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Care of the neonatal intensive care unit graduate

Jane Stewart, MD
Section Editor
Steven A Abrams, MD
Deputy Editor
Melanie S Kim, MD


Advances in neonatal intensive care have improved the survival of high-risk preterm and critically ill term infants (see "Incidence and mortality of the preterm infant", section on 'Trends over time'). Infants who are discharged from the neonatal intensive care unit (NICU) require continued comprehensive clinical care. Thus, the primary care provider needs to identify, understand, and manage their ongoing medical needs [1,2]. The primary care clinician plays a key role in providing optimal continuity of treatment by coordinating transition of care from the neonatologist, providing direct medical care, and facilitating ongoing care of the infant by subspecialists and other health professionals.

This topic will review the care of the infant who is discharged from the NICU. The discussion primarily focuses on preterm infants who represent the majority of NICU graduates, especially the issues in the care of the very low birth weight (VLBW) infant (birth weight ≤1500 g). Criteria for discharge and planning for discharge are discussed separately. (See "Discharge planning for high-risk newborns".)


With the advances in neonatal care, the number of preterm infants and critically ill term infants who survive and are discharged from the neonatal intensive care unit (NICU) continues to increase. Although most NICU graduates are discharged from the NICU when their adjusted gestational age is near or at term, they differ greatly in their medical needs compared with healthy term infants.

Because of the need to provide optimal care to the NICU graduates and address their specific medical issues, the American Academy of Pediatrics (AAP) has developed guidelines for the primary care provider in the management of the high-risk infant [3]. These guidelines highlight the shared responsibility of the care of the infant between the primary care provider and the neonatologist, the need for effective communication with the family and other professionals involved in the care of the infant, the importance of continuity of care at the time of discharge from the NICU, and the role of the primary care provider to identify and care for the problems associated with these infants. Specific quality-of-care indicators for the neurodevelopmental follow-up care of very low birth weight children have also been developed by an AAP expert panel and serve as a useful guide for primary care providers [4].

Based on the AAP guidelines, the role of the primary care clinician in the care of the NICU graduate includes [3]:


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Literature review current through: Sep 2016. | This topic last updated: Aug 27, 2015.
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