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Woman And Infants
Woman And Infants

NICU Discharge Instructions

Congratulations Going Home Checklist
Bathing your baby Caring for a sick baby
Car seat safety Circumcision care
Breastfeeding Bottle-feeding
Germ control Immunizations
Miscellaneous tips Playing
Sleep Taking your baby's temperature
Information Worksheet  

Congratulations

We have enjoyed caring for your baby and are pleased he or she can finally go home. We have compiled the following information to help make your family's transition home smooth, safe and enjoyable.

Remember, you can also call the Warm Line nurses at 1-800-711-7011. This free service answers questions about postpartum recovery, breastfeeding, newborn care and other women's health issues. Call weekdays, 9am - 9pm, or 9am - 5pm on weekends. Leave a message and a nurse will return your call within an hour.

Going Home Checklist

You must complete these items before your baby can go home. Discharge time is from 1 to 2 p.m. Speak with your baby's nurse if this time is a problem.

  • Find a pediatrician and schedule baby's first appointment
  • If your baby was born less than 35 weeks, bring in the car seat so we can observe him/her in it.
  • Take a CPR class (see secretaries for times)
  • Take a discharge class (see secretaries for times)
  • Sign the Hepatitis B vaccine consent
  • Sign the circumcision consent, if desired
  • Sign the RSV immunization consent if discharged between October and April
  • Complete the hearing screen
  • Set up appointment for Neonatal Follow-Up Program, if needed
  • Bring discharge outfit

Once you're home, you'll be doing all sorts of new tasks as you care for your baby. We've answered some of your questions below.

Bathing your baby

Bath time can be a special bonding time for you and your baby but he/she does not need a bath every day or it may dry the skin. Every two or three days is fine. Give sponge baths only until the cord stump falls off and the circumcision is healed.

Other bath time tips include:

  • Gather all supplies before starting the bath.
  • Bath water should feel warm on your elbow or wrist. Keep your water heater temperature below 120 degrees F to avoid scalding.
  • If bathing in the sink, use a towel or foam pad in the bottom of the sink or tub to prevent slipping.
  • Shampoo the head first, rinsing with clear water.
  • Wash the body from the face down, using only water on the face.
  • Use mild soaps such as unscented Dove, Johnson & Johnson Head to Toe, Basis or Tone.
  • Dry your baby thoroughly, especially in the creases of the arms, legs and neck.
  • Use a cream without perfume for dry skin. We prefer Eucerin or Aquaphor. Do not put lotion on the baby's face. If you apply lotion to his/her hands, cover them with baby mitts to avoid ingestion.
  • Never use baby powder. It is not necessary, and can be harmful to a baby's lungs.
  • Do not clean the ears or nose with cotton swabs.

Caring for a sick baby

Call the doctor if your baby appears to be ill, or starts to act differently to you. Babies can get sick very quickly. Early detection is always better.

Other than a fever, watch for the following signs of illness:

  • Vomiting
  • Frequent watery stools
  • Fewer than six to eight wet diapers a day
  • Change in skin color
  • Difficulty breathing
  • Not feeding well
  • Irritability
  • Less active than usual
  • Sleeping more than usual
  • Rash, other than a regular diaper rash

Using a bulb syringe

The bulb syringe is used to clear your baby's mouth or nose of formula or mucous. To use it:

  1. Squeeze the bulb.
  2. Gently place in nostril.
  3. Release the bulb.
  4. Remove the bulb and discard the material suctioned out.
  5. Repeat as necessary to keep your baby breathing easily.
  6. To clean the bulb syringe, wash it in hot soapy water and air dry.

What is RSV (Respiratory Syncytial Virus)?

RSV is a common virus that causes a mild cold in adults and children but in some babies can cause an infection in the lungs. Babies born before 32 weeks gestation or who have lung or certain heart diseases are at high risk of getting very sick with RSV. It most often occurs from October through April.

To protect your baby:

  • Wash your hands with warm water and soap.
  • Avoid crowds and close contact with other people.
  • et a monthly vaccine during RSV season if your baby is at the highest risk. The Special Care Nursery may give the first dose before you go home.
  • Avoid close contact with the baby if you or someone else has a cold or fever.
  • Be aware that kissing the baby can spread RSV infection.
  • Try to keep young children away from the baby.
  • Do not smoke around the baby.

