Getting Ready For Discharge….Home Sweet Home!Happy New Year! I’d like to send a special shout out to those precious families who spent their holidays in the NICU. Often in that rollercoaster world also known as the neonatal intensive care unit…it’s sometimes hard to believe or even consider that it will ever slow down or that you will ever eventually be able to go home. But for most families…home sweet home will become a reality and the rollercoaster does eventually stop. One of the best ways to look forward to that is to start preparing now. Whether your baby has been in the NICU 3 days or 3 months..it’s never too early to start getting ready to go home!! Often because the health care team is initially very focused on life and death decisions and day to day management we don’t always address anticipatory guidelines for discharge until very close to the discharge date. For some families the rapid progression from almost ready to go home to it’s time to go home can increase anxiety even more so than the admission!! Although the NICU can be a scary place,….. for many families it can eventually also become quite comfortable..a home away from home…..staff become family and monitors and equipment become friends. As a result… leaving the routine or perceived safety of the NICU suddenly places families into foreign and sometimes frightening territory.

Although each family will have to navigate its own path to become comfortable with the routine and quiet of home as compared to the NICU there are five essential steps on the yellow brick road to home that may help to ease the transition…most of which you can start working on right now. First identify your pediatrician..and give yourself time to interview the pediatrician as well as tour the office prior to discharge. Many families have not had a chance to select a pediatrician prior to delivery..and even if they have, their choice may change depending on the needs of their preterm infant at discharge. Many preterm infant require frequent visits after discharge for weight checks, reflux, or anemia and you will want to make sure your pediatrician is within a close traveling distance from your home. Some questions you may want to consider when interviewing your pediatrician are do they see premature infants in their practice? Are they comfortable with preterm babies on oxygen or monitors? Do they have separate entrances for well and sick children? and Do they offer the RSV shot or can they arrange for you to receive it if you quailify for it?In addition to identifying the pediatrician, you want to make sure you have an approved car seat with base. Your premature infant will require a car seat safety evaluation test prior to discharge. Many premature infants go home much smaller than term infants and their breathing and heart rate needs to be stable while sitting upright in the car seat. Your physician and staff will evaluate this prior to discharge. Prior to bringing your car seat to the hospital have your local fire department evaluate it for correct installation in your car. Most fire departments offer this service free of charge. Find out what type of formula your baby will be going home on at discharge……most premature infants will be discharged home on breast milk with additional additives or preterm formula. Make sure you know which store carries the formula you will need or the additive you will require to fortify your breast milk prior to discharge. Additionally remember to bring whatever special bottles or nipples you may be using at home for your baby to practice with in the hospital prior to discharge. For many families one of the most frustrating parts of discharge is finding the store that carries your premature formula and getting the baby used to a new nipple or bottle as well as a new routine. Additionally, if your premature infant is going home on medications..remind your physician or practitioner to give you the prescription 2-3 days prior to discharge so that you have time to get the prescription filled and time to practice giving it to your baby prior to discharge. Finally most neonatal intensive care units offer CPR training prior to discharge as well as the opportunity to spend the night with your baby prior to discharge. Allow yourself time before discharge to arrange to view the CPR video or to schedule CPR training for yourself and all caregivers for your infant. Additionally if your neonatal unit offers the opportunity to spend the night with infant prior to discharge, strongly consider using this option. Spending then night with your infant will give you the chance to be exclusively responsible for your baby for an extended period of time, to become used to care in some cases without a monitor and to become more comfortable with the typical breathing pattern of a preemie. Often parents notice things over this extended period of time that they did not appreciate during the 3hr visits for feeds. Identifying the pediatrician, locating the formula, verifying the car seat, filling the prescriptions, taking CPR and spending the night are just a few of the ways you can begin to look ahead and prepare to take your baby home. It may seem like it’s a long time away…but before you know it…your baby will be out of an isolette, into a crib and into your arms and into your home. It’s never too early to start planning for that special day. Wishing you and yours the very best!

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