71
Discharge from hospital

Taking home a preterm baby who required intensive care and many weeks in a neonatal unit is often daunting for parents (Fig. 71.1). Their fears are shared by parents of term infants who became seriously ill or have complex problems.

Fig. 71.1 Transition from intensive care to home.

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Questions

When can babies go home?

Most go home when their condition is stable and they have established feeding. Parents must be able to care for the baby and provide health-care needs.

Some babies requiring long-term oxygen therapy, e.g. for BPD (bronchopulmonary dysplasia), or gavage (tube) feeding can be managed at home (Fig. 71.2). Establishing such care at home will depend on the nature of the infant’s medical condition, its likely time course and if otherwise stable, the parents, home circumstances and community support available.

Should babies with bronchoulmonary dysplasia have a 24-hour saturation recording done before going home?

This is performed in some units a few days after oxygen therapy is stopped to confirm the absence of significant desaturations. Its value has not been established.

All infants who were preterm should be checked to ensure that they are able to maintain their airway and saturations when placed in a car seat.

Fig. 71.2 (a) Infant receiving oxygen therapy and gavage (nasogastric) feeding at home. (b) Same infant receiving oxygen therapy via an oxygen cylinder in a stroller at home. Long-term oxygen provided via an oxygen concentrator adjusted according to oxygen saturation from a monitor.

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Discharge planning

Good discharge planning aims to minimize parental anxiety and ensure seamless transfer of care between professionals in the hospital and community. This can be achieved by:

• having a named nurse with this responsibility
• starting discharge planning as soon as the baby is stableconsidering discharge arrangements (Fig. 71.3) during regular updates with parents and, if necessary, arranging pre-discharge meetings with the parents and other professionals involved, e.g. the family’s pediatrician or family practitioner, community nurses, health visitors, therapists, child development team.

Fig. 71.3 Parents and their baby leaving the neonatal unit. The items that need to be considered prior to discharge are listed.

Facilities where parents can room in with their baby for several days or longer (‘step-down units’) before going home are helpful, especially when establishing full breast-feeding.

Some units have specialist nurses who provide care in the family’s home and liaise with community-based services. Some of these nurses may also work on the unit and know the baby and family before discharge.