A guide to the discharge process

Once the initial shock of the NICU has worn off, one of your first questions may be “When will we go home?”

The truth is, that is a hard question to answer. Getting ready to go home is a process that begins when your baby is admitted but may last longer or shorter than expected. The real answer is “When your baby is ready.”

Is my baby stable?

In order to come home your baby will need to be “physiologically stable.” This means that they are able to meet their need to breathe well, eat well, and maintain their body temperature.

The medical care team in the NICU will watch your baby to make sure they are getting healthy and they are showing signs of good development. As difficult as the adjustment to the NICU might be, this is the best place for your baby to get the care they need. The doctors, nurses and the rest of the NICU team will do everything they can for your baby to have the best possible outcome. Depending on why your baby is in the NICU, they may need support in some or all of the following areas.

Learning to breathe

Many babies have problems breathing. If a baby is born preterm, they often have difficulty breathing because their lungs and brain are still maturing. Sometimes babies have breathing problems because of an infection, health condition or traumatic birth. All of these can be treated in the NICU.

Respiratory Distress Syndrome or RDS results when a baby has problems breathing and getting enough oxygen.

• Babies may be given a substance called surfactant to help them breathe more easily. Typically a baby produces surfactant in the last weeks of pregnancy. It coats the inside of their lungs and helps them move oxygen into their blood.
• If your baby is not getting enough oxygen, they may be given more using C-PAP (continuous positive airway pressure). With C-PAP, supplemental oxygen is delivered through a nasal canula (soft, flexible tubing) as the baby breathes through their nose.
• Sometimes a baby’s brain and respiratory system are not able to coordinate their breathing. When this happens, your baby may need a ventilator to help them breathe. The ventilator breathes for your baby until they are able to breathe on their own.

Apnea is when your baby “forgets” to breathe. It is very common in babies who are born early and whose brains are still developing.

• Your baby will be monitored for apnea and bradycardia, called “A’s and B’s.” Bradycardia is when the baby’s heart rate slows down. It often accompanies apnea.
• During “A’s and B’s” your baby’s skin color and heart rate may change and the heart and respiratory monitors attached to your baby will go off. The NICU staff will stimulate them and help “remind” them to breathe.
• It’s hard to imagine you could ever get used to this. Take comfort that episodes of “A’s and B’s” should decrease as your baby matures.

Learning to eat

For some babies eating doesn’t come naturally; it’s hard work. Most babies will not be ready to breast feed or take a bottle until they are around 34 weeks adjusted age. This is because their brain needs to mature enough to coordinate sucking, swallowing and breathing. Babies who have special health care needs may get tired before a feeding session is through.

• Nutrition Your baby will have unique nutritional needs based on their age and health. The neonatologist and NICU dietician will find the right combination of calories and nutrients to help your baby heal and grow. Intravenous nutrition, colostrum, breast milk (from the mom or from a donor), human milk fortifier and formula can all be used to meet these goals.
• Maturity You and your baby’s NICU team won’t just decide what they’re fed, but how they’re fed. Some babies might need intravenous (through the bloodstream) nutrition while they are stabilized. Many babies’ first feedings are gavage feedings where they are given food through a tube that goes through their mouth or nose and down to their tiny stomach. When you baby is stable and  ready (usually around 34 weeks if they were born preterm), they will be able to start breast feeding and taking bottles.
• Feeding Behaviors One of the ways you and the medical team will know your baby is ready to eat is you will start to see them develop feeding behaviors or “cues.” During Kangaroo Care (skin-to-skin care) your baby will start to smell and lick your skin. Soon they will start moving towards the nipple, turning their head to look for it (rooting), and suckling whether or not they are getting milk. These pre-feeding behaviors are reassuring signs that your baby is making progress.

Your baby’s maturing brain

Babies mature at their own unique rates. While your baby is in the NICU, they will be watched to make sure their nervous system and reflexes are maturing and that they’re developing good muscle tone and control of their movements. One of the most important things you and the NICU staff can do is create an environment that is as much like the womb as possible and protects their growing brain. Remember that they need to sleep and be protected from harsh lights, sounds and movement.

Homecoming

You will know your baby is getting close to coming home when they’ve started to put all these pieces – breathing, feeding, and controlling their temperature and reflexes – into place.

Take comfort in the fact that the skills you have learned in the NICU can make you an even better parent than you ever imagined and that the time you and your family spend here will benefit your baby in the long run.