Preparing To Leave The Neonatal Intensive Care Unit

While you are learning all you can about caring for your baby, the discharge coordinator or case manager plans your baby’s final exams and prepares for discharge. In this article, we’ll cover the common discharge tests undertaken as you prepare to leave the Neonatal Intensive Care Unit.

Note that common discharge tests are explained here, but not all infants in the NICU require all tests to be performed. Ask your baby’s nurse what to expect as the discharge time approaches.

NICU Eye exam

If your baby was 30 weeks gestation or less or weighed less than 1,500 grams (3 pounds, 5 ounces) at birth, an eye exam will be done between 4 and 7 weeks of age.

Babies born after 30 weeks of gestation and weighing between 1,500 and 2,000 grams may also have this type of examination performed if there stay in the Neonatal Intensive Care Unit has been especially difficult.

Follow-up exams will be scheduled if the findings of the first exam warrant it. The exam is to identify any changes in eye tissue caused by retinopathy of prematurity.

NICU Hearing test

Hearing tests – which are also called audiological screenings are performed in most NICU nurseries before discharge.

Electronic sound and response monitoring determine if your baby can hear. However, environmental conditions, such as background noise or a baby crying, can cause inconclusive results. If this happens, a second test should be scheduled in a more controlled environment.

If your baby responds to your voice or toys that make noise when he cannot see them, there is usually no reason to worry. After discharge, your healthcare provider should monitor your child’s hearing with regular health exams. If you are concerned about your baby’s hearing, never hesitate to insist on a more extensive hearing exam. These are available in a pediatric audiologist’s office or pediatric outpatient rehabilitation centres.

Newborn Metabolic Screening Test

All babies are tested shortly after birth to identify some rare but potentially serious or life-threatening conditions. The number of exams varies by state and country.

Newborn metabolic tests may yield inconclusive results if the baby is premature, critically ill, or required a blood transfusion prior to metabolic tests.

If the screening test suggests a problem, the doctor will speak directly with you and order follow-up tests. Learn about test results prior to discharge from the NICU and report findings to your pediatrician.

NICU Blood Count Test

A final hematocrit or hemoglobin-reticulocyte count test is usually performed in the week of discharge. Although unlikely, your baby may be anemic and may need a transfusion at this time or maybe prescribed an iron-based medicine to help his bones make new red blood cells.

If so, follow-up laboratory tests are usually done in a pediatrician’s office or an outpatient clinic.

NICU sleep study (pneumogram)

Babies with ongoing apnea and bradycardia may have a special test to help determine the cause of these episodes. In different regions, this test is called a sleep study, pneumocardiogram or pneumogram. Philosophies vary regarding the use of pneumograms and not all neonatal intensive care units use them.

A pneumogram does not answer all the questions about your baby’s apnea and bradycardia, and interpretations of the test vary regionally. The American Academy of Pediatrics (AAP) states that “pneumograms do not help predict sudden infant death syndrome (SIDS) and are not helpful in identifying patients who must be discharged with monitors for use at home.”

NICU Cranial ultrasound

If your baby was born before 30 weeks gestation, she probably had multiple head ultrasounds to check for intraventricular hemorrhage.

Some intensive care units will do a cranial ultrasound or another imaging study of the brain near discharge for babies weighing less than 1,000 grams at birth.

Your neonatologist may also suggest an MRI close to your baby’s original due date, to help predict the need for early intervention services and ensure the best developmental outcome.

Sometimes a different brain imaging technique can show abnormalities that a screening ultrasound would not pick up. This does not mean that the initial ultrasounds were misinterpreted, but simply that each test has its limitations.

Remember that the information we present here should not be used as a substitute for the medical advice and care of your pediatrician. There can be many variations in the treatment that your pediatrician might recommend based on individual facts and circumstance so speak to your doctors if insure about what to expect.

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