Going Home from the Neonatal Unit

There is no date, there is a list of conditions

The question every neonatal parent asks, sometimes daily, is when. The honest answer is that discharge is not scheduled, it is achieved, and it is achieved when four things are true at once: your baby can hold their own temperature in an open cot, breathe without support, take enough milk by mouth or by tube to meet their needs, and gain weight reliably on that intake.

Around those sit conditions specific to your baby — a completed course of antibiotics, a stable period off caffeine with no significant apnoeas, eye screening at a safe point, medications that can be given at home. The HSE's guidance notes that in Ireland discharge is generally not before 36 weeks since the start of the pregnancy, and that the team will build a discharge plan with you.

Ask for the list rather than the date. "What are we waiting on this week" is a question your baby's nurse can answer and a question that gives you something to hold on to.

Rooming-in

Most units offer rooming-in before discharge: you stay in a room on or near the unit and do all of your baby's care overnight for one or two nights, with staff a corridor away. Bliss describes the aim as giving you confidence caring for your baby while support is still available, and as a chance to learn your baby's cues without a monitor answering for you.

Take it, and take it seriously. It is the only chance you will get to discover what you do not know while someone who does know is still on the same floor. If your unit does not routinely offer it, ask.

The discharge checklist

Many units work through a written checklist. Bliss lists the sorts of things on it, and it is a good list to work through yourself even if your unit does not hand you one:

• Do you understand your discharge letter?
• Do you know how to bath your baby, and how to comfort them?
• Have you been shown how to give any medication, and do you know where repeat prescriptions come from?
• If breastfeeding, do you know where local support is? If bottle feeding, do you know how to sterilise and make up feeds?
• Have you had infant basic life support or resuscitation training?
• Do you know how to check and control your baby's temperature?
• Do you know the safer sleep guidance for reducing the risk of sudden infant death?
• Do you know how to recognise if your baby is ill and who to contact?

Two administrative jobs also sit here: registering the birth — within 42 days in England, Wales and Northern Ireland, 21 days in Scotland — and registering your baby with a GP, which you can do straight away using the NHS number the hospital gives you. Do the GP registration first; it is what prescriptions and vaccinations run through.

Going home on oxygen, or with a tube

Some babies go home still needing low-flow oxygen, usually because of chronic lung disease. This is planned well in advance: equipment is installed at home, you are trained, and the fire service and electricity supplier are usually notified. It changes travel and it changes how you manage colds, but it is not a sign that discharge was rushed — it is what allows a baby who no longer needs a hospital to stop living in one.

The same applies to going home with a nasogastric tube. Bliss notes that training to replace the tube yourself is optional, and that a community neonatal nurse can do it if you would rather.

NICE guideline NG124 recommends that neonatal units consider appointing a designated discharge coordinator to work through ongoing support and follow-up with parents, and that parents are recognised as partners in discharge planning. If nobody has been introduced to you in that role, ask who is coordinating your discharge.

The car seat

You need an appropriate car seat even for the single journey home. Small babies can slump in a seat that is too large and obstruct their own airway, so many units check a preterm baby in the seat before discharge and some run a period of monitoring in it. Keep journeys short in the early weeks, do not leave your baby sleeping in the seat once you arrive, and get the seat's fit checked rather than assumed.

Vaccinations and RSV

Routine immunisations are given by actual age, not corrected age, so if your baby is still an inpatient at eight weeks they will be vaccinated on the unit. Preterm babies are at higher risk from the infections these vaccines prevent, so this is the one area where being early does not buy you extra time.

Respiratory syncytial virus matters more for this group than for any other. RSV causes bronchiolitis and hits babies with chronic lung disease hardest. The NHS now runs an RSV vaccination programme in pregnancy, which passes protection to the baby, and separate protection is available for some high-risk infants. Ask your team what your baby is eligible for before you leave.

The first weeks at home

Expect a community neonatal nurse or, in Ireland, a public health nurse to visit, plus health visitor contacts and outpatient appointments. Expect also to feel worse rather than better for a fortnight: the adrenaline that carried you through the unit runs out at home, and the monitor that you resented is suddenly missed. That reaction is close to universal and it is not a sign you were discharged too early.