in breathing), BPD (chronic lung disease) or reflux (reverse of
food flow to esophagus from stomach). These are problems generally
caused by prematurity and gradually resolve. They may resolve before
your baby goes home, but if they do not, your baby may go home on
medications.
If your baby goes home on medications, your pediatrician may want the baby to gradually outgrow the current dose (allowing for the medicine to be tapered off) or they may want to increase the dose as the baby grows. Either way, before discharge, your baby's nurse will give you instructions on what the medications are for and how to give them to your baby.
You should plan to practice giving the medications to your baby whenever you visit. At discharge, you will be given prescriptions to fill for your baby.
3. Will my baby need a car seat?
YES! Your nurse will discuss car seat safety with you.
Car Seat Safety
Car Safety Seats
One-Minute Car Safety Seat Check up
Safe Transportation of Children with Special Needs
4. Will my baby start immunizations before going home?
Depending on the age of your baby, some immunizations may be given
in the hospital before discharge. Your baby will receive the first
of three Hepatitis B vaccines as soon as he/she weighs 2000 gms
(4 lbs. 6.5oz.).
If your baby is in the hospital at two months of age, he/she will receive his/her two-month vaccines, which include DTAP (Diphtheria/Tetanus/Acellular Pertussis), HIB (Haemophilus Influenzae type B), Polio and possibly Prevnar (Pneumococcal 7-valent Conjugate).
All of your baby's immunizations will be recorded on an immunization record card that will be given to you upon your baby's discharge home. You can bring this record card with you to each pediatrician's visit to continue recording your baby's immunizations. During cold weather your baby may receive the first of monthly synagis shots, to prevent RSV.
5. Will my baby need special equipment at home?
Sometimes caring for your preemie at home will take some special
skills and practice. If your baby is going home on a monitor or
on oxygen, you will receive special training in the hospital on
how to work with this equipment. You will also be required to complete
an infant CPR class before discharge. You are welcome to bring grandparents
or anyone else who might be caring for your baby to the class. Just
ask your baby's nurse for the dates/times available for the CPR
classes. We want you to feel confident in your ability to care for
your baby's special needs at home.
6. What kind of follow-up will my baby need?
There are several routine screening tests performed on your baby
in the NICU that may need to be repeated or require follow-up.
The newborn screen or PKU is a state mandated blood test that screens for a number of diseases. Sick preterm infants often have "false positive" results on the PKU and need to be retested when they are older and healthier. A hearing screen is performed on every newborn in the state, prior to discharge.
A routine screening for IVH (intraventricular hemorrhage) is done with a head ultrasound on any infant 34 weeks gestation or less. If this test is negative, no further testing is necessary. If the result is positive, the ultrasound is repeated often until the bleed is stable or until it has resolved. It is still possible that some follow-up care will be necessary. If your baby needs follow-up care with a neurologist, it will be arranged for you before discharge.
If your baby is less than 30 weeks gestation or less than 1250 grams at birth, he/she will have an initial eye exam by the pediatric ophthalmologist at four to six weeks of life. If this initial exam is normal, follow-up will be as recommended by the ophthalmologist. However, if the initial exam is abnormal, follow-up exams will be scheduled.
Before discharging your baby home, all of his/her present medical problems will be addressed.
7. What things at my home may need to be changed to protect my baby's health?
- Maintain a non-smoking environment. This is especially important
for baby sent home with oxygen.
- Wash your hands after handling food or taking care of other children
in the house. This is your best defense against germs.
- You can ask your family and friends to not visit if they have colds
or other contagious illnesses. Preemies are very susceptible to
germs.
- You can ask for early morning appointments at your pediatrician's
office in order to avoid crowded waiting rooms full of sick children.
- Try to avoid crowded indoor places like malls or movie theaters.
The baby has a higher risk of catching cold or infection in places
like these.
- Feel free to take your baby outside, weather permitting, of course. Don't expose the baby too long to drafts or direct sunlight. You may want to try using a hat or a stroller with a parasol to protect the baby from the direct sunlight. Do not use sunscreen on your baby unless advised to do so by your pediatrician.
Though this may seem like a lot of planning and even a bit overwhelming, you should remember that from the day your baby was born you have been learning and preparing for the day that your baby comes home. You have gotten to know your baby and have become very involved in his/her care, from the simple tasks such as bathing and feeding your baby, to the more complex tasks of measuring medications and giving treatments.
You have learned ways to prevent illness and ways to comfort your baby when he/she isn't feeling well. We want you to feel confident and be successful in caring for your baby at home. And even though we want you to have plenty of time to practice these things while your baby is in NICU, if you have any questions once you get home, we want you to feel comfortable in calling your pediatrician and/or the NICU.
Congratulations on your impending discharge!
MORE ABOUT US
- Visitation
- Virtual
tour - your first visit to the NICU
- Primary Care
- NICU Staff
- Accessories - equipment that may be used
- Special Tests or Treatments
- Special Conditions of a Baby
- Parenting and Positive Touch
- Kangaroo Care
- Infant Massage
- Breastfeeding
- Frequently Asked Questions
- Understanding your Preemie
- Going Home
- Common Medications
- Support Groups / Other Services
- Financial Assistance
- Daycare
- Helpful Links
