As a NICU nurse, one of the first questions I get asked is: “When can my baby go home?” Discharge day is a day parents will be anxiously awaiting, but we will need to make sure your baby is able to thrive on their own outside of the hospital. Many premature babies are discharged before their original due dates, and there are some that stay well beyond when they were due to be born.
There is not a specific rule or amount of time a premature baby has to stay in the NICU (neonatal intensive care unit), instead a set of milestones they will need to meet. A good acronym to remember for discharge day is A.F.T.E.R. (Antibiotics, Feeding, Temperature, Events and Respiratory). A.F.T.E.R. these milestones are met, your baby will be ready to go home.
Your baby has an immature immune system which makes it easier for them to get an infection. Some infants will be placed on antibiotics until their blood work shows that there isn’t an infection present. Your baby will need to be off antibiotics and free from signs of infection (such as trouble with breathing, feeding or temperature) before they can go home.
Preterm babies have a weak “suck and swallow,” and may not feed well at first. These babies will require a feeding tube. Some preterm infants are born so early they cannot have food in their stomachs until they are developed more. Good feeding is important for growth and normal blood sugar levels. Before being discharged from the hospital, your baby will need to be eating all food by mouth, either breastfeeding or bottle feeding, keeping their blood sugar level normal and not losing weight.
Your baby may be small and has not stored up much body fat. They may get cold and burn too many calories trying to stay warm. They may be placed in an incubator to help keep them warm and then moved to a crib when they are able to keep their temperature at a normal level by themselves. Your baby will need to be in a crib and having a normal temperature for at least 24 hours before going home.
In premature babies, it is common for apnea and/or bradycardic events to occur. Sometimes you will hear them called “As and Bs” or just “events.” Apnea refers to a period of time when breathing stops. Bradycardia is the slowing of the heart rate to under 100 beats per minute. Most babies will grow out of these events by the time they were due to be born. Most NICUs require babies to be free from events for 3-5 days before going home. This includes not having any events during their “car seat test,” a test that shows if the baby can sit in their car seat for 1.5 hours without any events.
Your baby’s lungs may not be fully developed at birth and they may have trouble breathing on their own or have apnea. Some babies will have a ventilator to help them breath and some may just need oxygen. Before going home, your baby will need to be breathing well on their own and off of oxygen.
Remember, every preemie will be different and your baby will move at their own pace. Rest assured that they will not be sent home until they are ready and doing well. Remember to take your baby to their scheduled follow up appointments. It is important for your baby to have a check up a few days after leaving the hospital to make sure they are doing ok.