NICU graduation is coming up! Hooray!

All yellow biomarkers mean your baby is meeting key NICU milestones. Your hospital and your doctors will probably want to keep an eye on your baby a little longer, and will have thoughts on the exact day your baby will graduate from the NICU. 

Checklist of Hospital Things to Do Before Discharge

Here are some more details that most hospitals will want to settle before you go home:

Updated Newborn Screening Test

An updated newborn screening test, usually drawn on a filter paper card (some states call it the PKU test). This tests for childhood illnesses that can be supported better if we know early if your child is affected (like cystic fibrosis or sickle cell disease).

Congenital Heart Disease Screening

It is done taking an oxygen saturation using a sticker-like probe from the right hand and leg. This test looks for congenital heart diseases that typically affect the structure of the heart. Many premature infants have had an echocardiogram or ultrasound of the heart so this may not be as critical for some babies. It is quick and easy.

Newborn Car Seat Test

Some hospitals place the infant in the car seat before your baby will go home, to check that it is in the right position for the ride home and for short trips in the early time at home. Car seats are rated by the testing agencies  for 4-22 lbs or 5-22 lbs. If your baby might go home before 5 lbs or 2275 gms, you will need to purchase the car seat designed for smaller children.

Circumcision

If you desire a circumcision for your infant boy, you will likely need to sign a consent and your team will have it done by one of the providers (in some states obstetricians perform them, in others, pediatricians or family medicine doctors are trained to do so).

Hearing Screen

All babies should have their hearing checked prior to going home from the hospital. A small probe is placed in the ear to do this.

CPR Training

Many hospitals offer infant CPR training (but do not require it). You can ask if your NICU offers this for parents before your baby comes home from the hospital.

Some doctors will order blood testing before discharge to measure key values and the effectiveness of medications and the infant’s maturation.

If your baby is graduating from The NICU to your home, here are some things you can do to prepare.

Check your smoke and carbon monoxide detectors at home.

Make sure your baby has a safe place to sleep on his/her back.

Find a pediatrician or family medicine doctor for your child. Make sure your health insurance for you and your baby are active.

If pumping breast milk, get all your breast pumping equipment clean and available (some mothers use the hospital pump during most of the NICU stay but can order a home pump that is often covered by her insurance).

Reach out to your tribe and set up meal trains, plans for weekly grocery shopping and cleaning.

Ask the medical team for an immunization record if the Hepatitis B and first set of immunizations have been ordered.

Think about diaper size and the style of wipes and bath items for the baby.

Get all caregivers up to date on vaccines. Your baby may be too little for certain vaccines so it is good to make sure caregivers are up to date on vaccines (including the flu vaccine) to protect your baby.

Things to review with your nurse:

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Preparing a bath

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Preparing a bottle and/or adding fortifier to breast milk or knowing how to use breast milk pumping equipment

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Taking the temperature

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Reviewing your baby’s feeding and sleeping cues

What to expect outside the NICU

The same biomarkers of maturation you tracked in the NICU will continue to mature and develop for your baby. There will be some things to keep in mind as you transition to home. There will always be some “growing pains” This is a milestone for you and your baby! 

Breathing

Now that your baby’s lungs are mature, crying is a milestone and you will certainly hear more cries!

Many techniques for calming a crying full term baby, may not work with preemies. The usual baby-soothing combination of movement and sound can be too much for a premature baby. They may cry even more.

Some soothing tactics for preemies you may try:

  • Wrapping or swaddling your baby, holding her comfortably close to you while you are still and quiet.
  • Skin to skin care like Kangaroo care. Resting quietly in dim light with your baby lying on your chest, with their ear next to the beat of your heart.

Eating

Preemies are also likely to go from feeding happily to crying all of a sudden, for no obvious reason.

This can be frustrating for parents, but knowing it is normal behavior for premature babies is a good reminder that they will grow out of it.

The strict way the medical team measures and times feedings can be a bit more flexible over the next few weeks. You may need to increase the amount you feed your baby based on my cues for feeling full-I may seem hungry after the first amount. I may also want to eat more frequently than the hospital schedule at home. That is alright.

Temperature

Your home doesn’t have to be as warm as the NICU now. Your baby is now well enough to be home and can maintain their temperature well.

Generally, a comfortable room temperature is around 63-70 Fahrenheit degrees. (17 to 20 Celcius). It is best to dress your baby in layers (approximately 1 layer above what you are wearing is usually just right), so if she feels too warm to you, you can remove one layer at a time. 

The first weeks after going back home can be tiring and a little bit disorienting. Be mindful about the number of visits you want to receive, accept the help that is offered by your friends and loved ones. Instead of a visit, have a list in mind (or written) of specific tasks that they can help you with. This not only helps you, but your tribe will feel connected. This way, when it is time to visit, it will be even more joyful!

Sleeping

Premature babies may be more sensitive for the first weeks or months, and may not be able to cope with much stimulation and interactions from their environment.

You may see that your baby needs a calmer, quieter life with less noise and less eye contact. They may find it harder to calm down and self soothe, can change their behavior and mood very suddenly, and can be a noisy sleeper (loud grunting is common). The more premature a baby was born, the more noticeable these things are, which is completely normal. This is because their nervous system didn’t get the chance to finish developing and this process will take a little longer. 

Inconsistency is the new normal: A premature baby tends to follow an inconsistent pattern of sleep and have more alert cycles. For example, your baby may wake up screaming from a deep sleep some of the time. Other times, they may be calm and drop into sleep without a drowsy state in between. Sleeping: Premature babies tend to sleep for shorter periods even though they may spend more time asleep. They have been used to the constant noise and lights of the NICU and may be unsettled by the quiet and darkness of your home at night. Premature babies also have a small stomach. They will only be able to take small amounts of milk at first. As a result, they may wake up more often to feed

Growth

Your pediatrician or family medicine physician will check that your baby is growing when you get home.

 

They can show you a growth curve at each visit. At the first visit, any weight gain is usually adequate growth because there are so many transitions as you get home.

Over the next few weeks, the baby will grow about 3-7 oz per week. You will really notice your baby filling out his or her clothing