Going home: Facilitating discharge of the preterm infant

Question 1

Prolongation of NICU stay has been associated with what bad outcomes?

Answer 1

Bad parent-child relationship
FTT
child abuse
parental grief/feelings of inadequacy

OTHERS:
increased nosocomial infections
growth and development

Question 2

When are infants ready for discharge?

4

Answer 2

need to do the following:

• thermoregulation
• breathing control
• respiratory stability
• feeding skills and weight gain

Question 3

How do you define Apnea of prematurity

Answer 3

cessation of breathing > 20s or 10-20s with desaturation or bradycardia

Question 4

How long is the half life of caffein?

Answer 4

up to 100 hours

Question 5

How long should you monitor a kid after the last apnea?

Answer 5

a minimum of 5-7 days (96% have none after 7 days)

one study showed that 5% of neonates had them up to 8 days after

Question 6

Which kids are at an increased risk of longer periods of apneas?

Answer 6

• kids 36 wks

for infants 13 days apnea free was indicated

Question 7

Is apnea of prematurity associated with SIDS?

Answer 7

No

No evidence to support this

Question 8

Should kids with apneas go home with monitors?

Answer 8

No evidence to support their use

Question 9

What should the target sats be for kids with BPD?

Answer 9

most authors suggest >90%

the only benefit seen with higher SaO2 targets were a nonsignificant reduction in progression to threshold ROP and a modest decrease in retinal ablative therapy for severe ROP
No study has looked at Pulmonary HTN

Question 10

Neonates needing ETT and garage feeding are at risk of oral aversion. Is there anything you can do to minimise this risk?

Answer 10

Non-nutritive sucking

• shortens length of stay in hospital and also facilitates transition from tube to oral feeding

Question 11

What are some family risk factors for bad neurodevelopment outcomes?

Answer 11

low educational level
poor socioeconomic circumstances
young maternal age
language barriers
inadequate housing
use of illicit substances
depression
lack of family support
unable parental relationship
infrequent family visits during NICU