I see all the time in my practice that parents of premature babies keep asking when their little one can be discharged home from the NICU. When that day arrives, they often panic and do not seem to be prepared.
Of course, nothing can prepare you for that experience if it is happening to you for the first time in your life. However, there are some steps you can take that will make you more comfortable with this new situation.
In this article, I will give you some clues about what you should do or consider doing so you are better prepared for your premature baby coming home.
Check if your insurance covers your baby?
If you have private insurance from your employer, you probably know that you can renew it or make changes once a year during the enrollment period, usually in November. However, if you have a baby, you can add your baby to your health insurance after birth (there may be a time window that you need to be aware of).
If you have option between two different insurance companies (mother’s and father’s of the baby) review carefully which policy will be better for your baby from a financial point of view, and which one will give better or easier access to doctors that your baby will need to see after discharge home.
If your family does not have private health insurance, contact the hospital case manager as soon as possible to discuss if Medicaid can cover your baby. If you are eligible, you should sign up for Medicaid right after birth.
Finish any pending home projects.
Commonly, parents plan to remodel their house or room for the baby and plan on significant construction in the house. Unfortunately, any remodeling is associated with dirt, dust, and smell of various chemicals – not an ideal environment for a newborn baby and even less so for a premature baby.
If you have not done all the necessary home improvements yet and your baby will be coming in two weeks, in my opinion, it is better to defer those projects until your child is over 1 or 2 years of age.
You want to allow enough time for all vapors of glues, chemicals, and paints to be removed from the house. It always takes more time to happen than you think.
Make sure you have all the supplies.
Make a list of all the items you need to buy for your baby. The absolute essentials are:
- crib for the baby
- appropriately sized diapers
- skin moisturizer
- cream for diaper rash
- formula or breast milk fortifier if applicable
- breast pump if applicable
- breast milk warmer if desired
- Changing table/space
- Set up for giving a bath
Choose a pediatrician for your little one.
Choose a pediatrician for your baby. Check that you are comfortable with his/her location. Find out what is the access to the doctor after hours, and ask if they feel comfortable with taking care of former premature babies.
Finally, confirm that your pediatrician is within a network covered by your health insurance, so you are not exposed to additional copayments and deductibles.
Find out about any additional medical appointments needed for your baby.
If your baby has still some unresolved chronic medical problems that need to be followed by subspecialists, find out who are those doctors and where are their clinics. Is it going to be easy for you to get there? Does your health insurance plan cover them?
We, doctors, tend to send babies for follow up to the doctors within our university network where we work and know everybody, but it does not mean that you can not take your baby somewhere else for future out-patient appointments.
Sometimes you may have better specialists or closer to your house. If you want to consider different options for post-discharge appointments for your baby, just discuss this with the health care team taking care of your baby in the NICU.
Learn all the skills needed.
While your baby is in NICU, visit your baby as much as you can. Each time, try to participate in anything that baby’s nurse allows you to do. Learn how to feed and burp your baby, how to change diapers, take a temperature, or give a bath. Learn how to draw medications and how to give them to your baby.
Whenever you are in NICU, observe your baby paying attention to breathing patterns and skin color. Try to recognize signs of trouble if any (turning blue, pause in breathing, choking, etc.). All these skills will be invaluable once you are on your own with the baby at home. Even if you had previously taken care of full-term babies, be aware that taking care of ex-premature baby is much different.
Fill all the prescriptions.
If your premature baby is sent home on any medications, make sure that you already filled prescriptions, you know how to draw them and how to administer them. It is also a good idea to know what are those medications for and what are their side effects that you should watch out for.
If you have other children at home, make sure that you have a safe place to store medications to prevent any accidental ingestion.
Learn how to use all the equipment.
If your premature baby is sent home on oxygen, monitors, or NG/G tube feedings, make sure you are very comfortable with operating that equipment. Learn well how to use it, how to troubleshoot, and who to call in case of malfunctioning equipment and the urgent need to solve the problem.
Consider your financial and job situation.
Having a baby is a joy but is also associated with additional expenses for the family budget. Having a premature baby adds up to your costs even more. Families have to consider all the implications of having one parent staying at home in order to take care of their baby.
What it would cost them to lose one income and what it would cost to rely on a lot of hired help to take care of the baby at home.
If the mother is a single parent taking care of the baby by herself, those choices are even more difficult. If you or your family are going through financial hardships, talk to the hospital social worker to find out if there are any assistance programs that you might be eligible for.
Who will be taking care of your newborn at home?
Even if the mother or father of the baby is planning to stay at home to look after their baby, sometimes they will need a break. There will be times when you will want to have somebody else to be familiar with your baby.
You will need to feel that it is safe to leave the baby under their care while you take needed rest or take care of some matters for which you have to go out of the house for few hours or even days.
Learn how to resuscitate newborn babies and infants in case of an emergency.
It is strongly recommended to you and all caretakers of your baby at home to learn how to resuscitate a baby and infant. In the rare case of emergency, when your baby turns blue or starts choking, you should know what to do and how to help your baby.
If not offered to you by NICU, where your premature baby is treated, call around and ask where you can learn those essential skills. You can probably find a course like that if you call a local fire station or a police station.
You can also search for CPR courses on the American Heart Association website (https://www.heart.org/). To find CPR classes, click on the link, then under the CPR tab, click on “find training center” and enter your address or zip code.
Consider quitting smoking cigarettes.
If you or anybody in the house is a smoker, now is the time to quit smoking. Sign up for programs that can help you with that. Cigarette smoke and many other pollutants may trigger breathing problems and possibly SIDS in former premature babies.
Ask about vaccinations needed for people around your baby.
Your newborn baby will be getting some vaccinations during the first year of life. However, due to prematurity, your baby will be more sensitive to acquire and get very sick with any exposure to various bacteria and viruses.
Ask your neonatologist and also your doctor which vaccinations would be recommended for you, your family, and all other caretakers who will be around your baby. Usually, we recommend that adults and children around your baby are current at least with flu shots, pertussis, chickenpox, and MMR vaccinations.
Relax and take a deep breath!
Finally, you need to relax a little bit and try not to be scared. It is a very joyful moment when your prematurely born baby is finally coming home from the NICU. If in doubt, ask your doctors, nurses, or therapists for help.
Many neonatologists will arrange for home health care nursing visits after the discharge of a very premature baby. That way, parents can have easier access to knowledgable health care professionals in their homes and can be reassured that they are doing a good job.
If you would like to learn what are criteria for discharge of premature baby from NICU, you can read my article here.
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“
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.