Getting Ready to Go Home

To help make your baby’s homecoming smooth, safe and enjoyable, you should be involved in your baby’s care as much as possible. This will help you to be more comfortable with bathing, feeding, temperature-taking, and giving medicine, if necessary.

When Will My Baby Be Ready to Come Home?

In general, an infant will be ready to go home when he/she:

• Can stay warm when dressed and wrapped in a blanket, without the use of a warmer or incubator.
• Continues to gain weight when moved from an incubator to an open crib.
• Has no episodes of apnea or bradycardia, and is no longer on medication to prevent these episodes.
• Has been stable without oxygen assistance, or is stable in a small amount of oxygen by nasal cannula.
• No longer has an IV and is taking all his feedings by breast or bottle.
• Has a stable medical condition 

Preparing to Take Care of Baby at Home

Choosing Your Baby’s Doctor:

Before your baby goes home from the NICU, you must choose a primary care doctor or clinic that will take care of your baby after discharge. The NICU doctor will contact the doctor you choose to review your baby’s care, and information about your baby will be sent to his office prior to your first visit. You will need to make an appointment for your baby to see the doctor within his or her first week at home. Find a TriHealth doctor.

Things that will be important to consider when choosing your doctor are:

• Experience in the follow-up care of NICU graduates.
• Insurance coverage/Medicaid coverage
• Cost of visits/co-pay
• Office location
• Office hours (evenings, weekends, holidays)
• After hours emergency care
• Appointment scheduling
• Group or Individual practice

Learning to Care for Your Baby

Parent Education: When your baby is close to coming home, it is important to plan your time with baby in the hospital, so you can become more comfortable with the care he or she will need. In addition to ‘hands-on” care, you will need to view several educational videos before discharge.

The hospital also offers “TotSaver”, a three-hour course that teaches cardiopulmonary resuscitation (CPR) techniques from the American Heart Association (AHA). It is designed to teach you how to recognize medical emergencies, seek emergency assistance for your infant and child, and how to perform CPR. TotSaver is a great course for parents, grandparents, older siblings and babysitters.

Rooming In: If you would like to become more comfortable with your baby’s care before going home, you may be interested in staying all day or overnight in a hospital room near the NICU. You can take care of all of your baby’s needs during that time – with your baby’s nurse nearby – should you need any assistance. Let your baby’s nurse know if you would like to room in.

Gathering Baby Supplies:

Before your baby is discharged you will need to have:

• 8 bottles and nipples (ask your nurse for suggestions).
• Infant crib, bassinet, or pack-n-play
• Fitted crib sheets
• Swaddle blankets
• T-shirts or onesies, sleepers and socks
• Diapers
• Infant formula (your baby may require a special formula after leaving the hospital).

Choosing A Car Seat

When your baby is ready to go home from the hospital, he or she must ride in a suitable car seat. If your baby is small, you should take extra care in choosing a car seat. An infant-only, rear-facing car seat is necessary. You will be asked to bring in your baby’s car seat a few days before discharge so your baby’s car seat positioning can be checked. Your nurse will also review important information about car seat use.

Choose a car seat that:

• Is the right size for your baby’s weight (Some car seats are limited to babies more than 5 pounds, but others fit babies from birth or 4 pounds).
• Has less than 5½ inches from the crotch strap buckle to the seat back; and less than 8 inches from the lowest harness (shoulder) strap position to the seat bottom (These straps will then buckle close to your baby’s body and keep him or her from slouching forward).

If you are using a second-hand car seat, make sure:

• It is in good condition
• It has all of its parts and instructions
• Is not more than 5 years old
• The manufacturer name, date, and model number are visible so you can see if the car seat has been the subject of any recalls

When installing your baby's car seat:

• Fasten your baby’s car seat in your car before bringing it to the hospital to make sure it fits.
• It should be placed rear-facing in the back seat and buckled tightly.
• Always read the car seat manual and your vehicle owner’s manual before you take your baby home to make sure you are using and installing your car seat correctly.
• Only positioning pads that come with the car seat can be used.
• Many local fire departments offer free assistance with car seat installation.
• Your baby should ride in a rear-facing car seat until age 2. *Remember, everyone in your car should wear a seat belt so that every member of your family is riding safely on every ride.

Your Baby's Feedings

You will be given information about the amount of breast milk or the amount and type of formula you should use for your baby’s feedings at home. Special formulas or nutritional additives may be prescribed by the doctor to meet the special growth needs of some infants born early or with digestive problems. It is very important not to change your baby’s formula without talking to his or her healthcare provider. Information concerning breast feeding frequency and use of supplements after breast feeding will also be discussed before discharge.

