If your baby was born prematurely, you may greet the day of discharge from the hospital with a mixture of joy and worry. You may have waited days, weeks, or even months to take your baby home. But when the day finally arrives it can be frightening to walk away from the security of the hospital nursery.
If you're anxious about caring for your preemie at home, remember that health care professionals do not send preemies home until the babies are ready. With some preparation and planning, you'll be ready, too.
Before being discharged from the hospital, a preemie must meet several basic requirements to ensure good health and fewer medical problems. Some nurseries require a minimum weight for discharge, but more often, the neonatal intensive care unit (NICU) staff will evaluate the baby on these three criteria:
Most preemies meet these criteria 2 to 4 weeks before reaching their original due date. Infants who have had surgery, were born with health problems, or who spent weeks on breathing machines and oxygen are the most likely to stay beyond their original due date.
Many preemies do not need specialized medical support after leaving the hospital, but all will need regular medical care and evaluation. This includes routine immunizations, usually on the same schedule as that for full-term babies.
Common medical problems premature babies may face in the long term include:
The discharge of a preemie from the hospital isn't a single event, but a process. That process is designed to ensure that the infant can survive and thrive outside the hospital, and it prepares parents to take care of the baby on their own.
Some hospitals offer parents of preemies a rooming-in period that allows them a brief stay in a hospital room with the baby to get some experience in taking care of the infant's needs. Although they're apart from the nursery and functioning as solo caregivers, the parents have the security of knowing that help is just down the hall.
As your preemie progresses, you can get ready for the big day and the weeks that follow by:
As soon as possible after the birth of your baby, call your health insurance company and ask to have your baby added to your policy; many insurers require that you do this within a few days of the birth.
Some insurers will provide home nursing visits for premature infants or even more extensive nursing care for infants with complex medical problems. Nursing providers and social service workers can help you determine what your insurance coverage will provide.
Also, set up a file for medical records, financial statements, and correspondence you're likely to have with the hospital and your insurance company.
Don't wait until the last minute to choose a pediatrician. In addition to the usual questions, ask whether the doctor cares for many premature infants. If your child may be going home with equipment like a ventilator or tube feeds, ask the pediatrician about his or her experience treating kids with these special needs. If you need a recommendation for a pediatrician well versed in treating kids with special needs, ask the NICU staff for their advice.
Schedule the first visit with the pediatrician before your child goes home. Ask the NICU staff when the appointment is needed — this usually is within 2-4 days of discharge from the hospital (unless the pediatrician has assumed care of the infant prior to discharge from the NICU).
Discuss with the NICU staff whether your baby will need home nursing or visits with medical specialists other than a pediatrician. If so, ask for referrals and contact info for those health care providers. In some cases, hospitals can coordinate several specialist visits so that they can happen on the same day. Ask if this service is available for you.
Also, your baby might need a few routine tests, including blood, hearing, and vision tests. Make sure you understand the tests needed after discharge.
Appropriate developmental follow-up is also important for very premature babies. Many ex-preemies continue to see specialists — including early-intervention specialists, neurologists, ophthalmologists, and physical therapists — for several years to measure their vision, hearing, speech, and motor skills.
To be prepared for emergencies, consider taking a course in infant CPR before your baby comes home from the hospital. (CPR training is required for all parents whose children are on apnea monitors.)
Make sure your partner takes the course, as well as grandparents or other caregivers who will be alone with the baby. The NICU staff may be able to recommend a program; in some hospitals, the nursery staff actually trains parents of preemies in CPR. The American Heart Association and the American Red Cross also can provide information on training.
If your baby is to be sent home with special equipment — such as an apnea monitor or oxygen tank — you'll be trained to use it. Make sure you understand what to do if something goes wrong.
Check to see if your county or state grants preferential parking stickers to parents with children on home oxygen. Call the local rescue squad to make sure they have equipment to handle a premature infant emergency and, if you live in a rural area, make sure they know how to get to your home.
If your baby is a boy, you'll need to decide about circumcision. Full-term baby boys usually can be circumcised before they leave the hospital; generally, the same applies to a healthy preemie.
Before heading home, your preemie will need to be in an infant-only car safety seat with a three-point or five-point harness system or a convertible car safety seat with a five-point harness system. Most car seats need to be modified with padding or head supports so that a preemie's head stays in a position that keeps the airway open. A preemie often does not have the muscle control needed to keep the head upright or to move it if he or she is having trouble breathing. Ask the NICU staff before adding any extra padding to a car seat.
As a precaution, many hospitals require that parents bring in their car seat for a test. The baby is placed in the seat and attached to a cardiopulmonary monitor that evaluates the heart and breathing.
Some babies have respiratory problems that prevent them from traveling in a traditional infant car seat. If that's the case with your baby, discuss using a special restraint system with your neonatologist or doctor.
If your baby will be on oxygen or an apnea monitor at home, you'll need to use these devices while traveling in the car. Once in the car, secure them carefully so in the event of a crash they won't be dangerous to passengers. If you have any questions about whether your vehicle is properly outfitted for the ride home, talk to the hospital staff before you leave.
Because of potential breathing problems, it's generally recommended that parents limit the time a preemie is in a car seat to an hour or so. If you'll be traveling longer than that, ask your doctor if it is OK for your baby. Once home, do not leave your baby asleep in the car seat. Instead, lay your baby on his or her back in a crib to sleep.
Although it varies from hospital to hospital, expect a meeting to review medical care after discharge, confirm follow-up appointments, and allow you time for questions about your baby. All debriefings should include a thorough discussion about caring for your preemie once you're home. Make sure you understand all the instructions and advice, and ask questions.
When you leave with your baby, make sure you have the telephone number for the NICU. These professionals can be a valuable resource, especially in the gap between discharge day and the baby's first doctor's appointment.
Expect to live quietly with your preemie at first. Because their immune systems are still developing, preemies are at risk for infections. So, you'll need to take precautions.
Here are some things to do in the early days to help your baby thrive:
Parents spend a tremendous amount of time caring for a preemie during the first few months at home. But it's also important to be good to yourself and not underestimate the stress of delivering earlier than expected.
Women are supposed to have 6 to 8 weeks to rest and recuperate after giving birth, but a baby's premature birth may reduce that recovery time. In addition, those long days in the NICU take a physical and emotional toll.
You might have a wide range of emotions during these first months. If your preemie has serious medical problems you may feel angry that the baby is sick or grieve for the loss of that healthy, perfect baby you dreamed of bringing home. And as with all women recovering from pregnancy, mothers of preemies may experience the hormonal shifts of baby blues or more serious postpartum depression.
To make the adjustment of living with your new baby easier, accept offers of help from family and friends — they can babysit your other children, run errands, or clean the house so you have time to care for the baby or rest.
Treat yourself well by getting enough rest, eating well, and exercising moderately. Seek support and encouragement from doctors, nurses, veteran parents, support groups, or online communities.
And if you're overwhelmed or depressed, do not hesitate to get professional help for yourself so you can fully enjoy your new baby.