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  1. Able to maintain normothermia in an open crib.

  2. Normal saturations in room air or completed arrangements and parental teaching for any supplemental oxygen or equipment needed

  3. No apnea/bradycardia for 5 days before discharge

  4. Tolerating feeds by mouth or other means without respiratory distress

  5. Appropriate weight gain for gestational age

  6. Home health service in place if needed

  7. Parental comfort with routine care, medications, any equipment needed, and any procedures needed

  8. Parental infant CPR instruction

  9. Appropriate follow-up arranged, including a primary physician comfortable with managing the level of care required and able to see patient within 2 days of discharge

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Discharge Planning

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  • Discharge planning should be started early, especially for infants with complex medical needs.

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Planning

Criteria

Timing

Follow-up

State newborn screen

All infants

Each state is different in terms of timing of screening and which disorders are screened for; check with your state on the timing and sample preparation

In Texas, two screens are done: First at 24–48 h of life; second at 7–14 d of life

Some states only require one screen

Second screen is usually to evaluate for false-negative results on the first screen

Some states only require one screening test, and others require two; check with your state on the number and timing of state screenings required

Cranial US

Infants born at <32 wk PMA or birthweight <1500 g

At 7 to 10 d of age or earlier at the discretion of the attending physician

No hemorrhage on initial screen:

  • If GA <28 wk, repeat at 4 wk chronological age and 36 wk PMA (or sooner if discharged <36 wk PMA)
  • If GA >28 wk, repeat at 4 wk chronological age or 36 wk PMA (or sooner if discharged earlier than 36 wk PMA)

If grade II IVH or greater:

  • Weekly cranial US to follow for development of post-hemorrhagic hydrocephalus; more frequently if clinically indicated

Ophthalmologic screen

All infants <30 wk PMA or <1500 g birthweight

or

Infants 1500–2000g birthweight if the infant is at high risk for developing ROP

31–33 wk PMA

Based on findings of initial screen (may be within a few days for pre-threshold disease to every 1–3 wk for immature retinas at risk of progressing to ROP)

Audiology screen

All newborns

Infants admitted to the level II nursery or NICU for ≥5 d require screening with an ABR

≥34 wk PMA

As needed for failed initial screen

Car seat testing

All infants born <37 wk PMA or older infants with disorders that may impact the airway (eg, hypotonia)

Can be tested immediately before discharge home

Vaccinations

See Chapter 19 (Infectious Diseases) for vaccination guidelines

Occupational therapy or physical therapy

Infants who meet one of the following:

  • Birth at ≤28 wk PMA
  • Birthweight <1000 g
  • Neurologic injury (IVH, PVL)
  • Any disorder that impacts movement
  • Orthopedic impairment

As soon as possible during the hospitalization

As recommended by consulting therapist

Early Childhood Intervention (programs are state-specific)

All infants <1500g birthweight or <32 wk PMA

All infants who are believed to be at risk for abnormal neurodevelopment or abnormal physical development

All infants who are believed to be discharged to a high-risk home situation (eg, multiple other children, young mother)

Initial screen is ...

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