Discharge and transfer

Transfer from the nicu  to a Post IC-HC or general hospital

The baby has already come a long way in a Neonatal Intensive Care Unit (NICU) and has now been transferred after a gestational age of at least 30 weeks and has a minimal weight of 1,000 grams. He does not need intensive care treatment in the NICU anymore, but can be looked after in a Post IC/ HC centre or in a neonatology department of a general hospital. After transfer, we try to keep the care similar as the care in the NICU. However, it cannot be avoided that some things are just a little different. Should there be any questions or doubts, it is important to keep talking to the nurse or the doctor.

In the first few days after the transfer, there will be a consultation with the paediatrician. What happened to your baby up until transfer will then be discussed and possibly the pregnancy too. In addition, the medical care will be explained and everything about the department. The plan for the first few days will be discussed. It is possible that your baby will have to recuperate from the transfer. In the first few days, we often see that we have to intensify the respiratory support a little. t. Care: We encourage you to be involved in the care for your baby as much as you can. We will help you care for your baby. Probably you already have helped with the care in the NICU. Discuss with the nurse what you can do yourself and when you wish to have some support. This might be when changing a nappy, taking the temperature and bathing.

When is your child ready to go home?

Your child can go home when you can give the care that your baby needs yourself. Generally, this means that your child does not need breathing support or monitoring anymore, and that he can keep himself at the right temperature in bed, can drink enough by himself and is growing well. In premature or SGA children this is often between 36-40 weeks and with a weight from 1800-2000 grams. These boundaries can vary between hospitals

Going home with support

In some cases, it is possible to learn how to give tube feeding so that you can go home with your child with tube feeding. At home your child can learn how to drink more by himself at his own pace until the tube is no longer necessary (also see the article “Learning how to drink”). You do not need to insert the tube yourself, but will get help from a special home care team. The paediatrician will guide you with feeding in the outpatient clinic. Sometimes it is necessary that a child goes home with oxygen and so also with monitoring. This will of course be discussed with you as parents beforehand. You will also be guided by a paediatrician when the oxygen therapy is phased out.

Information on discharge

Before discharge the nurse will give you information about feeding, the use of medication, treatment, and instructions for at home. Usually there will be a discharge consultation with the doctor and the nurse before discharge.

Follow up

Depending on the department advice, a follow up plan will be set up for your baby. This can be a special follow up consultation in the outpatient clinic, a regular consultation with the paediatrician or regular check-ups at the child health clinic.

Farewell to the hospital

Often you look forward to going home with your child, but you can also feel uncertain about it. It is nice to have your child home, but every now and then you might miss the doctors’ and nurses’ support. Sometimes there are certain considerations that need to be taken into account. It is very well possible that you will have questions about your baby when you are home, especially in the beginning. Make sure that once you leave the hospital you arrange who you can call if you are worried. For instance, this can be the Child Healthcare nurse or the Department of Neonatology. Please inform Child Healthcare that your child is home. The child healthcare medical specialist and nurses can help you with questions about your child. 

Do not forget the support from your family and friends. Be clear to them. Indicate what kind of help you would like and what you expect of them. Maybe you are still entitled to postponed maternity care; ask your health insurance company about this.

At home

After coming home from hospital many parents feel they have to get to know their child again. That is not odd, your child still has to get used to being at home. At the same time your child gets more and more curious about everything around him.

The brain of premature, SGA and ill children cannot always handle too much stimulation. Such overstimulation can come from outside, but also from within your child himself. Overstimulation from outside can be, for example, the sounds of other people in the house, the radio or TV, or going for a walk outdoors. Overstimulation from within your child can, for example, be hunger, tummy cramps and other discomforts. These ‘ordinary’ stimuli can be overwhelming for your child. You notice this because your child is more easily startled, is more difficult to comfort or sleeps more. It is logical that it makes you feel uncertain about if you are doing everything right.

  • Ensure structure: in the beginning it can help to maintain the hospital routine. After some time, you will notice that your child will search for his own sleep/waking pattern. There are fewer medical circumstances forcing him into a routine; he can now really indicate his own need for food and sleep in his own time. Make sure that the house is quiet and avoid overstimulation (not too many visitors at once and having to do the shopping). Peace and quiet as well as regularity are important. Ensure a good day and night routine.

