Dr.Wisniewski - NeoPedEdu

“When my baby can go home?” or “When my premature baby can be discharged home from the NICU?” is one of the two most frequently asked questions of me when I talk to parents of a premature baby after delivery and admission to NICU. In this post, I will discuss in detail when you can expect your baby to go home. However, I will not be able to give you an exact date for the discharge home of your baby depending on the level of its prematurity. The quick answer is that most premature babies who did not have any severe complications or surgeries will go home before 37 weeks of corrected gestational age. However, more critical is the functional maturity of the baby; that’s why I will explain to you the criteria that doctors take into account to make this important decision. Who are premature babies, and why they need to stay in NICU after birth? Prematurity is defined as the birth of a baby before completed 37 weeks of GA. In the USA, approximately 1 out of 10 babies is born prematurely. That rate will vary depending on your race and country of origin. Premature babies are born with all their organs being somewhat immature. Some of the mildly premature babies, such as those born at 35 or 36 weeks of gestational age, can stay with mothers after birth and go home within a few days after delivery. However, almost all babies born at less than 35 weeks of gestational age have to be admitted to NICU. Due to the immaturity of their organs, premature babies may need help and treatment for: hypothermia (low body temperature)poor feedingshypoglycemia (low blood sugar levels)breathing problems and need for supplementary oxygenapneas (short pauses in breathing rate)jaundice (yellow skin color due to an increased amount of chemical in the blood called bilirubin)low blood pressure In addition, some very premature babies develop complications during their stay in NICU that also need treatment and contribute to prolonged hospitalization: chronic lung disease (need for additional oxygen after 36 weeks of corrected age)intra-ventricular hemorrhage (bleed in the brain)NEC (severe necrotic and inflammatory disease in intestines)ROP - Retinopathy of Prematurity (disease affecting immature eyes that may lead to impaired visual acuity)severe anemia (need for blood transfusions) If you have a premature baby born before 32 weeks receiving treatment in the NICU right now, I encourage you to explore my book "Babies Born Early" in which I explain a lot of conditions mentioned above. What are the criteria that need to be met before a premature baby can go home? Given the number and complexity of problems that premature baby has to deal with after birth, each baby has its unique situation and predicting discharge date is very difficult if not an impossible task. In general, most premature babies go home before their due dates. If a baby was born extremely prematurely (less than 28 weeks of gestational age) and developed one or more of the complications mentioned above, such a baby has a higher chance of needing hospitalization beyond its due date. Below I am listing the most important criteria that neonatologists take into consideration to decide if a premature baby is ready to go home with its parents and family. Ability to maintain normal body temperature in an open crib. Many premature babies after birth have problems regulating their body temperature. It occurs due to lack of energy sources, immature brain, and the fact that room temperature is much lower comparing to maternal body temperature to which they were exposed for many months. We address that problem by placing those babies in isolettes or Incubators (Isolette is a fancy computerized plastic box in which we can regulate environmental temperature and humidity so the baby can be comfortable and will be able to maintain appropriate body temperature). All babies that are candidates to go home need to have healthy body temperature in open crib without too many layers of clothes or blankets for at least 48 hours before discharge. The baby should have a regular breathing pattern (No clinically significant apneas). Premature babies are known to have apneas. Apnea is a short pause in breathing. Sometimes we treat apnea with a medication called caffeine, and sometimes we watch it making sure it does not get worse. Regardless of the cause for the apnea, we do not want to discharge baby with significant apneas; therefore, that problem needs to be resolved before premature baby can go home. If the baby were treated with caffeine, most clinicians would delay discharge home for 5-7 days after the medication was stopped. No more significant bradycardias. The standard heart rate of a newborn is usually between 120-160 beats per minute. Some premature babies may have periods when their heart rate slows down to 80 per minute or lower. Such a clinical condition is called bradycardia. Persistent or recurrent periods of bradycardia are considered not safe, and we want a premature baby to outgrow that problem before discharge home. A premature baby needs to be consistently gaining weight on the current nutritional schedule. If