NICU Baby is Ready for Discharge

Is your NICU (Neonatal Intensive Care Unit) baby ready for discharge? Babies born too early (before 37 weeks) weighing 5 lbs or less are considered premature.

Parents celebrate when it’s time to bring a NICU baby home. So what does it take to get ready for discharge with your NICU baby?

What developmental milestones do your premature baby need to meet before leaving the hospital?

When my premature daughter was admitted to the NICU, I received a checklist of conditions to meet before bringing her home. I want to share some of the discharge standards we’ve encountered and what you can expect in preparation to go home with your premature baby. 

That was almost six years ago when we took our 28-weeker preemie daughter home from the NICU. A joyous occasion for our family and also laced with concerns regarding taking her home. Today, she’s a five-year-old kindergartener with the same feistiness when she was born.

Before this significant milestone happens, there’s plenty to check off from the NICU Discharge list. 

NICU parents take the lead in getting everything ready for the baby to go home. Thus, seeking education when it comes to caring for their newborn, adjusting from NICU to home life, and keeping a home that’s safe for a premature baby to transition.

From feeding, monitoring essential body functions, and passing screening tests, these are the primary basis for your NICU baby’s discharge.

What are the discharge criteria for a NICU baby?

NICU babies are discharged when these criteria have been met. Parents can be confident that their baby is monitored during this time closely to determine physiological maturity. The healthcare providers will be by your side as your baby undergoes these tests and explain what will happen.

It’s important to understand that every baby is not the same with their development, recovery, and even healing from illness.

The healthcare team may set the date your baby is for discharge depending on how they adjust to the test, and corresponding results give the best indication that your baby is ready to come home.

NICU baby is gaining steady weight with the nutrition the baby is receiving

• If your premature baby is feeding on their own with breastfeeding or bottle-feeding expressed milk/fortified breast milk/premature formula

• If your premature baby is gaining weight

NICU baby can regulate their temperature in an open crib

• When your baby is moved to an open crib, their temperature can drop and fluctuate. One criterion for discharge is when your baby can continue to adjust their body temperature without the help of an isolette (incubator). 

Stable breathing and heart rate of your NICU baby

• Premature babies can have heart issues such as PDA (patent ductus arteriosus), an opening in their heart structures, and low blood pressure (hypotension). 

• Their breathing may not stabilize; these premature babies may experience what they call the apnea of prematurity (when babies stop breathing).

• There are other two breathing problems that premature babies may experience: Bronchopulmonary dysplasia (BPD) the lung structures of a premature baby are damaged, destroying the lung tissues inside the air sacs and Respiratory distress syndrome (RDS) a baby’s lungs aren’t producing enough lung surfactant (the substance that keeps the air sacs in the lungs from collapsing.

Other discharge criteria for a NICU baby ready to go home include:

Able to pass the car seat test

The NICU staff are testing your baby’s heart and lungs’ stability at this time.

When premature babies aren’t tolerating the car seat challenge for 90-120 minutes, it will be repeated to reassess readiness.

Able to pass a hearing test

This hearing test is usually done the day or a day before the discharge date.

Screening for Retinopathy of Prematurity performed by a pediatric ophthalmologist

Your baby will be followed up closely for a year or more after discharge.

What are classes or education do NICU parents need to attend before bringing a NICU baby home?

It’s great to know how to care for your NICU baby at home. However, it can be intimidating to new parents when their newborns can have health issues added to being a newborn.

This time, the purpose of parental education is to ensure the safety and proper care of the premature newborn and the adjustment of parents to the needs of their baby at home.

Infant CPR (Cardiopulmonary Resuscitation)

• Ask your NICU nurse about the schedule and requirements to attend an Infant CPR class.

• Make sure you and your spouse attend the CPR class intended to educate parents on CPR steps in case of an emergency at home.

Safe sleep

• Your neonatal doctor will recommend a safe sleep method and discuss SIDS (Sudden Infant Death Syndrome). Be certain to clarify any unclear information you received.

• It’s best to keep babies around your bedroom in their safe bassinet or attached bed at night. 

• Know the precautions for preventing sleep accidents or injury. 

• Make sure everyone is aware of what not to place in your baby’s crib or sleeping space.

Proper feeding

• Suppose you decide to continue breastfeeding your NICU baby. In that case, there may be a need to fortify some of the feedings along with your breastmilk to help the NICU baby gain more weight. It’s important to discuss this with the neonatologist.

• Familiarize yourself with slow-paced feeding when introducing bottles to your NICU baby.

• The nurse can guide you through bottle-feeding your NICU baby with the slow-paced feeding technique. The nurse can also stay by your side while you bottle-feed your premature baby and check if everything is good. 

Car seat fitting and use

• Premature babies gain weight progressively. However, some infant car seats have weight limitations, and your baby may be weighing less than the required weight. 

• Make sure you purchase the appropriate intended car seat according to your premature baby’s weight when the time comes.

• The NICU nurse will do a car seat test (tolerance test) in days before discharge. This test will also be the perfect time to ask for other precautions to safely strapping your premature baby in the car seat.

Signs and Symptoms to watch out at home

• The nurse will also go over all the signs and symptoms your premature baby may experience at home and what to watch out for.

• Don’t hesitate to ask a question from the NICU doctor (neonatologist) about your baby’s health conditions.

Oxygen use:

• Premature babies may require supplemental oxygen when they are discharged from the NICU. 