    Let your child see and feel that you are there for him, by carrying/holding your child safely with you. That helps him to develop a feeling of security and safety and stimulates the bonding between you two.
  • Older children: Do you also have older children? They may feel happiest in their familiar daily routine and habits. The more you succeed in keeping your older child(ren)´s daily routine the same as always, the safer your newly born child will feel.

    Older children usually notice when their parents are under a lot of pressure and strain. Children also feel they should not make their parents’ life more difficult by bad behaviour. If carers stick to the normal routine and habits as much as possible, this provides support. Try to make sure that it is not too busy for your older child(ren) with extra outings and sleepovers in less familiar surroundings.
  • Visitors at home: Now that your child is finally home, everybody wants to visit. But premature, SGA or ill children need extra peace and quiet and routine. They are still extra sensitive to everything that happens around them. It is important that visits are well spaced out: not too many people at the same time and also not for too long. For instance, in the beginning your child will not enjoy being held by many different people, that can be unsettling and stressful.

    Try not to disturb your child’s routine too much: when your baby is asleep, let him sleep. You can also choose to invite everybody at the same time for a baby shower. Of course, your child does not have to be there the whole time.

    Any family and friends who have a cold, fever, have been sick, or have diarrhoea should wait before coming to visit. So should people with a cold sore or shingles.
Sudden Infant Death Syndrom (SIDS)

Sometimes babies die unexpectedly in their sleep even though they had seemed healthy. This is known as cot death and is also called Sudden Infant Death Syndrome (SIDS). There is still a lot unclear about the cause of cot death. However, a number of risk factors are known. Some factors cannot be changed, but others can. The factors we can influence are,:

  • Sleeping on his back: It is best to let your baby sleep on his back. From lying on his side, a baby can easily roll onto his tummy even after a few weeks. Lying on his front has a number of negative effects. It is possible that a baby will then lie with his nose and mouth against the mattress which then more or less stores the exhaled air, and when lying on his front, the baby can give off less heat and so may become too warm
  • Overheating: As a result of poor ventilation in the baby’s bedroom and too many layers of bedding, your baby may become too hot and his breathing may stop. When a baby cannot get rid of the warmth to the surroundings or the body temperature goes up, we speak of overheating. The blood vessels in the skin open wide in an attempt to cool down. The heart will become overloaded as a result.
  • Sleeping together: The safest place for a baby to sleep is in his own cot or cradle. Sleeping together with your baby in the same bed is a risk factor, especially in the first four months. The baby can become hot, get stuck between mattresses, fall out of bed or press his face against the pillows. Apart from that, a sleeping parent might roll on top of the baby. The risk increases by fatigue and stress, for instance.
  • Smoking: Parents smoking increases the risk of cot death. This also applies to passive smoking (smoke that stays behind in the clothes or hair) This has an adverse effect on the baby’s oxygen supply, growth and lung function.
  • Medicines: Calming medicines can play a part in cot death. Calming agents can make the baby sleep too deeply and so can have a negative effect on the breathing. If you give breastfeeding, you should only use these medicines in consultation with a doctor.
  • Breastfeeding: If you give breastfeeding, you reduce the risk of cot death. There is not much yet known about the causes.
Processing your own emotions

Once you are home and the first period of getting used to this new life together is behind you, many people around you will think that “everything is okay now”. But many parents also notice that after being home for two or three months they are only just able to process what they have gone through in the past weeks and months. They feel sad or out of sorts in another way. The people around them do not seem to understand that easily, but that is quite normal. You stayed afloat when it was really necessary and now that there is some time and routine, you are able to look back and sometimes relive the anxious times very intensely. Partners can also have very different emotions during this period. If you do not succeed in understanding each other, you can ask for help. Give each other the chance to deal with it in their own way and deal with your memories in the way that suits you.

