LBW Discharge

Criteria

Dr. Nandkishor S. Kabra

DM (Neonatology), MD (Ped), DNB (Ped),
MNAMS, MSc (Clinical Epidemiology, McMaster University, Canada)
Consultant Neonatologist and Director, NICU,
Surya Hospitals, Santacruz (W), Mumbai
 Outline
 Introduction
 Medical criteria - clinical condition
 Screening criteria - imp tests
 Parents readiness - KMC, medications
 Psycho-Social readiness
NICU - high risk babies, stressed parents
Responsibility of NICU Team
 Ensure - parents understand the importance
of physiological maturity and stability
 Clinical readiness
 Training of parents in all aspects of regular
care of the babies
 Extra attention is needed to avoid
complications
 Discharge Planning
 Ideally start at the earliest possible
opportunity and adjusted according to
infant’s clinical progress with oral
feeding, etc.
 Neonatal medical team, parents,
nursing staff, lactation counselor and
as required other sub-speciality
experts
 Timing of Discharge
 Many factors …
 Developed versus resource limited settings
 Treating physician - utmost priority should be
the safety and wellbeing of the baby, as a
rushed decision…
 Financial considerations and resource
limitation impact decision making
 Treating team should try their best to
convince all stakeholders…
 Ideal…
 Typically discharged once they fulfill
the criteria described below
 Essential criteria being a gestation
close to 35 weeks
 Weight of close to 1600 to 1800 grams
 GA is a critical factor which is more
important than the weight
 1. Medical Criteria
 Clinical condition
 Physiologic Maturity
 Thermoregulation …
 Capable of maintaining normal
temperature in cot with normal level of
clothing at usual ambient temperature
 KMC Care
 Control of Breathing and
Respiratory Stability
 PT baby - free of respiratory support
and caffeine for at least 5-7 days
before discharge
 PT baby - free of significant apnea,
bradycardia and desaturations
episodes for at least 3 days while being
off caffeine
 PT babies with BPD …
 Weight Gain
 Wt 1600 -1800 gm
 PT baby - crossed birth weight and has a
stable weight gain of 15-20gm/kg/day for 3
consecutive days
 GA*
 Parents capability - assessment
 Baby’s well being - most important
 Risks explained
 Feeding
 Mother confident - complete suck feeds
 Off the feeding tube for at least 3 days,
without any significant desaturations
episodes during this period
 NNS
 Vaccination
 PT babies - Initial Vaccinations - just
prior to discharge
 Follow-up vaccinations as per
chronological age
 2. Screening Criteria
1. USG Brain
2. ROP, long term follow-up plan*
3. OAE, BERA at follow-up
4. Osteopenia of Prematurity
(If not done already / missed, plan in
follow-up)
 Screening - Labs
Hb, Electrolytes
Osteopenia of prematurity:
Calcium, Phosphorous, Alkaline
Phosphatase
Thyroid function tests
Basic NBST
Full Pre-Discharge Assessment
 Anthropometry – Growth Charting – Weight, Head
Circumference, Length
 Head to Toe
 Eyes, Oral Thrush
 Inguinal and umbilical hernia
 Diaper rash, CDH
 Injection sites, Skin rash
 Neurodevelopmental assessment
3. Parents Readiness
 Counseling of parents+ before discharge
 Parental education should be an
ongoing process as a part of family
centered care in NICU
 Hand hygiene and measures to prevent
infection
 Feeding guidance
 Temperature care at home, home KMC
 Baby routine cares (e.g. nappy
changes, bathing, feeding, positioning
etc.)
 Administration of medications including
nutritional supplements
 Importance of supine sleeping to
prevent SIDS
 Pediatric and Neuro-developmental
Follow-up
 Risks of re-admission
 List of danger signs, documented in
discharge summary so that they can
seek medical attention immediately
(poor feeding, lethargy, fever, blue
episodes, breathing difficult, reduced
urine output, worsening jaundice and
others) and emergency transportation to
the nearest facility
https://iapindia.org/pdf/1409-Ch-052-Identifying-sick-newborn-
IAP-parental-Guideline.pdf
In rare situations (special cases)
Tube feeding
Stoma care (surgical babies)
Home oxygen where necessary

 Specific training sessions, infant safety

advice, demonstration of first aid (infant
CPR) including management of choking
specially for high-risk neonates
 Importance of attending all follow up
appointments including ophthalmology
review, physiotherapy and other
supportive therapies as applicable
 Specific training on simple home
interventions- Visual/Auditory/Tactile
stimulation
 Medications
 Are prescribed medications essential?
 Compliance to medications
 Implications of missing doses
 Teach the parents how to administer the
medication in the correct dose while in
NICU
4. Psycho-Social Readiness
 Psycho - Social circumstances:
 Family Ready?
 Grand Parents support?
 Address all parents questions/concerns
 Formula Feeds - economy, affordability
 Preterm to term formula
 Social circumstances
 It is important to review the social
circumstances (home environment,
hygiene, infection risk, ability of parents to
carry out home instructions and attend for
follow up), and appropriate referral should
be made where additional support might
be needed
 ICE -Local pediatrician contact
 Discharge Summary
 Concise and Complete
 Focus on the important aspects of follow
up (reviews and tests) including
grouping of appointments for family’s
convenience where possible
 Pre-designed templates, and it is good
practice to amend/revise this from time
to time as part of the QI
 Compliance to Follow Up
 Provide a easy post discharge support
system
 Follow-up the baby 3-7 days after the
discharge date
Parents are coping well?
Baby is gaining weight?
Answer any new questions
 Take Home Message
 Discharge Planning – VIMP task
 Adequate thought and consideration should
go into planning and execution, Policy
 M-S-PR-PS criteria*
 Good to have a guideline including checklists
to cover all aspects comprehensively
 Process should be reviewed regularly as part
of the department QI initiative