If your baby was born prematurely, you may greet the day of
discharge from the hospital with a mixture of joy and worry. You
may have waited days, weeks, or even months to take your baby home,
but when the day finally arrives it can be frightening to walk away
from the security of the hospital nursery.
If you're anxious about caring for your preemie at home,
remember that health care professionals do not send preemies home
until the babies are ready. With some preparation and planning,
you'll be ready, too.
Health Challenges of Premature Infants
Babies born at less than 37 weeks' gestation are considered
premature, and they often begin life with serious medical
challenges. They may need support for a number of medical issues,
including breathing problems that require supplemental oxygen or a
ventilator, temperature regulation, feeding problems, apnea
(irregular breathing), or jaundice (when a baby's immature
liver initially can't dispose of excess bilirubin, a yellow
pigment produced by the normal breakdown of red blood cells).
Because of these needs, premature infants may have to spend
weeks or even months in a
neonatal intensive care unit (NICU)
. Fortunately, with support and growth, the immature organs recover
and eventually function independently in most cases.
By the time of hospital discharge, most preterm infants do not
require specialized medical care, but all continue to need good
supportive care. For some, special medical needs persist even after
discharge.
The hospital medical team will send your baby home with a
follow-up plan of medical care that will coordinate care with your
pediatrician and other medical specialists as needed.
Requirements for Discharge
Before being discharged from the hospital, a preemie must meet
several basic requirements to ensure good health and fewer medical
problems. Some nurseries require a minimum weight for discharge,
but more often the NICU staff will evaluate the baby on these three
criteria:
- Can the baby maintain body temperature in an open crib for at
least 24-48 hours, depending on how premature the baby was at
birth?
- Can the baby take all feedings by bottle or breast without
supplemental tube feedings?
- Can the baby gain weight steadily?
Most preemies meet these criteria 2 to 4 weeks before reaching
their original due date. Infants who have had surgery, were born
with malformations, or who spent weeks on breathing machines and
oxygen are the most likely to stay beyond their original due
date.
Medical Needs After Discharge
Many preemies do not need specialized medical support after
leaving the hospital, but all will need regular medical care and
evaluation. This includes routine immunizations, usually on the
same schedule as that for full-term babies.
Common medical problems premature babies may face in the long
term include:
-
Apnea.
Premature infants commonly have episodes of
apnea
, or pauses in breathing, that improve as they mature. Babies
will not be discharged if the apnea causes a slow heart rate or a
change in color. However, some nurseries send infants home on
apnea monitors if the infants have mild apnea that does not cause
a change in color or heart rate or require stimulation to make
the baby breathe again. Other nurseries may monitor preemies
until the breathing pattern reaches maturity, usually about 44
weeks' post-conceptional age.
Doctors will decide if your baby needs a monitor; if so, anyone
who will be alone with the infant at home will need to attend a
training session on using the monitor and learn how to perform
infant cardiopulmonary resuscitation (CPR).
-
Other breathing problems.
Preemies commonly have respiratory difficulties and need
supplemental oxygen or a mechanical ventilator. Most recover and
do not require supplemental oxygen by the time they graduate from
the NICU. However, some develop a more chronic lung condition
called
bronchopulmonary dysplasia (BPD)
, which involves scarring and inflammation in the lungs. Infants
with BPD may need supplemental oxygen and medications for
prolonged periods even after discharge. They can be sent home on
oxygen or medications to help their lungs function better.
If your baby will need oxygen after leaving the hospital,
equipment for administering it at home and in transit will be
coordinated before discharge.
-
Infections.
Like other organ systems, the immune system of a premature infant
does not function as well as that of older kids or adults. This
places preemies at risk for contracting infections (especially
viral ones) after discharge.
Although preemies can become infected with many different
viruses, they're particularly vulnerable to
respiratory syncytial virus (RSV)
, a common viral infection in young kids that's often
mistaken for a cold or the flu. Although RSV causes few problems
in adults and older kids, in preemies it can lead to severe
illness, breathing problems, or even death, and is a common cause
for rehospitalization of preemies.
An immunization is available to help protect infants from RSV.
Preemies born at less than 32 weeks and any born from 32 to 35
weeks who have certain risk factors - someone smoking at home,
time spent in day care, or contact with multiple children -
should receive the vaccine.
