Discharge from hospital

A specialised discharge manager or nurse can ideally guide the parents through the most important tasks during the first time at home. After weeks or even months in the neonatal intensive care unit (NICU) families get to the point where a new episode begins: When the baby is in a stable condition and reached specific physiological milestones, the transfer to home is planned some time in advance, ideally in dialogue between parents and the health care team.

The date for discharge does not necessarily depend on the due date of birth or the age of the child. The health care team decides if a baby is ready to go home by assessing the most important physiological competencies of the baby, for example whether the baby is able to regulate the body temperature (thermoregulation), how well the baby is feeding, if the baby gained enough weight. But even in case the baby still has certain feeding or breathing difficulties or requires special attention, the parents may well take their baby home.

They then receive the necessary information and education to gain the necessary confidence and competency to look after their child at home. Follow-up support will have to be arranged. When a baby is still on medication, parents are provided with appropriate information on why it is needed, how to give it and how to react if side effects might occur. The health care team usually organises a meeting to discuss the anticipated date and steps for discharge. Structured discharge management programmes are meant to support parents by informing and training them on key aspects of action regarding the care of their baby. Through targeted parental training, in-depth conversations and organisational assistance parents are prepared for a safe discharge.

Parents should always discuss all important concerns and questions with their health care team: they need to feel confident to provide the care their baby needs themselves. It is also important for them to know how their baby behaves when feeling uncomfortable.

Before discharge, parents and health care professionals discuss several issues to make sure that the family is ready to go home. Questions that need to be clarified may include among others:

• Do the parents know about the most comfortable and safe (sleeping) positions for the baby?
• Are the parents self-confident with their handling of the baby?
• Are the parents instructed in nappy changing, skin care, and general newborn care?
• Do the parents know how to bath their baby? 
• Have the parents been instructed how to give medication if needed (dosage, side effects, missed doses)? 
• Have the parents been shown how to use specialist equipment such as apnoea monitor or oxygen if needed?
• Have the parents learned how to feed their baby, how much and how often the baby should drink?  
• Do the parents have enough information and support to breastfeed?
• If the mother expresses her milk, are the parents instructed in how to use and sterilise the milk expression sets and the bottles?
• If the mother expresses her milk, is she instructed in how to express, storage, and transport the milk?
• If the parents are bottle feeding, are they instructed in how to prepare the baby’s feeds and how to sterilise the bottles?
• Do the parents know what the normal body temperature of their child should be like and how to monitor and control it? 
• Have the parents been informed about typical developmental milestones of their baby?
• Have the parents learned about proper hygiene measures at home e.g. proper house cleaning and hand washing techniques?
• Do the parents know who to call or where to go, when they recognise any health problem or other anomalies of their baby?
• Are the parents provided with the most important telephone numbers in case of emergency? 
• Have the parents received resuscitation training? 
• Are the parents informed about Sudden Infant Death Syndrome (SIDS) and how to prevent it?
• Have the parents been informed on how often they need to bring their baby to the hospital or to the follow-up care centre for examination and has the first follow-up visit been scheduled before discharge?
• Do the parents have contact to a professional to visit the family at home, have they met the person and have they scheduled the first visit?

There are different models to better prepare the parents and families for the discharge of their baby. Parents should always ask for possible options in their respective hospital:

In some units, parents have the possibility to take over step by step the care of their baby, for example providing baths, dressing, and changing the nappy. Such preparations will help parents to find their parental role and make them feel confident about doing these tasks alone at home. Some hospitals offer the possibility of “rooming in”. This means that the parents can stay in one room together with their baby and can take care of their child for a few days and also overnight.

This is a good opportunity for parents to gain more confidence in caring for their baby, while nurses or midwives are around to help if necessary. Some days before discharge, parents may be allowed to bring their own equipment, e.g. feeding bottles or clothes, so that the baby can get used to them. This can also be an opportunity for parents to ask the health care professionals, if the equipment is appropriate for the baby.

As parents need to take many aspects into consideration in order to prepare for discharge and for taking their baby home for the first time, it could be helpful to organise some of these tasks in advance to avoid last-minute stress.