The Discharge Process
When can my baby go home?
In most cases, parents can take their baby home once the baby is able to do certain things without help:
• Breathe – your baby must be able to breathe without help from any equipment. Your baby should have a period of time with no prolonged pauses in breathing (i.e. no apnea). In a few cases, babies may be sent home with oxygen support after parents are shown how to use the equipment.
• Eat and grow – your baby must be able to suck from the breast or a bottle and must be gaining weight at a healthy rate.
• Keep warm – your baby must be able to keep his or her body heat stable while fully clothed in an open crib. In most cases, babies who weigh more than four pounds (2,000 grams) can maintain their temperature.
Sometimes, a baby must remain in the Neonatal Intensive Care Unit (NICU) a while longer if he or she has other health problems. You may be asked to “room in” with your baby (stay overnight in the NICU) shortly before discharge to help you learn how to address any issues your baby may have during the night.
What is the purpose of a discharge process?
Babies born prematurely or with health problems have unique needs that must also be met at home. Leaving the watchful care of the NICU staff can be stressful for parents. For instance, along with the issues listed previously (breathing, feeding, keeping warm), other unique needs that may be addressed at home include:
• Checking your baby for signs and symptoms of infection and jaundice;
• Safely giving your baby medicines;
• Learning about infant cardiopulmonary resuscitation (CPR);
• Learning about car seat safety (small babies may have breathing problems when placed in a car seat, so you should know how to use a car seat properly);
• Tracking the growth and change in your baby’s motor skills and emotional balance (neurodevelopment);
• Follow-up visits to check for healthy growth, nutrition, hearing, and vision in your baby.
The American Academy of Pediatrics advises the discharge process include:
• Educating parents about their baby’s needs;
• Helping parents find and contact a primary care doctor for the baby;
• Arranging for follow-up care;
• Developing a plan of care for home;
• Locating and coordinating other services for support and help at home;
• Assessing the baby for medical problems.
American Academy of Pediatrics (2008, November). Hospital discharge of the high-risk neonate: proposed guidelines Pediatrics, 122(5), 1119-26.
What should parents do?
There are many key actions you should take to help your baby make the move from the NICU to home. Below is a general list of key steps you should follow:
• Work with your baby’s health care team to make sure the steps listed above take place and make sure all your questions are answered;
• Know what tests have been done for your baby before leaving the hospital and what tests still need to be done;
• Record details about your baby, such as tests performed before discharge, medicines to take home, training received, and other important details;
• Make a list of the names and phone numbers of your baby’s main doctor and any other health care providers;
• Know when your baby is due for checkups and be sure to take him or her to every checkup advised, including recommended visits to a specialist;
• Ask if a copy of your baby’s discharge summary is available. This is a copy of the medical notes made about your baby while in the NICU that gives details about health problem(s), treatment(s), medicine(s), follow-up needs, other types of medical help advised, and what information parents have been given. Make a copy for your baby’s primary doctor and keep a copy of this file at home;
• Know what signs may show your baby is having health problems and who to contact if this occurs;
• Make sure you receive training about car seats, giving medicines, and other special issues about your baby’s care. Read to keep up-to-date about special aspects of your baby’s care, such as feeding and sleep. Look into costs involved with your baby’s care. If you have health insurance, find out what is covered and what is not covered. If you do not have health insurance or if your plan does not cover all your baby’s needs, find out about other sources of assistance;
• Take time out to care for yourself. Keep in mind that you have been through a stressful time. Reducing your own stress will also be helpful for your baby;
• Most importantly, get answers to all of your questions before you bring your baby home.
Building bridges to care.
Leaving the NICU is a major change for you and for your baby. The discharge process is like crossing a bridge from one care setting to another. Not only do you need to know what to do and how to handle issues at home, you also need to be sure there are doctors and nurses available to help you, your baby, and your family through the years ahead.
Moving forward . . . talk to your baby’s doctors and nurses about these issues:
• How soon can I return to work?
• When can I place my baby in day care?
• When can I leave my baby with other care providers?
Medicines for your baby at home:
When you and your baby are ready to leave the Neonatal Intensive Care Unit (NICU), doctors may prescribe medicines to give your baby at home. Here are a few tips to help you make sure you are ready to give medicine safely:
Before you leave the hospital, check and double-check. Hospitals are advised to provide patients (or their parents) with a complete list of medicines the patient will be taking after discharge, as well as instructions about how to take the medicine. When you are prescribed medicines to take home with your baby, health care staff is advised to ask you to repeat the instructions they give you about the medicine. It also is a good idea to carry a list of your baby’s medicines with you at all times. If you need to seek urgent care for your baby, having this list handy is very helpful to doctors.
Mistakes with medicines are one of the most common types of medical errors. These errors have a higher risk of causing harm in babies than in adults. Babies are at higher risk when taking medicines because:
• Most medicines are made for adults, so they have to be prepared in a special dosage and/or formula for babies;
• A baby’s body is less able to process medicines (especially if the baby is very small and/or ill);
• Babies cannot tell you when they feel ill due to a medicine; therefore, parents often do not know if the medicine has had certain side effects.
A time to be extra careful with medicines is when your baby changes doctors, is admitted to the hospital, transferred to another hospital, or is referred to a different type of doctor for certain health problems. These are often called “transitions in care.” It is helpful to have an updated list of your baby’s medicines that you can give to his or her doctor at these times. Hospital staff is now advised to check your list against any other medicines that might be prescribed for your baby.
Giving your baby medicines at home:
Studies show parents are more likely to make a mistake when giving medicine to an infant or toddler than when giving it to an older child. The effects of medicines vary with every baby, mainly because the dose given is based on the baby’s weight. If your baby was born early and/or with a low birth weight, medicine dosages will differ from those given to healthy, full-term infants of the same age. A key safety step for parents is to make sure you are always giving your baby the correct dose and giving it exactly as prescribed by his or her doctor or nurse.
Things to know about your baby’s medicines:
• What it is and what it does.
• Amount to be given.
• Timing for each dose.
• How to give the medicine.
• Side effects to be aware of.
• Where to find help if you have questions.
• The name of the medicine (both the brand and generic names).
• What to do if your baby vomits the medicine.