Car seat safety

It is not safe or legal for a child to travel in a car unless secured in a car seat. Unfortunately, 97% of car seats are not installed correctly. Women & Infants' valet and security personnel are certified to install and check the car seat at discharge. We recommend that you install the car seat before the baby's discharge and have our qualified staff inspect it.

Parents of babies born at less than 35 weeks gestation or weighing less than 5 pounds will undergo a "car seat challenge" before going home. You will be asked to bring the car seat in a day or two before discharge so we can monitor the baby in it. If your baby cannot breath properly in the seat for 90 minutes, he or she will need to go home in a car bed.

In addition, for pre-term infants, there are the following recommendations:

  • Seat should have a five-point restraint system or measure 5.5 inches or less from the back of the seat to the crotch strap.
  • A larger seat may be substituted once the child weighs 8 to 10 pounds.

To know the car seat is safe:

  • Use a seat that is federally approved for infants less than 5 years old.
  • Check the owner's manual in your car.
  • Use locking clips or other objects if necessary.
  • Install the seat in the car's back seat, facing backwards. Never put an infant in the front seat, especially if the car has air bags. Safety research and state law mandates that seats be in the rear-facing position until the baby is one and weighs at least 20 pounds.
  • Check the seat's expiration date. Most have a five-year life.
  • Replace any seat that has been in a car accident, even a minor one.

Circumcision care

  • Rub A&D ointment on a gauze pad and place over the tip of the penis at each diaper change for 4 to 5 days or until the redness clears up.
  • If bowel movement gets on the penis, gently clean the area with water and cover with A&D ointment.
  • Call your baby's doctor if you notice a thick yellow or greenish discharge, a bad odor or bleeding.
  • If the baby is not circumcised, clean the penis gently. Do not pull the foreskin back to clean.

Feeding

Choosing to breast or bottle-feed your baby is a personal decision.

Breastfeeding

Premature babies often have a harder time learning to breastfeed so it's important to be patient and get plenty of support. You can call the Warm Line or join a support group at the hospital or through La Leche League (847-519-7730).

Follow these breastfeeding guidelines:

  • Feed your baby when he/she shows early signs of being hungry. These feeding cues include: fluttering eyelids; noises; moving arms and legs; and sucking motions. Although your baby may have been on a 3- or 4-hour schedule in the hospital, he/she may want to feed more often at home.
  • Offer the breast every time he/she is hungry but at least 8 to 12 times in 24 hours.
  • Give your baby time to latch on.
  • A typical feeding for a full-term, breastfed baby is up to 20 minutes at each breast. Many SCN babies, however, have limited energy for feeding.
  • You may need to supplement with pumped breast milk or formula, as directed by your doctor on the discharge sheet, if your baby nurses less than 15 minutes at each breast, doesn't latch after 5 minutes of trying, or shows signs of stress, such wrinkling the brow, stretching hands or fussing at the breast. As your baby grows, he/she should breastfeed longer and need less supplemental feeding.
  • Continue to supplement until your baby is nursing at each breast for 15 to 20 minutes and is gaining weight well.
  • Continue pumping to maintain your milk supply even if you must supplement. Double pump for 15 minutes after each feeding - eight times in 24 hours or about every three hours until your baby is nursing at each breast for 15 to 20 minutes and is gaining weight well.

How do I know my baby is getting enough milk?

  • A weight check with your pediatrician or family practice doctor twice weekly may be needed until your baby is gaining weight well.
  • For a full-term baby, 6 to 8 wet diapers show that the baby is getting enough fluid: 4 or more bowel movements show that the baby is getting calories to help him grow and thrive. For a premature baby, diaper counts are important, but do not show the complete picture. The weight check is the most important measure.
  • There will be normal growth spurts when your baby wants to nurse more often, every one to two hours. These spurts may last for 24 to 48 hours. During these times, cut back on chores and take short naps to help conserve your energy. Continue to drink fluids through the day and eat a variety of good foods.

How should I store breast milk?

  • Sterilize bottles and nipples by boiling them in clean water. The pediatrician can tell you how long to sterilize.
  • Wash your hands in hot, soapy water. Clean the containers in hot soapy water, rinse and turn them upside down to dry.
  • Breast milk may be stored in the refrigerator for five to seven days or frozen for up to six months.
  • Store milk in 2-ounce portions that are dated, so that no milk will be wasted.

How should I warm the milk?

