Discharging From NICU Online Course(s) & Continuing Education

Survival in preterm infants has increased over the last few years, and this has been accompanied by an increasing focus on the importance of nutrition and the effects of preterm birth on later outcomes. Providing nutrition to sick preterm infants in the NICU is complex, and almost all preterm infants are discharged with growth outcomes (weight and length) considerably below their birth centiles. This is important because data show an association between poorer growth and nutritional status in the NICU, and worse longterm neurodevelopmental outcomes. Whilst greater efforts are required to improve nutritional status prior to discharge, the post-discharge setting represents a time period when brain growth is also rapid, and where the potential exists to improve outcome through nutritional interventions. However, the potential benefits of improved brain outcomes need to be considered alongside the possibility of metablic harm induced by excessively rapid growth which may increase risks of obesity and later chronic disease. This talk will consider the continued importance of breast milk after discharge, the potential role of fortifiers and supplements in meeting nutrient requirements, and issues around the timing of introduction of complementary foods.

Lactation consultants would benefit from expanding their understanding of the impact of the NICU stay on the family; moreover, they would benefit from identifying the essential role they could play in assisting families to accomplish a positive, healthy, and smooth transition home.
Despite continuing efforts to reduce prematurely worldwide, a significant number of infants are born too early or in a fragile medical condition. Many of these infants experience a lengthy stay at the NICU. Lactation support varies across facilities, but families, especially mothers, develop strong connections with their lactation consultant. As one of their most consistent providers in the NICU, the lactation consultant has the opportunity to recognize families’ need for continuing support after discharge and strategies to protect the breastfeeding relationship, attachment, and mental health in the long term.

Discharge teaching programs are typically established based on what we as health care providers think parents need to know. Reality sets in very quickly for families after taking home a premature newborn. Despite thorough discharge teaching and parent involvement in hospital, parents are surprised by the challenges they face post-discharge. Feeding, behavior, reflux, sleep, and parenting troubles top the list. Based on over twenty years’ experience working with premature infants and their families beyond discharge, the presenter will reveal common challenges encountered and discuss research-based and practical strategies for the NICU team to share with parents to smooth the transition home. A greater knowledge of post discharge sequelae and preventative strategies will aid the NICU team in optimizing the discharge process and ultimately improve outcomes for babies and parents.

While approximately 80% of UK mothers initiate breastfeeding, by 3-4 months, just 15% of infants receive any breastmilk. Despite the low rates of breastfeeding nationally, in 2021-22, 64% of the NICU graduates in our unit were discharged receiving breastmilk. One possible reason for the higher rates of breastfeeding in this population may be our innovative home NGT feeding programme. In order to hasten discharge from NICU, many mothers feel under pressure to introduce bottles to meet “full oral feeding” criteria. The home nasogastric tube (NGT) feeding programme focusses on the infant’s and family’s needs, without rushing the infant towards full oral feeding, which some are not yet ready for. In this way, all oral feeds can be at the breast, with NGT feeds as required for supplementation. We aim to reduce unnecessary days in hospital, reduce readmissions post-discharge, keep families close to their infants, and embrace the integration of families as essential members of the neonatal care team. This presentation will discuss the practicalities of designing a discharge pathway that optimises parental confidence and ensures competence with home administration of NGT feeds. It will also discuss how to predict which infants are ideal candidates for short-term home NGT feeding, and how to transition to direct breastfeeding. Finally, the presentation will present a case for home NGT feeding as an intervention to protect the mother’s breastfeeding goals, optimise clinical outcomes for infants, and improve the experience of neonatal care for families.

Many preterm infants remain vulnerable following discharge from the neonatal intensive care unit (NICU). Health challenges persist beyond the NICU including respiratory illness, breastfeeding progression, bottle feeding incoordination, behavior and development issues, impaired growth, infrequent stooling, and gastroesophageal reflux. Preterm infants are up to two times more likely than full term infants to be hospitalized in the first year of life. Parents are challenged to transition their premature baby home and to keep them home!

Community-based, specialized follow-up services following NICU discharge have a powerful impact. The Neonatal Transition Team in Calgary, Alberta, Canada provides post-NICU follow-up for very-low-birth-weight infants and their families. The team consists of community health registered nurses with advanced skill in premature infant outcomes, feeding and neurodevelopmental assessment, and a consultation partnership with nutritional and feeding specialists. While home visits have been the backbone of this service, the team questioned the feasibility and acceptance of virtual care and completed a three month quality improvement pilot. This virtual care pilot demonstrated optimization of health-care resources by providing safe, high-quality care at a reduced operational cost. The pilot was instrumental in the team’s management during the SARS-COVID-19 pandemic. Virtual care has been fully operationalized into the service delivery model and expanded to serve other newborns with feeding or growth challenges.