When will my baby be ready to go home?
Will my baby need medications at home?
Will my baby need a car seat test?
Will my baby start immunizations before going home?
Will my baby need special equipment at home?
What things at my home may need to be changed to protect my baby's health?
What kind of follow-up care will my baby need?
1
When will my baby be ready to go home?
There is not a specific weight requirement for discharge from NICU/CCN, but most pediatricians will want your baby to weigh more than four pounds before they discharge them. 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 seven 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.
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2
Will my baby need medications at home?
Preemies are commonly treated with medications for apnea, Bronchopulmonary Dysplasia (BPD) or reflux. 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. Prior to discharge home, you will be given prescriptions to fill for your baby. You will be asked to bring the medications back to the nursery to be checked by your baby's nurse before you and your baby go home.
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3
Will my baby need a car seat test?
If your baby was born at less than 37 weeks gestation or currently weighs less than 5.5 lbs., he/she will need a car seat test. Sometimes the pediatrician will ask for the baby to be tested in the car seat for some other medical reason other than those previously stated. In a car seat for a preemie, the harness straps should come out of the seat at no more than 8 inches up from the bottom of the seat back. The crotch strap should come out no more than 5 inches from the bottom of the seat back. To support the baby while in the seat, use rolled up receiving blankets on each side of the baby and between the baby's legs. A small infant should not be placed in a car seat with a shield, abdominal pad or armrest in an area that could directly impact the infant's face or neck during an impact. Should your baby not pass the car seat test, he should travel lying flat in a car safety bed. If this is the case, you should also avoid the use of other upright equipment such as an infant swing, seat or carrier until the infant has some more time to grow.
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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 2000gms (4 lbs. 6.5 oz) or 30 days of age, whichever comes first. 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 in an immunization record book that will be given to you upon your baby's discharge home. You can bring this record book with you to each pediatrician's visit to continue recording your baby's immunizations.
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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 (cardiopulmonary resuscitation) 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.
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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 cpver to protect the baby from the direct sunlight. Do not use sunscreen on your baby unless advised to do so by your pediatrician. Many sunscreens contain chemicals that can interact negatively with your baby's delicate skin.
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 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/CCN, if you have any questions once you get home, we want you to feel comfortable in calling your pediatrician and/or the NICU/CCN. Congratulations on your impending discharge!
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8
What kind of follow-up care will my baby need?
There are several routine screening tests performed on your baby in the NICU/CCN 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. Repeat tests are often performed while they are still in the NICU/CCN, but sometimes need to be performed in the pediatrician's office. The state will forward the results to your pediatrician who will forward the information on to you. A hearing screen is performed on every newborn in the state. An Algo hearing test is performed once your baby is 34 weeks gestation or older. If a baby does not pass the hearing screen in one or both ears, a mores sophisticated hearing test called a BAER is performed once the baby is older. The BAER test will be arranged for your baby by the pediatrician on an outpatient basis. A routine screening for IVH (intraventricular hemorrhage) is done with a head ultrasound on any infant 34 weeks gestation or less on day of life #3. If this test is negative, no further testing is necessary. If the result is positive, the ultrasound is repeated weekly 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 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 every one to two weeks and if there is a 3+ eye disease (ROP) diagnosed, the baby will need to be scheduled for surgery by the ophthalmologist. Before discharging your baby home, all of his/her urgent medical problems will be addressed. We will arrange for follow-up of all non-urgent medical problems such as BPD or reflux. If your baby has Bronchopulmonary Dysplasia (BPD), he/she will be seen at the BPD clinic on a regular basis. If your baby has been diagnosed with reflux, he/she will be seen on a regular basis by a pediatric gastroenterologist. If your preemie has ROP (retinopathy of prematurity), we'll check with the ophthalmologist before sending him/her home to arrange for follow up on an outpatient basis. Also, your baby's first pediatrician's appointment might be made for you. This usually takes place one to two days after discharge. If your baby was under 33 weeks gestation at time of birth, arrangements will be made for your baby to be seen by "early intervention". Early intervention is designed to evaluate the growth and development of premature infants, handle any problems that may develop and provide parents with resources and services that may help in the everyday life of their preemie. Finally, your pediatrician may order Visiting Nurse visits for your baby. The visiting nurse may come to your home to evaluate the progress of your baby by weighing and measuring the baby and by discussing with you any issues you may have encountered since bringing your baby home.
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