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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, which is provided by the primary care provider clinician.

This topic will review the care of the infant provided by primary care clinician who is discharged from the NICU. The discussion focuses on preterm infants who represent the majority of NICU graduates. Criteria for discharge and planning for discharge are presented separately. (See "Discharge planning for high-risk newborns".)


The primary care provider plays a key role in providing optimal continuity of treatment for NICU graduates by coordinating transition of care from the neonatologist, delivering direct medical care, and facilitating ongoing care for specific medical conditions of the infant by subspecialists and other health professionals [1-3].

To help facilitate and optimize the quality of care for these infants, the American Academy of Pediatrics (AAP) has developed guidelines for the primary care provider in the management of these high-risk infants [4]. We concur with these guidelines that 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 clinician to provide direct care for these infants. The primary care clinician:

Communicates with the neonatologist and family during the NICU course of the infant; especially important when the infant is getting close to being ready for discharge to home or transfer to a Level 2 facility. Ongoing communication facilitates the transfer of medical information (patient's medical history, medications, and technologic needs); allows collaborative arrangements for follow-up with primary, subspecialty, and neurodevelopmental care; and determines the appropriate timing of transfer. For the family, contact with both the neonatologist and primary care provider decreases confusion, anxiety and uncertainty regarding transfer of care. (See "Discharge planning for high-risk newborns".)

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Literature review current through: Sep 2017. | This topic last updated: Sep 25, 2017.
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