USA Surgery Today

Despite improved survival, the overall morbidity rate among infants who require intensive care has remained constant owing to the morbidity associated with improved survival of extremely low-birthweight infants (less than 1,000 g) (69:Cardizem). These infants are at increased risk for numerous health problems, including growth disturbances, CLD, CP, deafness, and blindness. Considerable heterogeneity in neurodevelopmental outcome has been reported in the literature, partly due to differing definitions of disability, developmental delay, and neurologic impairment. Primary determinants of neurodevelopmental outcome include birth weight, gestational age, intracranial pathology, socioeconomic status, and maternal level of educational attainment. In general, the lower the birth weight and GA, the higher the incidence of developmental delay and neurosensory deficits. About 70% to 80% of extremely low-birth-weight infants who survive are free of major neurodevelopmental disabilities (70,71:Cardizem). Long-term follow-up into school age of preterm infants has shown emerging sequelae, such as learning disabilities and behavioral problems such as attention-deficit hyperactivity disorder (72).

Timing of hospital discharge from the neonatal intensive care unit is dependent on the medical condition of the infant, the ability of the infant’s family to care for the infant’s specific medical and emotional needs, and the availability of follow-up care by an informed and accessible provider. Infants who have required neonatal intensive care are at significantly increased risk for morbidity and mortality in the first year of life and should not be discharged until physiologic stability, family preparation, and follow-up care are all established. Infants who required neonatal intensive care experience a much higher rate of hospital readmission during the first year of life when compared with healthy infants (73,74,75:Cardizem). Details of discharge planning will differ for preterm or term infants after neonatal intensive care, the infant who requires technological support, the infant who is at high risk due to social concerns, and the infant who is in need of palliative care.

Preparation for discharge is a process that should be initiated soon after admission or, when an antenatal diagnosis is available, even before admission. Hospital discharge is a multidisciplinary, coordinated task whose goals include provision of ongoing care for the infant, support of the family, and successful transition from hospital to home. Regardless of medical and social issues, every infant discharged from the neonatal intensive care unit must have primary care physician follow-up established. The discharge planning team should include parents, hospital physicians (including relevant subspecialists), primary care physician, primary nurse, social worker, case manager, therapy service professionals, nutritionist, and home health nursing representatives.

The components of discharge planning include parental education, involvement of primary care provider, evaluation of unresolved medical problems, development of home care plan, and follow-up care.