Going home from the neonatal unit

The date of discharge depends on your baby. Most babies are ready close to their due date. The team looks for a few skills:

• Your baby breathes steadily without a machine. There are no more pauses in breathing that need help. Some babies go home with a little oxygen, with a clear plan.
• Your baby stays warm in a normal cot, dressed like any other baby, outside the incubator.
• Your baby takes all feeds from the breast or bottle. The feeding tube is gone. Feeds no longer tire your baby too much.
• Your baby gains weight steadily, day after day.

You need to be ready too. Before discharge, the team will teach you to feed, bathe, give medicines and take the temperature. Ask for a written summary of the stay and the list of appointments.

Premature babies leave with a follow-up plan. It depends on how early your baby was born and what happened in the neonatal unit. Not every baby needs every check. Here are the most common ones.

• Your pediatrician sees your baby in the first days at home. The pediatrician checks weight, feeding and color.
• A head ultrasound looks through the soft spot on the head. It checks the brain, especially after a bleed seen in the neonatal unit.
• An eye doctor checks the back of the eye. Very premature babies can have abnormal blood vessels there. They need to be found early.
• Your baby has a hearing test, if it was not done before discharge.
• Blood tests check the bones. They measure calcium, phosphorus and vitamin D. Premature babies miss the last weeks of stocking minerals before birth.
• Many premature babies take vitamin D. Some need iron or other treatment for anemia, a low red blood cell count. Your doctor checks the blood count and adjusts the treatment.
• A heart ultrasound is done if the team heard a murmur or saw a small opening in the heart. This opening is normal before birth. It often closes on its own.
• At each visit, your doctor measures weight, length and head size, and checks milestones. Always by corrected age.

Keep a notebook with the dates, results and questions. Bring it to every visit.

A premature baby fights infections less well than a baby born at term. A simple cold for an adult can be serious for a small baby, especially in the first months.

• Wash your hands before you touch your baby. Ask everyone else to do the same.
• Keep visits short and few in the first weeks.
• Keep away anyone with a cold, a cough, a fever or diarrhea. Even a mild one.
• Avoid crowded places, especially in winter.
• Do not let anyone smoke near your baby, in the house or in the car.
• Everyone who cares for your baby should be up to date on vaccines, including flu and whooping cough.
• Keep breastfeeding or giving breast milk if you can. It helps protect your baby.
• Keep up skin-to-skin time at home. It still helps.

Your baby’s own vaccines follow the birth date. Do not delay them.

RSV is a common virus. In older children and adults, it causes a cold. In young babies, it can cause bronchiolitis, an infection of the small airways. Premature babies are at higher risk of severe illness and of needing the hospital.

RSV spreads most in the colder months. Ask your doctor when the season starts here. There are two ways to protect a baby. One is an antibody injection given to the baby before or during the season. The other is a vaccine given to the mother during pregnancy. Most babies need only one of the two. Ask your doctor before discharge which one suits your baby.

Hand washing and keeping sick people away are still the best everyday protection.

Call the Red Cross on 140 or go to the emergency room if your baby:

• stops breathing, even for a short time, or breathes very fast
• struggles to breathe, grunts, or the skin sucks in under the ribs
• turns blue, grey or very pale around the lips
• is very hard to wake or floppy

Call your doctor the same day if your baby:

• has a temperature of 38 °C or higher
• feels cold and stays cold even when dressed warmly
• feeds poorly or tires during feeds
• has fewer wet diapers than usual
• vomits often, or vomits green
• has a swollen belly or blood in the stool
• looks more yellow than before
• has a cough or a runny nose and seems unwell

If something about your baby worries you and it is not on these lists, call your doctor.