  • Put the container of breast milk in a bowl of warm water to bring it to room temperature. Do not microwave or boil. That can destroy the nutrients.
  • Check the temperature before feeding the baby to make sure it is not too warm.
  • Discard any milk not finished within one hour of the feeding start.

What should my baby's bowel movements look like?

  • They should be soft and unformed and may look seedy or have little lumps.
  • Babies may strain when having a bowel movement. This is normal as long as the stools are soft and without blood. Call your baby's doctor if you see blood.

What if I am having difficulty breastfeeding?

  • If you are having difficulty breastfeeding, call Women & Infants' Warm Line at 1-800-711-7011. The Warm Line nurse can schedule an appointment with a lactation consultant.
  • Nursing Moms, Etc., a breastfeeding supply store at Women & Infants, offers breastfeeding pumps and supplies. They are open Monday - Saturday, 10am - 5pm and Sunday, 10am - 3pm, or call 401-453-7940.

Bottle-feeding

Helpful hints for bottle-feeding:

  • Hold your baby while feeding. Do not prop up the bottle. It can cause choking.
  • Look at and talk to your baby while feeding to bond.
  • Discard any formula if not used within 1 hour after feeding begins.
  • Feed your baby every two to four hours, waking him/her when small if a nap is longer than four to five hours.
  • Sterilize bottles and nipples by boiling in clean water.
  • Bottles by Avant and Healthflow may be easier than the standard flat Playtex nurser. Note that premature infants may not be strong enough to use a regular bottle.
  • Avoid changing nipple types when your infant first arrives home.
  • Monitor feedings for dribbling or choking, which may signal the need to change to a firmer, slower flowing nipple.

How much should my baby take?

  • Feeding amounts and times vary from day to day. Follow the discharge instructions.
  • Focus on the total taken over the entire day versus the amount taken at one feeding.
  • Follow your pediatrician's recommendations after discharge, as this amount will change as your baby grows.

What kind of formula should I use?

  • Premature infants may go home on a formula containing iron and extra nutrients. Babies needs iron to stay healthy and active so use iron formula for the first year.
  • Your pediatrician will instruct you on when to change formulas.

How should I warm the formula?

  • Warm the bottle in a pan of hot water. Do not use a microwave because it may unevenly heat the formula and burn the baby. Also, important vitamins may be destroyed.
  • Test the formula's temperature on the inside of the forearm to make sure it is not too hot.

How should I prepare the formula?

  • Formula comes in powder, concentrate and ready-made versions. Prepare powder or concentrate by adding tap water that has been boiled for five minutes and cooled, following directions on the can.
  • Once prepared, each type may be slightly different in color and thickness.
  • If using concentrate, pour the formula into bottles and refrigerate until ready to use. Throw away any unused prepared formula after 48 hours. If you are using powder, pour just the sterilized water into bottles and refrigerate. At feeding time, add the appropriate amount of formula powder to the water and mix well. This prevents having to discard unused prepared formula.
  • Ready-to-use formula does not require any preparation. Pour desired amount of formula into clean bottles, cap and refrigerate.

Germ control

Hand washing is the best way to prevent illness. Follow these guidelines:

  • Keep antibacterial soap, paper towels and liquid hand sanitizer handy.
  • Wash hands frequently throughout the day, always before feeding your baby and after every diaper change.
  • Ask friends and family to wash hands before touching the baby.
  • Keep waterless soap in your car and diaper bag.
  • Wash your baby's toys and pacifiers regularly in hot soapy water.

To wash your hands well, you must:

  • Have paper towel or clean towel handy.
  • Wet hands with warm water, then add soap.
  • Rub hands together and lather. Wash hands for 20 seconds.
  • Wash around fingernails and between fingers.
  • Rinse with warm, running water.
  • Dry hands completely with paper towels or clean towel.
  • Turn off the faucet with the towel.

Immunizations

Immunizations are shots that offer protection from certain diseases and many are required by law. Click here to view an immunization chart.

If your baby is in the Special Care Nursery for a long time, he/she may be given some immunizations before going home. The pediatrician will give the baby others later. You must sign a consent form for the immunizations.

Miscellaneous tips

Temperature of the house

  • Keep the thermostat above 68 degrees F.
  • Keep the baby away from drafts, open windows, fans, and air conditioners.
  • Dress the baby the way you feel comfortable and add one more layer.

