PROCEDURES FOR DISCHARGING AN INFANT
FROM THE NEWBORN INTENSIVE CARE UNIT
I. Criteria for Discharge
A. As a general rule, most preterm infants are not mature enough to be discharged to home until they weigh approximately 1800 grams (4 pounds). Exceptions may be made above and below this weight depending on whether there are other physiological problems, or if there are complicating social situations, etc. Nevertheless any infant eligible for discharge must meet several other criteria (defined below)
B. Gaining weight for 48 hours on all p.o. feeds (there may be exceptions).
C. Can maintain normal body temperature in an open crib for at least 48 hours wearing normal baby attire (including a head cap and a single blanket for former premature infants).
D. Underlying apnea and bradycardia is under adequate control (generally defined as no stimulation requiring events for at least 72 hours).
E. Medical condition is stable, (e.g., congestive heart failure, BPD)
F. Hematocrit is stable or not rapidly falling. We should assure close follow-up for the moderately anemic baby (Hct < 25, retic count < 3.0%).
G. Parents have demonstrated ability to care for the baby and the home situation is deemed acceptable (often requires a home visit by DSS).
H. Follow-up primary pediatric care and any appropriate specialty care have been arranged.
II. Planning for Discharge (in cooperation with MSW, the primary nurse, and the follow up physician or physicians)
A. Plan Ahead
1. Notify nurses, and case manager as far ahead of time (at least one week) as possible to allow parent teaching, especially with complicated infants.
2. Discuss with Social Worker as far in advance as possible.
Identify primary care Physician. Also note if the patient will receive care in the Health Department.
Has the infant received appropriate immunizations (including Synagis in the RSV season)?
5. Plan necessary follow-up appointments; coordinate follow-up to prevent multiple trips to Children’s Hospital.
6. Is the infant eligible for intervention services? Discuss with SW, OT, PT.
7. Have the parents had CPR training and monitor training? – this should be scheduled at least one week prior to discharge or, more preferably, when infant is transferred from the Intensive Care area to the Intermediate area. Infants going home on oxygen should receive CPR training prior to discharge.
B. Anticipate Routine Discharge Requirements (a discharge order sheet is available and should be used for these infants).
1. Circumcision (should be > 1800 grams). If the patient is on the Teaching Staff, contact Jenny Hudson, MD in the Newborn Nursery at least a week ahead of the anticipated discharge so that she can obtain parental consent. Our Pediatric Teaching Staff will not circumcise an infant > 60 days old.
2. Ophthalmic exam (see protocol)
3. Audiology screen (all patients)
4. Car seat test for infants < 2000 grams or < 37 weeks gestation (measuring ability to maintain O2 saturations > 90% for 60 minutes in an appropriate car seat for infants)
5. Recent hematocrit and/or retic count
6. State metabolic screen (T4, PKU, etc.) - sent on day 1 of life. South Carolina now screens for 25 metabolic disorders by tandom mass spectrometry.
7. For selected infants, a pre-discharge CXR - - - if not normal in past
C. Medication or Other Treatment
1. What medications after discharge are needed?
2. Special equipment: O2, monitor, suction, nebulization.
3. Physical or Occupational Therapy
4. Public Health Nurse or other nursing follow-up
5. Vitamins, Iron, Special formulas (WIC infants will need prescriptions for some formulas)
6. Immunizations - has the infant been immunized or is he/she eligible? Be certain parents have been provided with up-to-date immunization records.
D. Follow-Up Care
1. Primary Physician:
a. check that referring and follow-up physician are the same
b. call referring physician and discuss status and choice of follow-up
c. call follow-up physician and arrange follow-up if different from referring physician.
2. Neonatal Developmental Follow-Up Program Appointments:
a. All babies with birth weight < 1500 grams or < 30 weeks EGA
b. All babies with known chromosomal abnormalities, severe visual or auditory abnormalities, severe neurological malformations or complications, including discharge home on anticonvulsant
c. Some infants with mechanical ventilation > 7 days
d. see Chapter 21 for complete list of other risk factors making an infant eligible for the Neurodevelopmental Follow Up Program
E. Day of Discharge
1. Perform comprehensive physical exam. An attending physician also needs to examine the patient on the day of discharge.
2. Talk to parents
3. Verify follow-up
4. Double-check that D/C criteria have been met by checking the three page Discharge form kept in every patient’s green bedside chart.
F. Discharge Summary
1. Update the problem list in EPIC before infant’s actual physical discharge - If the patient's pediatrician is entered into Epic a discharge summary should be automatically forwarded to the pediatrician.