Network: What also can help you to keep going is using your network, like your family and close friends. Do not be afraid to ask for their help: usually they are glad to help. When someone else can babysit for a couple of hours, you can get some rest and relaxation. You can also use professional babysitting agencies. Some agencies also offer babysitters for at night. It was also an incredibly anxious time for your parents, your child’s grandparents. Apart from worrying about their grandchild, they also saw how hard it was for you. Undoubtedly, they wanted to help wherever they could – maybe an older child stayed with them – but they also had a feeling of powerlessness when seeing your child in an incubator. It is a relief for them too that their grandchild is home now. Talk together about what happened; that gives relief and support. Most grandparents like to visit as often as they can. It is good to arrange that from the beginning. You want them to have the space to bond with their grandchild, but as the parent you are in control. You know your child best.

The involvement of grandmothers and grandfathers and other family, such as brothers and sisters, or very close friends, can give you a feeling of really being supported. Sometimes it is hard to understand exactly what is useful and necessary and which things you prefer to do yourself (shopping, cooking dinner, etc.) Be clear about what you would like them to help with as they cannot guess. Then you will avoid any unnecessary tension between you.

When everything is back to normal and calm again, your older children will feel you are around more again. Usually, they will catch up on the time when they were extra quiet. Just like you as a parent are very tired from the last few weeks. It is good to regularly get some extra help. For instance, you can do something together with your older child and leave the baby with a babysitter.

Help: do you feel sad, anxious or unhappy in another way? Do not hesitate to contact your general practitioner for help. Asking for help is a sign of strength, and shows that you are trying to do the utmost for you and your family.It is not strange at all if you do not feel well after such an emotional period, you are not alone in this. For contact with other parents, you can also look at the patient association website for parents of incubator children.

Tips for at home
Feeding

When your baby goes home, he is usually given 8, but sometimes 7 feeds. How much your baby needs to be fed will be discussed with you at discharge. Maybe in the hospital your baby has become used to being fed at set times. At home you can stick to those times or slowly adjust to your own daily routine. The child health clinic will give you further advice on feeding, unless otherwise agreed with you.

Breastfeeding

If your baby is breastfed, then in principle he can drink as much as he wishes, unless otherwise agreed with you. When your baby is satisfied, you know that your baby has been fed enough. Make sure your child wets about 4 nappies a day. In this way you are sure that your baby has been fed enough. A breastfed baby usually has soft baby poo. After a few weeks, the number of dirty nappies can vary from one in 6 days to 7 nappies a day. For as long as you give your baby only breastfeeding, or more than half of the time breastfeeding, you have to give your baby vitamin K and vitamin D every day.

Formula feeding

If your baby gets formula feeding, then it is important to follow the instructions on the pack. The nutrition must be prepared per bottle. In the Netherlands tap water can be used. You can heat the bottles in a microwave, with a bottle warmer or in a bain-marie. The prepared formula feeding cannot be kept for longer than an hour. Always throw away what is left. Always check if the feed is at the right temperature, for instance, by dripping a drop of the formula on the inside of your wrist. Bottles and teats must be rinsed with cold water after use and after that they must be cleaned with hot water and washing-up liquid. Use a special brush for the inside of the bottle. Bottles and teats can be washed in the dishwasher. The advice is to wash or boil these once every 24 hours.

Taking a walk outside

You can go for a walk with your baby outside. Even when it is colder, that is fine. Dress your child as usual (romper, baby grow, coat, and hat) and put your baby in a (if you like) pre-warmed pram. When there is a frost, put an extra blanket in the pram. Make sure that your baby does not get too hot. In summer make sure you protect your baby from the sun. After the walk, check your baby’s temperature an extra time.

Sleeping position

The department of neonatology (and also homecare) advises that you let your baby sleep on its back. Turn his head to the left or right and alternate. For more information on “sleeping safely” go to this website

Crying

It is normal that your baby sometimes cries. Try to find out what is making him/her cry and take away the cause, if possible. Causes of crying:

  • Hunger
  • Dirty nappy.
  • Being tired or overtired.
  • Your baby needs to burb. 
  • After the feeding your baby has colic (tummy ache) (in this case, your child will cry loudly and persistently and seem stressed). 
  • Pain.
  • Seeking contact/attention. 
  • He is out of sorts for some reason. 
  • Transition to another feeding routine. 
  • A day adjusting breastfeeding. 
  • A high or low temperature.