Safe Sleeping and Positioning

• Place your infant completely on his back for sleep (not on the stomach or side). If your baby moves to another position, it is not necessary to correct the position as long as you have followed this guideline. Some medical conditions require special sleeping positions that will be discussed with you, if needed.
• Use a firm mattress. Soft objects such as pillows, quilts or comforters should not be placed in the infant’s crib or bassinet.
• Infants should sleep in their own beds, not with other siblings, adults, pets, or on couches or adult beds.
• Consider offering a pacifier at nap time and bedtime.
• Wedges and positioners should not be used.
• A baby should sleep in a smoke-free home.

Tummy Time-To-Play

Placing your baby on his or her tummy while awake and while you are watching your baby is very important for development.

• Belly time is important. It helps with:
  • Muscle strengthening
  • Preventing a misshapen head
  • Visual development
  • Nerve growth
   
• Provide tummy time frequently during the day. When doing so: 
  • You need to watch your baby while on their tummy
  • Your baby should be awake during tummy time
  • Provide tummy time for at least 20 minutes at a time and 3-4 times during the day
  • Tummy time should be on a firm surface (a blanket on the floor) or on your chest while you are laying back and awake
   

Provide a Smoke-Free Environment:

Do not smoke around your baby. Children who are exposed to second-hand smoke have more respiratory illnesses, like colds, bronchitis, and ear infections, and have an increased risk of SIDS (Sudden Infant Death Syndrome). A premature infant, or one who has had breathing problems while hospitalized is especially at risk. If you must smoke, please do so outside and change your clothing before caring for your baby. Smoking in another room does not protect the child from second-hand smoke and its effects.

Circumcision

Circumcision is a surgical procedure in which the skin covering the end of the penis is removed. Circumcision is usually performed by a doctor in the first few days of life or before discharge from the nursery. An infant must be stable and healthy to safely be circumcised.

You will need to sign a special permit for this procedure so that it can be done before your baby goes home. The circumcision is done by your obstetrician. When done without pain medicine, circumcision is painful. There are pain medicines available that are safe and effective. The American Academy of Pediatrics (AAP) recommends that they be used to reduce pain from circumcision.

Scientific studies show some medical benefits of circumcision. Parents may want their sons circumcised for religious, social, and cultural reasons. Since circumcision is not essential to a child’s health, parents should choose what is best for their child by looking at the benefits and risks. If you have questions about circumcision ask your obstetrician or pediatrician.

Follow-Up Appointments

You will need to schedule your baby’s appointment with his or her pediatrician for within the first week of discharge. The NICU care coordinator will schedule any specialist appointments your baby may require.

Additional Care Your Baby May Have Before Going Home

Immunizations

Childhood immunizations (vaccines or baby’s shots) provide protection against several major diseases and help prevent illness. Immunizations begin in infancy and continue through childhood. Your baby may receive his first immunizations while still hospitalized. Hepatitis B vaccine is given to most babies before discharge. DPT (Diptheria, Pertussis, Tetanus), HIB (haemophilus influenzae), and Prevnar (pneumococcal pneumonia) vaccines are usually given at 2 months of age. Your baby’s nurse will review immunization information with you before those immunizations are given.

Synagis

Infants who are born prematurely and/or have Bronchopulmonary Dysplasia (BPD)/Chronic Lung Disease may be at higher risk for Respiratory Syncytial Virus (RSV) infection. Respiratory infections caused by RSV are most common during the winter months and are usually mild, but can cause severe illness in infants who were born prematurely or who have lung problems. RSV illness usually occurs November through April, and may cause wheezing, nasal congestion, rapid breathing, cough, irritability, poor feeding, fever, and turning blue (cyanosis).

• RSV is highly contagious and is usually spread from person-to-person. You can decrease your baby’s risk of exposure to RSV by staying away from places where large crowds are present (such as daycare centers, grocery stores, shopping malls, church), avoiding people who are ill, and using good handwashing.
• Synagis is a medication that offers protection against RSV illness. It is given monthly by injection at your doctor’s office or by a home nurse from November through April. If Synagis is indicated for your infant, we will discuss this with you and your baby will receive his first dose before going home. The care coordinator will make arrangements for its continued administration after discharge

Hearing Screens

Hearing is very important to growth and development. Every baby receives a hearing screen before going home from the hospital. The results of the hearing screen will be given to the parents. You will be notified if any follow-up testing is needed.