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Discharge planning for high-risk newborns

Jane Stewart, MD
Section Editors
Steven A Abrams, MD
Kathleen J Motil, MD, PhD
Deputy Editor
Melanie S Kim, MD


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 [1].

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 [1].

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 [3].

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Literature review current through: Sep 2017. | This topic last updated: Sep 25, 2017.
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  1. American Academy of Pediatrics Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate. Pediatrics 2008; 122:1119.
  2. Brooten D, Kumar S, Brown LP, et al. A randomized clinical trial of early hospital discharge and home follow-up of very-low-birth-weight infants. N Engl J Med 1986; 315:934.
  3. Smith VC, Hwang SS, Dukhovny D, et al. Neonatal intensive care unit discharge preparation, family readiness and infant outcomes: connecting the dots. J Perinatol 2013; 33:415.
  4. Smith VC, Dukhovny D, Zupancic JA, et al. Neonatal intensive care unit discharge preparedness: primary care implications. Clin Pediatr (Phila) 2012; 51:454.
  5. Eichenwald EC, Aina A, Stark AR. Apnea frequently persists beyond term gestation in infants delivered at 24 to 28 weeks. Pediatrics 1997; 100:354.
  6. Darnall RA, Kattwinkel J, Nattie C, Robinson M. Margin of safety for discharge after apnea in preterm infants. Pediatrics 1997; 100:795.
  7. Eichenwald EC. Apnea of Prematurity. In: Primary Care of the Premature Infant, Brodsky D, Ouellette MA (Eds), Saunders Elsevier, Philadelphia 2008. p.19.
  8. Task Force on Sudden Infant Death Syndrome, Moon RY. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 2011; 128:1030.
  9. Kotagal UR, Perlstein PH, Gamblian V, et al. Description and evaluation of a program for the early discharge of infants from a neonatal intensive care unit. J Pediatr 1995; 127:285.
  10. Kun S, Warburton D. Telephone assessment of parents' knowledge of home-care treatments and readmission outcomes for high-risk infants and toddlers. Am J Dis Child 1987; 141:888.
  11. American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics 2007; 120:898.
  12. American Academy of Pediatrics. Immunization in special clinical circumstances. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove, Il 2015. p.68.
  13. Saari TN, American Academy of Pediatrics Committee on Infectious Diseases. Immunization of preterm and low birth weight infants. American Academy of Pediatrics Committee on Infectious Diseases. Pediatrics 2003; 112:193.
  14. Furck AK, Richter JW, Kattner E. Very low birth weight infants have only few adverse events after timely immunization. J Perinatol 2010; 30:118.
  15. Willett LD, Leuschen MP, Nelson LS, Nelson RM Jr. Risk of hypoventilation in premature infants in car seats. J Pediatr 1986; 109:245.
  16. Merchant JR, Worwa C, Porter S, et al. Respiratory instability of term and near-term healthy newborn infants in car safety seats. Pediatrics 2001; 108:647.
  17. Salhab WA, Khattak A, Tyson JE, et al. Car seat or car bed for very low birth weight infants at discharge home. J Pediatr 2007; 150:224.
  18. Ojadi VC, Petrova A, Mehta R, Hegyi T. Risk of cardio-respiratory abnormalities in preterm infants placed in car seats: a cross-sectional study. BMC Pediatr 2005; 5:28.
  19. Davis NL. Car Seat Screening for Low Birth Weight Term Neonates. Pediatrics 2015; 136:89.
  20. Safe transportation of premature and low birth weight infants. American Academy of Pediatrics. Committee on Injury and Poison Prevention and Committee on Fetus and Newborn. Pediatrics 1996; 97:758.
  21. Bull MJ, Engle WA, Committee on Injury, Violence, and Poison Prevention and Committee on Fetus and Newborn, American Academy of Pediatrics. Safe transportation of preterm and low birth weight infants at hospital discharge. Pediatrics 2009; 123:1424.
  22. Bass JL. The infant car seat challenge: determining and managing an "abnormal" result. Pediatrics 2010; 125:597.
  23. Kornhauser Cerar L, Scirica CV, Stucin Gantar I, et al. A comparison of respiratory patterns in healthy term infants placed in car safety seats and beds. Pediatrics 2009; 124:e396.
  24. Elder DE, Russell L, Sheppard D, et al. Car seat test for preterm infants: comparison with polysomnography. Arch Dis Child Fetal Neonatal Ed 2007; 92:F468.
  25. Schutzman DL, Salvador A, Janeczko M, et al. A comparison of the infant car seat challenge and the polysomnogram at the time of hospital discharge. Arch Dis Child Fetal Neonatal Ed 2013; 98:F411.
  26. Arya R, Williams G, Kilonback A, et al. Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle. Arch Dis Child Fetal Neonatal Ed 2017; 102:F136.
  27. Miles MS, Holditch-Davis D, Schwartz TA, Scher M. Depressive symptoms in mothers of prematurely born infants. J Dev Behav Pediatr 2007; 28:36.
  28. Rogers CE, Kidokoro H, Wallendorf M, Inder TE. Identifying mothers of very preterm infants at-risk for postpartum depression and anxiety before discharge. J Perinatol 2013; 33:171.
  29. Casiro OG, McKenzie ME, McFadyen L, et al. Earlier discharge with community-based intervention for low birth weight infants: a randomized trial. Pediatrics 1993; 92:128.
  30. Casey PH. Growth of low birth weight preterm children. Semin Perinatol 2008; 32:20.