Many parents count the days until they can bring their preemies home. Although the big day is without a doubt exciting, it may also feel intimidating to walk away from the well-equipped environment of the NICU. Fortunately, there are guidelines that help you prepare yourself and your home for the day that your infant is ready.
What are the Requirements for Discharge?
Medical staff do not discharge preemies from the hospital until they are ready. To determine readiness, most hospitals check for the following basic requirements:
- Will the baby be able to maintain body temperature in an open crib for at least 48 hours (without the assistance of the hospital’s infant warmer light)?
- Is the baby able to breastfeed or bottle-feed (without the need for an extra feeding tube)?
- Can the baby gain weight at a state rate?
Many preemies meet all three criteria within a few weeks of their original due date. However, babies born with health problems, who undergo surgery, or who need breathing machines may stay in the NICU beyond their original due dates.
How Can I Prepare for Discharge?
Think of preemie hospital discharge as a process instead of a one-time event. In the weeks leading up to the discharge, consult with the unit on the opportunities to dress and diaper your infant as much as possible. As the discharge date approaches, facilities have rooming-in options that allow parents to gain experience with gaining for their baby’s basic needs.
For example, you may be able to room-in overnight or spend a few days pumping breastmilk and meeting with a lactation consultant. If your baby is on a medication regimen, nurses may also teach you had to administer medicine and similar treatments to suit your child’s needs.
From a logistical standpoint, other tasks to prepare for discharge include the following:
- Check medicine records and confirm insurance coverage
- Choose a pediatrician and set appointments
- Take an infant CPR class (receive special training in infant cardiopulmonary resuscitation (iCPR)
- Install car seats
- Attend a discharge class or debriefing
What are Common Medical Needs After Preemie Discharge?
While specific medical needs depend on your child’s unique condition, all preemies need to be scheduled for routine medical care and evaluations. These requirements include pediatric checkups and immunizations that follow the same general schedule as full-term babies.
In addition to routine evaluation, you may need information on the following:
- Apnea – Some premature infants suffer from apnea (short pauses in breathing). Although the condition is likely to improve as the infant matures, many hospitals send preemies home with apnea monitors for use until the infant’s respiratory pattern reaches maturity. You and anyone left alone with your infant will need to attend a class on how to use the monitor and must know how to perform infant CPR.
- Bronchopulmonary dysplasia (BPD) – Although most preemies no longer need extra oxygen or ventilators when they leave the NICU, infants with diagnosed with BPD experience extra scarring or irritation of the lungs. These babies will need oxygen and medication long after discharge, so the hospital will send the appropriate equipment for administering oxygen and medicine to your baby. You may also need to attend a training session if required.
- Feeding plan – Preemies need plenty of nourishment to continue to grow and develop. However, their intestines may not be developed enough to consume the same way as full-term babies. Ask the NICU for a feeding plan for your infant. Medical professionals may advise using a concentrated formula to give your baby the recommended nutrients.
- Gastrostomy tube (or G tube), nasogastric tube (NG tube), or total parenteral nutrition (TPN) – Infants who are too weak for oral motor feeding (such as coordinating swallowing and breathing) may have a tube inserted through the skin, nose, or vein. The hospital will inform you if your child requires one of these methods for feedings.
- Infections – Confirm with the hospital that your preemie has received the required RSV injections and that anyone who will be in close contact with your child is up to date with immunizations.
What are Additional Tips for Getting Through My Discharge Checklist?
Medical Records and Insurance Coverage
Have your baby added to your insurance policy as soon as possible after birth. Be advised that many insurers require that you contact them within days of the infant’s birth. The benefit is this is that many insurers cover home nursing, social service workers, and extensive therapies and treatments for premature infants. Contact your insurer to verify policy coverage. You will also need to set up a file for important documents, medical records, and financial statements from the hospital and the insurer.
Choose a Pediatrician and Schedule Appointments
The next important step is to choose a pediatrician who works with premature infants. If your baby is going home with special equipment or tubes, you need to choose a pediatrician who works with special-needs infants. The first required appointment usually occurs within 5 days of hospital discharge (unless the same pediatrician has already been working with your child in the NICU).
You will also need to discuss follow-up testing for your preemie. These may include blood testing, hearing, vision, and developmental tests. If early intervention is required, your pediatrician may provide referral to specialists. You can also contact The Warren Center for referral to early childhood intervention specialists (such as physical therapists).
Learn Infant CPR and Other Specialized Training
Parents and anyone expected to be alone with the baby (such as grandparents) should take a class on infant CPR. Be advised that anyone caring for a child on an apnea monitor or oxygen tank must know CRR.
If your child is on home oxygen, obtain a preferential parking sticker from your county or state if permitted. You can also confirm that the local rescue square has the equipment required to care for a small infant and that emergency response teams know how to get to your home.
Install an Infant Car Seat
Most hospitals require that you bring in the automobile for a car seat test before taking the infant home. Many car seats must be modified with extra padding or head support, and the hospital tests the car seat by seating the infant while still hooked to the monitor to evaluate steady heartbeat and breathing. If the hospital detects problems, you will need to consult with a neonatologist on a preemie restraint system or help traveling with the baby’s apnea monitor and oxygen tank. You will also need to limit any car travel to no more than an hour at a time.
Attend the Discharge Meeting and Debriefing
This meeting is where you pick up a copy of your baby’s discharge summary, discuss follow-up appointments, and ask any questions about at-home care. In addition to learning about any special equipment, you may also receive advice on home interaction (such as limiting visitors or public places until your child’s immune system grows stronger).
Prepare Your Home
Plenty of hand sanitizers and correct-size diapers are just a couple of important items when preparing a home for a premature baby. Consult with your healthcare provider if you have questions about the first few weeks of caring for a preemie.