Discharge planning for high-risk newborns
- Jane Stewart, MD
Jane Stewart, MD
- Assistant Professor of Pediatrics
- Harvard Medical School
- Section Editors
- Steven A Abrams, MD
Steven A Abrams, MD
- Section Editor — Neonatology
- Professor, Department of Pediatrics
- Dell Medical School at the University of Texas at Austin
- Kathleen J Motil, MD, PhD
Kathleen J Motil, MD, PhD
- Section Editor — Pediatric Nutrition
- Professor of Pediatric Nutrition
- Baylor College of Medicine
For neonates who require a lengthy birth hospitalization, shortening the duration of neonatal hospitalization as much as possible is beneficial because it decreases the risk of hospital-acquired neonatal morbidity, shortens the period of separation of the parents from the infant, and lowers medical costs [1,2]. However, infants who require neonatal intensive care remain at increased risk for morbidity and mortality following discharge from the neonatal intensive care unit (NICU). These include infants who were born preterm, require technological support, have complicated family issues, or have an irreversible condition that may result in early death .
Comprehensive discharge planning is required to minimize the risk of morbidity and mortality from premature discharge and to prevent prolongation of the hospital stay in an infant ready for discharge. This includes assessment of the neonate's medical status and readiness for discharge, completion of routine predischarge screening and care, parental education, and specific planning for follow-up and home care.
Discharge planning for high-risk newborns will be presented here. The focus is primarily on premature infants, as they represent the majority of NICU graduates. The care of the NICU graduate is discussed separately. (See "Care of the neonatal intensive care unit graduate".)
Discharge planning helps to ensure a smooth transition from the neonatal intensive care unit (NICU) to home. On the other hand, premature discharge home may place the infant at increased risk for morbidity and mortality. As a result, the American Academy of Pediatrics (AAP) published discharge guidelines in 2008 for the infant cared for in the NICU .
Discharge planning should be developed and implemented by a multidisciplinary team consisting of physicians, nurses, neonatal nurse practitioners, respiratory therapists, occupational and/or physical therapists, dieticians, pharmacists, case managers, and social workers. The process can begin soon after an infant is admitted to the NICU and is continued through regularly scheduled planning sessions during hospitalization. Successful discharge preparation facilitates family readiness and ultimately improved outcomes in the important transition from the NICU to home .
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