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Planning for Discharge
Planning for Your Baby’s Homecoming
One of the very first things all parents want to know is when their baby may go home. Although we can’t always predict exactly when a baby will be discharged from the nursery, a good rule of thumb is that a baby will be ready to go home when the medical problems are resolved and the baby is old enough to breathe regularly, keep warm without using excess energy, and take a bottle or breastfeed easily. If a baby was born prematurely, all of this usually happens at 36-38 weeks. By that time, the baby also usually weighs about 4 to 4 ½ pounds.
We will inform you in advance when the time of discharge is approaching so that you have enough time to prepare for your baby’s arrival. We will make plans and help schedule your baby’s first medical appointments. If your baby still needs medicines, special care, or a monitor, we will provide you with instructions and plenty of practice before the baby leaves the hospital. We offer a source for classes in cardiopulmonary resuscitation. We will also review essential topics in the care of the newborn, including basic subjects, such as how to give your baby a bath and take a temperature.
West Penn Follow-up Program
Depending on the type of medical conditions your baby had or how prematurely your baby was born, we may schedule an appointment for your baby in our Developmental Follow-up Program. This program is an extension of our nursery in which we continue to evaluate the children we have cared for on a regular basis. A neonatologist and a developmental specialist evaluate each child to monitor developmental progress and offer appropriate guidance. The purpose of this program is to help ensure that every child who began life at West Penn Hospital prematurely or with medical problems has all the help that can be offered to achieve his or her full potential.
Ask your baby’s social worker, doctor or nurse if you have any questions or concerns.
Other Developmental Resources
There are developmental resources available to you in addition to the Developmental Follow-up Program here at West Penn. Each community has early intervention programs which provide developmental services at no out-of-pocket cost to families. Early Intervention programs offer periodic developmental tracking services which provide you with information about what developmental skills your baby will be accomplishing next.
Some babies and families may benefit from more frequent developmental services which might include developmental specialists, physical therapists or speech therapists. Early Intervention programs are designed to monitor your baby’s development, provide education to help you anticipate upcoming developmental milestones and therapy services to address any developmental issues. These services are able to be provided in your home, by professionals who keep in mind how early, small and/or sick your baby has been.
The services you receive through Early Intervention are very different from the evaluations we will do in the West Penn Follow-up Program. The latter is designed to evaluate the developmental progress of your baby. We will usually only see your baby three or four times a year to do this. Early Intervention, on the other hand, may provide weekly or monthly services that give you ongoing advice as to your baby’s developmental needs and how you can best meet these needs.
Your baby’s social worker will refer you to your local county Early Intervention program. Participating in these programs is voluntary, and we encourage you to take advantage of them.
Going home is an exciting time but can also be very scary and overwhelming. Just because you’ve left us doesn’t mean you can’t call us when you need to. We realize you have tried to absorb an overwhelming amount of information during your baby’s stay in the NICU, so if you need help, please call us or your pediatrician. Remember that you have gotten to know your baby well during the hospital stay. This knowledge will help to ease the transition to home. Trust your instincts!
- You will need identification to take your baby home. Your hospital identification band should be presented in addition to photo identification.
- If you wish to have your son circumcised, you will be asked to sign a permission form. Circumcision is performed a few days prior to discharge.
- Before discharge your baby will have blood drawn for a screening test that will check for a number of treatable conditions. A copy of the results from this test will be sent to your doctor. You will also be contacted if there are any positive results.
- To ensure that your baby has a healthy start, be sure that he or she receives the appropriate immunizations. Check with your baby’s doctor or the Health Department to determine the immunizations your baby should receive.
- To reduce the risk of Sudden Infant Death Syndrome (SIDS), always place your baby on his or her back to sleep.
- If your baby meets the criteria, an eye exam may be performed prior to discharge.
- A hearing screening will be performed on your baby prior to discharge.
- You will receive instructions about formula and vitamins and about making arrangements for your baby’s first doctor’s appointment. We will keep your pediatrician or clinic up to date about your child’s care while at West Penn Hospital and will forward a summary of the course of treatment after discharge.
- Your baby’s photograph will be taken shortly before discharge. Necessary forms will be available in the NICU.
- You will need to bring an appropriate car seat prior to your baby’s discharge. We may need to see if your baby is stable sitting in the car seat as most seats are not designed for babies that are premature. This will mean placing the baby in the car seat for one to two hours while we monitor breathing and heart rate. If your baby has any difficulties in the car seat, we will discuss alternatives with you for safe traveling.
Car Seat Safety
You will need to bring an appropriate car seat with you a few days prior to discharge. You will be asked to view a car seat video and review the car seat education. In addition, we will observe your baby in your car seat to assure he or she is stable during travel.
A young infant’s bones are fragile and muscles supporting the head are not yet fully developed. Therefore, infants should only ride rear-facing until they reach the weight limit of the car seat you are using. Rolled blankets tucked in on each side of the baby help to fill empty spaces and provide additional support for a newborn’s head and shoulders. A blanket may be placed over the child only after all straps are fastened. Don’t tip the seat back too far; the back must not be reclined more than 45 degrees from the vertical.
If you have questions about appropriate car seat use, please ask the nurses, or contact one of the following resources:
- PA Chapter of the American Academy of Pediatrics, 1.800.CAR-BELT
- PA DOT AUTO SAFETY HOTLINE, 1.888.DASH.2.DOT or www.nhtsa.dot.gov
- Allegheny County Health Department, 412.247.7821