Preparing to Go Home

Planning for discharge is an ongoing process that begins as soon as your baby is admitted to the NICU or SCN. See below for info on discharge criteria, rooming in, RSV, and tips related to caring for your baby once you take him or her home.

Your baby will be discharged from the NICU or SCN when he meets discharge criteria based on his age, size, and condition. In addition, you must be prepared and comfortable to assume care of your baby at home. You and your baby’s medical team will determine together when the time is right for your baby to leave the hospital and if you need the help of a home health services provider.

Before your baby is ready to go home, these milestones must be reached:

• Graduation to a crib. Your baby must be able to maintain his body temperature in a regular crib.
• Consistent breathing and heart rate. Your baby must be able to breathe on his own and can’t have periods of apnea (not breathing) or bradycardia (too slow a heart rate). When your baby has five to seven straight days of consistent, steady breathing with or without oxygen, it’s a sign that he may be ready to go home.
• Feeding and gaining weight. Your baby must be able to take in enough calories to be gaining weight. This is usually from breastfeeding or a bottle.
• Parent skills. Before you go home with your baby, the NICU or SCN staff will help you learn these skills:
• Well baby care
• Using home equipment
• Feeding
• Performing CPR
• Giving medicine
• Fitting your baby in your car seat

Why wait?

Like many new parents, you’re probably eager to take your baby home. And like many other parents, you might be wondering, “What’s taking so long?”

The most common answer is the baby’s ability to eat. Learning to eat is a skill like any other, and it takes time for a baby to acquire it. This learning process can be slow, uneven, and unpredictable. Your baby may be eating very well for a few days, then seem to forget how it all works, then start eating like a champ again. This is completely normal (if a little frustrating). Try to be patient. Understand that for your baby's safety, the NICU or SCN staff will let your baby set the pace.

During your baby’s stay in the NICU or SCN, the staff will work with you to teach you how to care for your baby at home. Shortly before you go home, you may have the opportunity to share a room with your baby (“room-in”) for a determined amount of time. This rooming-in period is like a dress rehearsal for going home. It gives you a chance to practice all you’ve learned with a nurse close by for help and advice.

During the rooming-in period, the nursing staff is available to take your baby’s vital signs, to answer questions, and to assume care of your baby in case of an emergency situation. Rooming-in is intended to resemble a home-like atmosphere in that parents assume total responsibility for the physical care and supervision of their child.

The rooming-in period is usually 12 to 48 hours. Ideally, both the mother and father are involved as well as other adult family members who may be involved in your infant’s care. You must remain with your baby, or have another caregiver remain with your baby, during the entire rooming-in period. During the rooming-in period, you use any monitoring or other equipment you will need to use at home.

Suggestions for what to bring from home for rooming-in include:

• Parents: Comfortable clothing, toothbrush, comb, personal grooming items, snacks, alarm clock, note pad for writing down questions and taking notes on your infant’s care
• Infants: Going home clothing including a hat and coat, blankets for wrapping, positioning, etc., car seat (this is a must!), any special equipment

During the rooming in experience, you will be responsible for:

• Providing all care according to physician orders and the home care plan
• Arranging for relief periods with your co-caregiver(s) or hospital staff
• Notifying the bedside nurse for help if you have questions or problems
• Giving a complete report to the next caregiver, which will include the child’s status and needs

During the rooming in experience, hospital staff will be responsible for:

• Monitoring medicine use according to physician’s orders
• Making regular visits to the room to document the child’s status according to hospital policies and procedures
• Providing oral instructions if called about a problem
• Intervening and providing care for the child if a problem or emergency is identified

RSV stands for respiratory syncytial [sin-SISH-uh l] virus, a common virus that affects people of all ages. Most of the time, RSV causes only cold-like symptoms in infants and children.

However, in premature infants or infants with lung problems, RSV infections can be a bigger problem. They can result in serious lung disease, sometimes requiring or prolonging hospitalization. Premature babies are most affected because their lungs have not yet fully developed. These babies also have not yet received natural virus-fighting substances from their mothers.

How RSV is spread

• By touching, kissing, or shaking hands with an infected person
• Through the air by sneezing or coughing
• From counter tops, used tissues, towels, sheets, blankets, or toys (because RSV can live on these things for several hours)
• In crowded households and day care centers

How you can prevent RSV

• Wash your hands with soap and warm water before touching your baby, and ask others to do the same.
• Keep people who have colds away from your baby including brothers and sisters. Parents or other caregivers who feel ill should wear a mask and refrain from kissing the baby.
• Don’t smoke near the baby because exposure to tobacco smoke increases the severity of an RSV infection.
• Avoid taking your baby to crowded locations, such as shopping malls.
• Ask your baby’s doctor about a medicine that can help prevent your baby from getting severe RSV disease.

What to look for

Symptoms of RSV can worsen rapidly in some children. Call your doctor if your child has any of the following symptoms:

• Fever
• Trouble breathing (rapid breathing, gasping for breath)
• Wheezing or coughing
• Blue or gray skin color

Some babies will need to go home with monitors or equipment. The most commonly used home equipment is oxygen and a cardiac and apnea monitor. Before you go home, a home health agency will deliver your equipment to you and teach you how to use it. The rooming-in experience described earlier will give you the opportunity to practice using this equipment before your baby goes home.

Once home — when your baby is awake and being watched — give her some play time on her tummy. “Tummy time” helps your baby’s muscles develop, and it helps her more quickly gain the skills to roll over, crawl, pull to a stand, and walk. Tummy time can also help prevent your baby’s head from flattening, which can happen if your baby spends all her time on her back. Follow these tips:

• Do it early. Begin giving your baby some tummy time on his first day home from the hospital.
• Do it regularly. Put your baby on his tummy two to three times each day for a few minutes. As your baby grows, increase the amount of time he plays on his tummy.
• Do it with your baby. Get down on the floor with your baby. Give him some toys to reach for, or lie down on your back and put him on your chest. Your baby will learn to enjoy playing with you in this position.
• And remember, if your baby falls asleep, gently place him on his back. For sleep, back is best.