Whether your baby has been in the NICU for a few hours or several months, it’s normal to feel overwhelmed. Regardless of the amount of time, the question all parents want to know is still the same: “When can my baby leave?”
When the time comes for your baby to go home, it can be incredibly exciting yet scary for NICU parents. But you can do this! You have navigated and survived the NICU after all.
Being involved in your little one’s care as much as possible—especially close to discharge—is important and will help you feel even more comfortable when it’s time to take your baby home.
There are several milestones that need to be met for your baby to be discharged from the NICU, plus a certain amount of planning prior to discharge, as well as supplies to have on hand. It can be overwhelming, but just remember it's totally OK to rely on your NICU nurses, friends and family to help you with the transition.
As a NICU nurse, my favorite part of my job is preparing a mama to take her baby home.
Milestones a NICU baby must hit before being discharged
Decreased level of respiratory support
Your baby may have required a higher level of oxygen support when they were first admitted to the NICU. They will need to wean off the ventilator, CPAP or high flow nasal cannula before going home. However, it’s not uncommon for babies to go home on oxygen. If not off oxygen, they must be able to tolerate a regular nasal cannula at a fairly low liter-per-minute rate.
The nurses will wean your baby out of the isolette or warmer as your baby grows. Your baby needs to successfully maintain their own temperature in an open crib before they can go home.
Meeting feeding goals
There are so many variables involved in this particular milestone. Some babies aren’t in the NICU for eating-related issues. On the other hand, it can often be the final step needed before they are able to go home. Your baby needs to be taking all of their milk by bottle or breastfeeding. While there are some exceptions, this typically means no more feeding tube.
No more As and Bs
If you have a preemie in the NICU, you are well-aware of the term “As and Bs”. The nurses monitor and keep track of apnea and bradycardia events throughout your baby's NICU stay. Each NICU is different, but your baby generally needs to be free of A and B events for at least five days before going home. (As with feeding tubes, there are certain exceptions.) This is to ensure that your baby outgrows the events and doesn’t have repeats at home.
Special equipment training
Sending babies home on oxygen, a monitor and/or with a feeding tube may happen in some cases. This is undoubtedly scary for parents, but rest assured that the nurses will make sure you are fully comfortable with any equipment before your baby goes home.
NICU discharge planning
The NICU should have some type of checklist for tasks that need to be completed before your baby is discharged. Checklist items may include:
- Watching discharge videos, including car seat, baby care, and CPR
- Making a pediatrician appointment for 1 to 3 days after discharge from NICU
- Car seat study
- Overnight stay
Make sure to ask your nurse any questions that may arise. Remember, there are no silly questions—seriously. Your nurses are there to help you feel at ease about taking your baby home.
Caring for a NICU baby at home
Following feeding schedules
It’s important to keep your baby on the same feeding schedule they followed at the NICU—at least in the beginning. This ensures that your baby is getting the amount of food they need to gain weight. Every baby is different, so it’s important to follow the discharge instructions around feedings. After the first few weeks at home, follow up with your child’s pediatrician for directions on how often and how much to feed your baby.
Keeping up with sleep schedules
If you maintain your baby’s NICU feeding schedule, they will most likely follow the same sleep schedule as well. Of course, babies have more awake periods as they grow. While the NICU tries to maintain a quiet environment, it’s still loud compared to home. I have had parents tell me their baby had a hard time falling asleep at home because it was too quiet. They found that using a white noise or sound machine helped a lot.
It’s important to put your baby “back to sleep”, as recommended by the American Academy of Pediatrics. You may have seen your baby sleeping in different positions in the NICU, but it’s critical to follow the back to sleep guidelines at home, always placing baby down on their back when napping or sleeping.
While your baby is in the NICU, they get diaper changes during each feeding and care times, and sometimes in between (looking at you, blowouts!). That equates to at least eight diaper changes in a 24-hour period, and often more. You can probably expect similar numbers at home.
When to call the doctor
It’s normal for babies to not always eat the same amount each day, but it’s important that they are consistently eating their minimum amount on most days. It should include this number in your discharge instructions (i.e. X amount of ounces every three or four hours; or X amount of ounces every 24-hour period).
Keeping track of eating activity, at least at first, is key. I know you will be tired as you try to get into a routine, but this can be as simple as jotting down the time and how much they ate on a notepad or other tracking device. When you call the doctor, you will have this information ready and they can advise you on what to do next. Be sure to call if your baby isn’t eating as much as they normally do.
Changes to diaper frequency
While you don’t need to keep a meticulous log of every wet and dirty diaper, it’s important to note if there are any dry diapers or unusual stools (i.e. diarrhea, color change, etc.). Keeping track of these things will be helpful when you need to speak to the doctor.
Babies’ frequency of stools vary widely, but you will soon know what is normal for your baby. Just make note when anything changes. While your baby may not stool every diaper change, they should at least have a wet diaper. It’s OK if there is a dry diaper here and there, but two in a row can be concerning.
If they're inconsolable
Call the doctor if your baby is unusually fussy or inconsolable.
If a fever develops
While in the NICU, your baby had their temperature checked during each feeding and care time. This isn’t necessary at home. If your baby feels warm or cool, then you can take their temperature. If your baby has a fever (greater than 38 degrees C or 100.4 F), call the doctor.
Supplies to have on-hand
These tiny humans sure need a lot of supplies, don’t they? You already know about the basics such as clothes, blankets, bottles, diapers, wipes, diaper creams and bouncers, but there are a few others that are especially important for NICU infants.
I always make sure that parents have at least a couple of bulb syringes to bring home. It’s important to keep one of these in the car seat with the baby. If you’re driving and your baby spits up, that bulb syringe may be a lifesaver by quickly clearing the mouth or airway. If you’re unsure how to use it, ask your nurse to show you while your baby is still in the NICU.
Coping with the transition
It’s normal to feel both excited and scared during this time. Ask for help when you need it, but don’t be afraid to set boundaries with family and friends. People will want to come see the baby, and it’s OK to ask them to hold off due to germs. Babies coming out of the NICU have a weaker immune system, so it’s important to keep them at home and away from people.
When family and friends ask what you need, let them help. This may include ordering food and leaving it on your doorstep, or helping care for older siblings. Know that it’s completely OK if the house isn’t tidy or you have heaps of dishes in the sink and piles of laundry scattered around. These precious early days are a sacred time for baby and mama to spend together. Home at last.