In winter months, the first dose of vaccine generally is given
prior to discharge, then monthly throughout the RSV season, which
runs from late fall through late winter or early spring. Preemies
discharged at other times of the year may also need immunizations
once wintertime arrives. Some infants who were especially
premature may also need to be vaccinated for a second RSV season.
Preemies can be given the injections at home by a nurse or in the
doctor's office. The vaccine does not always prevent RSV
infection but can lessen its severity. Ask your doctor whether
your baby should receive RSV immunizations.
Appropriate developmental follow-up is important for very
premature babies. Many ex-preemies continue to see specialists,
including early-intervention specialists, neurologists,
ophthalmologists, and physical therapists, for several years to
measure their vision, hearing, speech, and motor skills.
Preparing for Discharge
The discharge of a preemie from the hospital isn't a single
event, but a process. That process is designed to assure the
medical staff that the infant can survive and thrive outside the
hospital, and it prepares parents to take care of the baby on their
own.
Some hospitals offer parents of preemies a rooming-in period
that allows them a brief stay in a hospital room with the baby so
they can gain some experience in taking care of the infant's
needs. Although they're apart from the nursery and functioning
as solo caregivers, the parents have the security of knowing that
help is just down the hall.
As your preemie progresses, you can get ready for the big day
and the weeks that follow by:
- Checking medical records and insurance coverage
- Choosing a pediatrician and making medical appointments
- Learning CPR and receiving specialized training
- Making a decision about circumcision
- Outfitting your vehicles with car seats
- Attending a discharge debriefing
Check Medical Records and Insurance Coverage
As soon as possible after the birth of your baby, call your
insurance company and ask to have your baby added to your policy;
many insurers require that you do this within a few days of the
birth. Some insurers will provide home nursing visits for premature
infants or even more extensive nursing care for infants with
complex medical problems. Nursing providers and social service
workers can help you determine what your insurance coverage will
provide.
Also, set up a file for medical records, financial statements,
and correspondence you're likely to have with the hospital and
your insurance company.
Choose a Pediatrician and Make Medical Appointments
Don't wait until the last minute to choose a pediatrician.
In addition to the usual questions, ask whether the doctor cares
for many premature infants. Ask when you should schedule the first
visit with the pediatrician - usually with a week of discharge from
the hospital (unless the pediatrician has assumed care of the
infant prior to discharge from the NICU).
Discuss with the NICU staff whether your baby will require home
nursing or visits with medical specialists other than a
pediatrician. If so, ask for referrals and for the telephone
numbers of those health care providers.
In addition, your baby might need to undergo routine tests,
including blood, hearing, and vision tests. Make sure you
understand the tests needed after discharge.
Learn CPR and Receive Specialized Training
To be prepared for emergencies, consider taking a course in
infant CPR before your baby comes home from the hospital. (CPR
training is required for all parents whose children are on apnea
monitors.) Make sure your partner takes the course, as well as
grandparents or other caregivers who will be alone with the baby.
The NICU staff may be able to recommend a program; in some
hospitals, the nursery staff actually trains parents of preemies in
CPR. The American Heart Association and the American Red Cross also
can provide information on training.
If your baby is to be sent home with special equipment - such as
an apnea monitor or oxygen tank - you'll be trained to use it.
Make sure you understand what to do if something goes wrong.
Check to see if your county or state grants preferential parking
stickers to parents with children on home oxygen. Call the local
rescue squad to make sure they have equipment to handle a premature
infant emergency and, if you live in a rural area, make sure they
know how to get to your home.
Make a Decision About Circumcision
If your baby is a boy, you'll need to decide about
circumcision. Full-term baby boys usually can be circumcised before
they leave the hospital; generally, the same applies to a healthy
preemie.
Outfit Your Vehicles With Car Seats
Before heading home, your preemie will need to be in an
infant-only car safety seat with a three-point harness system or a
convertible car safety seat with a five-point harness system. Most
car seats need to be modified with padding or head supports so that
a preemie's head stays in a position that keeps the airway
open. A preemie often does not have the muscle control required to
keep the head upright or to move it if he or she is having trouble
breathing.