When your baby cries a lot, it is important not to get into a vicious circle: becoming increasingly tired, irritable and less able to tolerate things, causing your baby to cry even more. Try to come up with practical solutions, such as arranging a babysitter so that you can get a good sleep yourself, or sometimes spending the night apart. It can also help to keep a crying diary to create an overview for yourself.

If you think your baby is in pain, is crying abnormally often or loudly, or if the crying worries you, please contact your GP, paediatrician or the child health clinic. See also the article “Crying baby”.

    Follow up

    Outpatient check-ups with the paediatrician: The number of check-ups at the outpatient clinic can vary from none, a one-off check-up to more check-ups.Your baby will be seen by a specialist nurse or by the paediatrician in the outpatient clinic. You will also go to the child health clinic for checks.

    Outpatient clinic for premature babies: In some hospitals, babies, who were born prematurely or whose birth weight was too low, can go to a special outpatient clinic for premature babies. This is often a combined consultation with the neonatologist, physiotherapist, speech therapist and a child healthcare nurse. Psychological aftercare may often be offered by the psychologist in the outpatient clinic, possibly in combination with different appointments at the premature babies’ clinic consultation hours.

    Incubator aftercare: Usually parents of a newborn baby have the right to at least 24 hours of maternity care spread over eight days, depending on their health insurance. If your baby is in hospital these days, then you will not no longer be eligible for this. As a parent of a prematurely born baby or a baby who was hospitalised in the department of neonatology, you will miss this maternity care. Then you miss all the help and advice given by the maternity caregiver, which may just help you a little bit in establishing the best daily routine. It is also rather difficult to suddenly be alone or with the two of you after all that care in hospital. Most maternity centres offer postponed maternity care or incubator aftercare. A specialised maternity caregiver will then visit a few times to give information, advice and tips. She will come for a few hours (mostly 3 times 3 hours) to give tips and guidelines, so that after the period in hospital you can look after your baby with confidence at home. In hospital you already did a lot by yourself and you learned a lot, but at home it can be just a bit different. She can answer questions like: What is the most convenient place for the bath? Is the baby’s room too hot or too cold? How does breastfeeding fit into my daily routine? Some maternity centres do not have specialised maternity care givers. Then ask for someone with a lot of experience. But note: postponed maternity care is not included in basic healthcare insurance. You have to have additional insurance. So please check your insurance policy carefully to see if it is included and what is covered and what not. Of course, you can always call your insurance company to check.

    Back to work

    The weeks fly by and before you know it you are expected back at work. Since January 2015 maternity leave has been increased for mothers whose children were admitted to hospital after birth or during the period of the maternity leave. This is based on the principle that a mother must be able to spend ten weeks at home with her child after having been discharged from hospital. Your total maternity leave is normally sixteen weeks. If your child is born prematurely, you will get the weeks from before the due date, added on after the birth. If those extra weeks do not add up to ten weeks at home together, you are entitled to a maximum of ten weeks extra leave. The Employee Insurance Agency (UWV), however, does not include the first week, so that in practice it may turn out to be a maximum of nine extra weeks. It is good if your employer supports you in getting back to work. Often this can be in consultation with an occupational physician. Get in touch in time. If your occupational physician/employer works together with you to find a flexible solution, many frustrations can be avoided. If there were medical complications around your delivery, then the standard leave of absence is hardly enough time to recover. Inquire whether previously made arrangements about your return can be more flexible and if there are special leave of absence arrangements. The social worker can help you with this.

    If you are self-employed, then the situation is different. If you do not work, you do not earn any money. But you do have the freedom to decide yourself if and how much you will work. Talk to your partner and other people around you to see how your business can continue for this period.

    After the birth of their child, partners get a week of fully paid parental leave. You can take that leave immediately, but it is also allowed at any time in the four weeks after the birth. This Act also guarantees that partners can take an extra five weeks of parental leave in the first half year after their baby’s birth. In that period, you are entitled to 70% of your salary. If your child is in hospital for a longer period of time, this leave is naturally not enough. Then it is possible to apply for care leave.