• Your assigned nurse will instruct you on how to manage oxygen use with your baby at home. 

• List down the precautions and what not to do when oxygen is used around the home.

• List down the settings, prepare the oxygen accessories and tank.

• You may also ask for a direct number to order the next oxygen tank to replenish your supply. Again, the social worker will let you know about resources on this, or they may have set it up for you already.

Preparing to take your NICU baby home can bring up anxieties and worries typical of your experience. 

You may be doubting yourself if you’ll be able to care for your premature baby. Unfortunately, it’s common for parents to feel this way. Seek additional support when you think everything becomes overwhelming.

The parental classes/ programs are set to help NICU parents prepare for an easy discharge and transition from NICU life. 

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RELATED POST: Tips for a Struggling NICU Mom: Surviving the NICU Life

What can you do to prepare and get ready for discharge with your NICU baby?

1. Prepare the home for your premature baby – safe environment/ purchase the essentials.

• You may want to change the air filters on all vents in the house.

• Procure a room HEPA air portable

• A humidifier 

• A white sound machine

• Getting a bassinet or safe sleeping space for your baby

• Make sure no smoking around the baby and in the home (shower if you do before getting close to the baby)

• Purchase a first-aid baby kit for your premature infant, apnea monitor/oxygen monitor (if baby uses oxygen), and thermometer.

• Newborn Clothing and accessories

• Baby Caddy for Essentials or Baby Roller Organizer.

With this in mind, I couldn’t get everything ready beforehand as I did with my son’s full-term birth. I could only shop for a few outfits and a homecoming outfit closer to the discharge date for my daughter.

We used the items listed above to make our home as ready as possible for the baby.

You may be wondering why the white sound machine. You already know there are plenty of beeps and alarms buzzing 24 hours a day in the NICU. My daughter has been used to these hospital sounds. So, I made sure that what she hears besides our voices is a soothing sound that can calm her.

2. Confirm you have a proper car seat fit for your baby – current safety standards.

Make sure you purchase the appropriate car seat for your premature infant. In addition, you may need to buy a travel system that goes with the car seat for ease of baby transport in and out of the home and clinic visits.

Always double-check the car seat expiration date. The car seat must be a rear-facing one and has no extra things around it.

3. Arranging a leave from work to support the critical transition of your baby at home

If you happen to work outside the home, you may request several days off or officially apply for an FMLA (Family Medical Leave of Act) extension to care for your newborn.

Back when I was still working as a nurse, and I got approved for extended leave to bond with my premature daughter for an additional one month at home. That was very much needed and helpful as our family transitioned with her being home with us.

Contact your human resource department and your boss on what you can avail yourself of at this time of transition. 

This arrangement will also depend on the type of work you have, so check with upper management what benefits you can avail.

4. Setting up follow-up appointments for your NICU baby with their doctors and therapists.

Planning your routine includes appointments with your baby’s pediatrician to check for growth, development, and overall health. Your premature baby may be at risk for any developmental delays.

Your baby may also see therapists the same as when they were still in the NICU. The home routine will include visits to these early intervention sessions.

5. Prepare your other children for the homecoming of their premature sibling(s).

• Your other children will have a big transition once the baby is home.

• Let them know that they can bond with the baby, and they also need to be gentle around the baby.

• Talk openly and let them understand why they need reminders about washing hands regularly and keeping hands away from the baby’s face and hands (baby puts hands in their mouth all the time).

• It’s helpful to answer your children’s questions about the birth/NICU time of the baby and have age-appropriate answers. Not knowing all the answers are okay. Then, you and your children can look them up and learn together.

• There’s also a program in NICU about sibling’s experiences; check with your nurse. This resource prepares your children to visit the NICU. However, they can also talk about strategies in helping your children with their questions when their premature sibling is coming home. 

• Have them make something special to welcome their baby sibling. Also, let them participate in the preparation, like putting the baby things in order in the bedroom/baby room. 

• Read books about Premature Baby and Siblings: Our New Baby is in the NICU by Lindsey Lucky or Waiting for A Baby: A Sibling Visits the NICU by Jennifer Bracci

RELATED POST: Helping a Sibling of a NICU Baby Adjust

Looking ahead while looking back

You’ve come this far. Finally, it’s discharge time!

Getting ready to leave the NICU is a milestone for your premature baby and your family. 

There will be some challenges ahead, and going through the NICU experience gives parents a different perspective on everything. Parents involvement matter as they get ready for discharge from the NICU with your baby.

Try to reach out to your support system and your baby’s healthcare providers. 

It is scary, and you’ll feel doubtful if you’ll be doing things right with your baby at home. In addition, it can get overwhelming for you and the family.

Trust yourself; you are what your baby needs. 

Trust your instinct about your baby. Continue to seek information to help you care for your baby at home and leave an open line with your baby’s doctor. 

You can always list your questions, write down your NICU life to remember, and give thanks to all the excellent NICU team that cared for your baby and your family.

Now, you’ve come to the end of your NICU journey. It’s time to focus on bonding with your premature baby and have the family settle into your new routine with the rest of the family.

The information written in this post is for general purposes only. Please seek healthcare professional advice for any concerns you have for your baby. This information doesn’t substitute medical advice.

Do you have a premature baby in the NICU? For NICU graduates’ parents, how did you prepare when it was time for NICU discharge?