you are a parent of a very premature baby, you know that the most apparent feature of prematurity is low birth weight and small size. Also, all babies after birth lose some of their birth weight in the first few days of life. Consistent weight gain is probably the most important criterion to meet for preemies before we can send a former premature baby home. Stable oxygen requirement if the baby is on additional oxygen for breathing. If your premature baby developed BPD (Chronic lung Disease), resulting in the prolonged need for supplementary oxygen, sometimes we send such a baby home on oxygen provided that the amount of oxygen needed is not very high, and it does not fluctuate a lot over time. If your baby is receiving gavage NG/OG or G -tube feedings, you need to be comfortable with providing those feedings at home. Unfortunately, some babies, particularly those who were extremely premature or born as micro-preemies, have a hard time to learn how to feed by mouth and from the bottle. In those situations, we can send babies home provided parents, and all caretakers learn how to give feedings using various tubes and are comfortable with such a solution. Special equipment. If special equipment (oxygen tanks, monitors, tubes, dressings) is needed for a baby at home, all that needs to be ordered, delivered to parents’ house, and parents need to learn how to use it prior to discharge home. Medications. If the baby will remain on any medication after discharge, prescriptions should have been written, filled, and parents have to learn how to administer them to their baby. Health problems. All acute and chronic problems that the baby has been suffering from should have been resolved or stable, so there is no more need for very frequent laboratory testing. Subspecialty doctors should clear baby for discharge and indicate if they need to see the baby in outpatient clinics for follow-ups. Parents are comfortable with the discharge decision. Parents have to feel that they are ready for the baby to come home. That involves a lot of learning. Parents should be able to feed the baby without problems. They need to demonstrate that they know how to use the necessary equipment and how to give medications to the baby. Finally, it is ideal that parents learn how to do CPR if ever needed. As you can see above, the decision to send a premature baby home from NICU is a very complicated process and must be individualized. Each newborn baby has a different set of medical problems, and each family has a distinct ability to learn tasks needed to take care of the baby. Health care providers need to be able to adjust their decision to those factors. Is there a specific weight that the premature baby needs to achieve before going home from NICU? It may be surprising to you, but there is no specific weight criterion for a baby to go home from the NICU. The preemie must be mature enough, and all essential vital organs such as lungs, heart, digestive system, and central nervous system must be functioning in the way that it is safe for the baby to be at home with its family. The best indicators of such maturity are signs that baby is: feeding without difficulties, gaining weight, breathing regularly, having regular heart rate and is able to maintain its normal body temperature in open crib. What to do if I am scared to take my prematurely born baby home? It is common for parents to want their baby home as soon as possible, but when that day is around the corner, to feel scared and have doubts. Parents always question themselves if they will be able to do everything right. The best solution is to visit your baby very often during the NICU stay. Try to learn as much as you can from NICU nurses. Learn: how to hold your baby correctly, how to change the diaper, do the bath, give medications, and how to feed your baby. Feeding premature baby differs from feeding a full-term baby and may take a long time to learn. Share your doubts with your baby’s nurses and doctors so they can reassure you and support you as much as you need. Finally, doctors can arrange for a home health care nurse to visit you at home to check on your baby often and to address any questions and problems you may have after taking your baby home. Summary: The majority of premature babies will go home before their due date or even by 37 weeks of gestational age. There are many different criteria that babies have to meet before the decision about discharge is made. There is also significant variability across different hospitals and countries regarding the duration of hospitalization of different babies. You can read about those differences in the scientific article here If you would like to learn how you can prepare for your baby's discharge from the NICU, please read my article on this topic. Disclaimer: This article is only for general information purposes. It should not be viewed as any medical advice. There is a small chance that information here may be inaccurate. You should always discuss all health-related matters with your doctor before making any decisions that may affect your health or health of your family members.