Outings

  • Avoid taking the baby out in bad weather.
  • Dress the baby according to the weather.
  • Avoid direct sun light and dress your baby with protective clothing, and a hat. Babies can burn very easily. Ask your baby's doctor about the use of sunscreen before six months of age.
  • Avoid large crowds for one to two months after discharge, and during the cold/flu season.

Playing

  • Place the baby on tummy for playtime.
  • Try a thin roll using a small towel or blanket under chest to raise baby a bit for comfort when he/she is on their tummy.
  • Place interesting objects - a mirror or your face - in front of the baby to encourage head lifting and propping on arms.
  • Enjoy social play with your baby. They enjoy face-to-face play, with lots of touching and gentle movement.
  • Encourage midline activities such as hand to mouth and patty cake.
  • Try bright, highly contrasting toys and mirrors.

Sleep

The American Academy of Pediatrics recommends that healthy infants sleep on their backs at night and naptime to reduce the risk of Sudden Infant Death Syndrome (SIDS). Rotate the baby's head from side to side with each nap. Do not use pillows, blankets, or waterbeds. They are not safe for the baby.

  • Always put your baby to sleep on his or her back, unless your doctor has told you otherwise.
  • Babies need 16 to 20 hours of sleep every day. Be alert for cues that your baby is getting tired or over-stimulated. Cues include stretching arms out; yawning; avoiding eye contact; falling asleep; or furrowing brows.
  • Buy a firm mattress should be firm. Never lie your baby on a pillow, or comforter.
  • Do not put any stuffed toys or blankets near baby during sleep time.
  • Place your baby on his/her tummy for short periods of time while he/she is awake. This helps prevent your baby from developing flat spots on the head, and helps develop chest and neck muscles.

Remember, that the NICU or SCN was a bright, noisy place and your baby may have some trouble adjusting to sleeping at home. To help, you can:

  • Set routines for naptime and bedtime.
  • Help your baby learn to soothe him or herself back to sleep.
  • Encourage regular activity during the day, and quiet time at night.
  • Rock or play soothing music for at least an hour.

Taking your baby's temperature

Learn how to take your baby's temperature when he/she is well, so you will know how to do it when he/she gets sick.

A digital thermometer is the most accurate to use with your baby. Ear probe thermometers are not recommended for newborns, pacifier thermometers may not be accurate, and glass mercury thermometers are no longer sold in most states. Make sure the package clearly says the thermometer is for rectal or under the arm (axillary) use.

A temperature of 100.4 degrees F or above is considered to be a fever in a newborn.

Taking an axillary temperature

A normal axillary reading is 97.2 to 98.8 degrees F.

  1. Hold the thermometer at a 45-degree angle and place the bulb in the baby's armpit.
  2. Hold your baby's arm snugly against his/her side.
  3. Digital thermometers take only a few seconds to read. Refer to the package directions for specific information.
  4. Clean thermometer after each use.

Taking a rectal temperature

Never take a rectal temperature on a premature baby unless your physician has said it is okay. A normal rectal temperature is 97.7 to 99.7 degrees F.

  1. Put a lubricant on the end of the bulb.
  2. Lay your baby on his or her belly, side or back on a firm surface.
  3. Hold your baby still by gently pressing the palm of your hand against the baby's back just above the buttocks (bottom).
  4. With your other hand, gently insert the thermometer so that just the shiny tip is one-half inch into anal opening.
  5. Clean thermometer after every use.

What should I do if my baby has a fever?

  • If your baby is less than eight weeks old, call your baby's doctor right away. Make sure you tell the doctor if the temperature was taken axially or rectally.
  • Keep clothing to a minimum.
  • Try to give your baby fluids.
  • Give the correct dose of Tylenol (acetaminophen) or Motrin (ibuprofen), as instructed by your doctor. Never give aspirin.

Information Worksheet

Health Care Providers

Pediatrician:
Name: ____________________
Telephone: ____________________

Specialist:
Name: ____________________
Telephone: ____________________

Specialist:
Name: ____________________
Telephone: ____________________

Specialist:
Name: ____________________
Telephone: ____________________

Visiting Nurse follow-up visit:
Date: __________ Time: __________
Contact: ____________________

Neonatal Follow-Up Clinic visit:
Date: __________Time: __________
Contact: ____________________

While in the NICU the following people have been primary members of your baby

Neonatologist: ____________________
Resident: ____________________
Primary Care Nurse: ____________________
Social Worker: ____________________
Other: ____________________
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