As a precaution, many hospitals require that parents bring in
their car seat for a test. The baby is placed in the seat and
attached to a cardiopulmonary monitor that evaluates the heart and
breathing.
Some babies have respiratory problems that prevent them from
traveling in a traditional infant car seat. If that's the case
with your baby, discuss using a special restraint system with your
neonatologist or doctor.
If your baby will be on oxygen or an apnea monitor at home,
you'll also need to use these devices while traveling in the
car. Once in the car, secure them carefully so in the event of a
crash they won't be dangerous to passengers. If you have any
questions about whether your vehicle is properly outfitted for the
ride home, talk to the hospital staff before you leave.
Because of potential breathing problems, it's generally
recommended that parents limit the time a preemie is in a car seat
to an hour or so. If you'll be traveling longer than that, ask
your doctor if it is OK for your baby.
Attend a Discharge Debriefing
Although it varies from hospital to hospital, expect a meeting
to review medical care after discharge, confirm follow-up
appointments, and allow you time for questions about your baby. All
debriefings should include a thorough discussion about caring for
your preemie once you're home. Make sure you understand all the
instructions and advice, and ask questions.
When you leave with your baby, make sure you have the telephone
number for the NICU. These professionals can be a valuable
resource, especially in the gap between discharge day and the
baby's first doctor's appointment.
At Home With Your Baby
Expect to live quietly with your preemie at first. Because their
immune systems are still developing, preemies are susceptible to
infections
. Therefore, you need to take some precautions. Visits outside the
home should be limited to the doctor's office for the first
several weeks, especially if your baby is discharged during the
winter months.
Because doctors' offices commonly have several kids with
viral infections, try scheduling your appointment as the first of
the day or request to wait in an examining room instead of the main
waiting area. Ask the doctor how limited your baby's contact
with other kids and adults should be during these first weeks.
Most doctors recommend not visiting public places with preemies.
And limit visitors to your home: anyone who is ill should not
visit, nobody should smoke in your home, and all visitors should
wash their hands before touching the baby. Talk to your doctor
about specific recommendations - some family visits may need to be
postponed to allow your little one's immune system to grow
stronger.
Babies' success at feeding and sleeping is important to
their health. Expect your preemie to sleep more than a full-term
baby, but for shorter periods. All babies, including preemies,
should be put to sleep on their backs to reduce the risk of sudden
infant death syndrome (SIDS).
Most preemies need 8 to 10 feedings a day with no more than 4
hours between each - any longer and the baby may become dehydrated.
Six to eight wet diapers per day show that the baby is getting
enough breast milk or formula.
Take advantage of these quiet weeks together to enjoy
skin-to-skin contact, also known as kangaroo care. Most intensive
care nurseries encourage parents to begin kangaroo care prior to
discharge; the nursing staff can show you how.
In a warm room at home, dress your infant in only a diaper, then
place the baby on your chest and turn your baby's head to one
side so that his or her ear is against your heart. Research
indicates that kangaroo care can enhance parent-child bonding,
promote breastfeeding, and improve a preemie's health.
Taking Care of Yourself
Parents spend a tremendous amount of time caring for a preemie
during the first few months at home. But it's also important to
be good to yourself and not underestimate the stress of delivering
earlier than expected. Women are supposed to have 6 to 8 weeks to
rest and recuperate after giving birth, but a baby's premature
birth may reduce that recovery time. In addition, those long days
in the NICU take a physical and emotional toll.
You might have a wide range of emotions during these first
months. If your preemie has serious medical problems you may feel
angry that the baby is sick or grief for the loss of that healthy,
perfect baby you dreamed of bringing home. And as with all women
recovering from pregnancy, mothers of preemies may experience the
hormonal shifts of baby blues or more serious postpartum
depression.
To make the adjustment of living with your new baby easier,
accept offers of help from family and friends - they can babysit
your other children, run errands, or clean the house so you have
time to care for the baby or rest.
Treat yourself well by getting enough rest, eating well, and
exercising moderately. Seek support and encouragement from doctors,
nurses, veteran parents, support groups, or online communities. And
if you're overwhelmed or depressed, do not hesitate to get
professional help for yourself so you can fully enjoy your new
baby.
Reviewed by:
Michael L. Spear, MD
Date reviewed: June 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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