FROM THE NEWBORN INTENSIVE CARE UNIT
I. Criteria for Discharge
A. As a general rule, most preterm infants are not mature enough to be discharged to home until they weigh approximately 1800 grams (4 pounds). Exceptions may be made above and below this weight depending on whether there are other physiological problems, or if there are complicating social situations, etc. Nevertheless any infant eligible for discharge must meet several other criteria (defined below)
B. Gaining weight for 48 hours on all p.o. feeds (there may be exceptions).
C. Can maintain normal body temperature in an open crib for at least 48 hours wearing normal baby attire (including a head cap and a single blanket for former premature infants).
D. Underlying apnea and bradycardia is under adequate control (generally defined as no stimulation requiring events for at least 72 hours).
E. Medical condition is stable, (e.g., congestive heart failure, BPD)
F. Hematocrit is stable or not rapidly falling. We should assure close follow-up for the moderately anemic baby (Hct < 25, retic count < 3.0%).
G. Parents have demonstrated ability to care for the baby and the home situation is deemed acceptable (often requires a home visit by DSS).
H. Follow-up primary pediatric care and any appropriate specialty care have been arranged.
II. Planning for Discharge (in cooperation with MSW, the primary nurse, and the follow up physician or physicians)
A. Plan Ahead
1. Notify nurses, and case manager as far ahead of time (at least one week) as possible to allow parent teaching, especially with complicated infants.
2. Discuss with Social Worker as far in advance as possible.
Identify primary care Physician. Also note if the patient will receive care in the Health Department.
Has the infant received appropriate immunizations (including Synagis in the RSV season)?
5. Plan necessary follow-up appointments; coordinate follow-up to prevent multiple trips to Children’s Hospital.
6. Is the infant eligible for intervention services? Discuss with SW, OT, PT.
7. Have the parents had CPR training and monitor training? – this should be scheduled at least one week prior to discharge or, more preferably, when infant is transferred from the Intensive Care area to the Intermediate area. Infants going home on oxygen should receive CPR training prior to discharge.
B. Anticipate Routine Discharge Requirements (a discharge order sheet is available and should be used for these infants).
1. Circumcision (should be > 1800 grams). If the patient is on the Teaching Staff, contact Jenny Hudson, MD in the Newborn Nursery at least a week ahead of the anticipated discharge so that she can obtain parental consent. Our Pediatric Teaching Staff will not circumcise an infant > 60 days old.
2. Ophthalmic exam (see protocol)
3. Audiology screen (all patients)
4. Car seat test for infants < 2000 grams or < 37 weeks gestation (measuring ability to maintain O2 saturations > 90% for 60 minutes in an appropriate car seat for infants)
5. Recent hematocrit and/or retic count
6. State metabolic screen (T4, PKU, etc.) - sent on day 1 of life. South Carolina now screens for 25 metabolic disorders by tandom mass spectrometry.
7. For selected infants, a pre-discharge CXR - - - if not normal in past
C. Medication or Other Treatment
1. What medications after discharge are needed?
2. Special equipment: O2, monitor, suction, nebulization.
3. Physical or Occupational Therapy
4. Public Health Nurse or other nursing follow-up
5. Vitamins, Iron, Special formulas (WIC infants will need prescriptions for some formulas)
6. Immunizations - has the infant been immunized or is he/she eligible? Be certain parents have been provided with up-to-date immunization records.
D. Follow-Up Care
1. Primary Physician:
a. check that referring and follow-up physician are the same
b. call referring physician and discuss status and choice of follow-up
c. call follow-up physician and arrange follow-up if different from referring physician.
2. Neonatal Developmental Follow-Up Program Appointments:
a. All babies with birth weight < 1500 grams or < 30 weeks EGA
b. All babies with known chromosomal abnormalities, severe visual or auditory abnormalities, severe neurological malformations or complications, including discharge home on anticonvulsant
c. Some infants with mechanical ventilation > 7 days
d. see Chapter 21 for complete list of other risk factors making an infant eligible for the Neurodevelopmental Follow Up Program
E. Day of Discharge
1. Perform comprehensive physical exam. An attending physician also needs to examine the patient on the day of discharge.
2. Talk to parents
3. Verify follow-up
4. Double-check that D/C criteria have been met by checking the three page Discharge form kept in every patient’s green bedside chart.
F. Discharge Summary
1. Update the problem list in EPIC before infant’s actual physical discharge - If the patient's pediatrician is entered into Epic a discharge summary should be automatically forwarded to the pediatrician.