Able to maintain normothermia in an open crib.
Normal saturations in room air or completed arrangements and parental teaching for any supplemental oxygen or equipment needed
No apnea/bradycardia for 5 days before discharge
Tolerating feeds by mouth or other means without respiratory distress
Appropriate weight gain for gestational age
Home health service in place if needed
Parental comfort with routine care, medications, any equipment needed, and any procedures needed
Parental infant CPR instruction
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
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 grade II IVH or greater:
| |||
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:
| 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 usually after discharge from hospital, but referral should be made before discharge | |
Women, Infant, and Children Program (programs are state-specific) | All premature infants All infants that are to be discharged on special medical formulas | Referral should be made before discharge | |
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