Getting Ready For Discharge….Home Sweet Home!

Happy New Year to all of our Preemie Prints families! I’d like to send a special shout out to those precious families who spent their holidays in the NICU.  Often in that rollercoaster world also known as the neonatal intensive care unit…it’s sometimes hard to believe or even consider that it will ever slow down or that you will ever eventually be able to go home.  But for most families…home sweet home will become a reality and the rollercoaster does eventually stop.  One of the best ways to look forward to that is to start preparing now.

Whether your baby has been in the NICU 3 days or 3 months..it’s never too early to start getting ready to go home!!  Often because the health care team is initially very focused on life and death decisions and day to day management we don’t always address anticipatory guidelines for discharge until very close to the  discharge date. For some families the rapid progression from almost ready to go home to it’s time to go home can increase anxiety even more so than the admission!!  Although the NICU can be a scary place,….. for many families it can eventually also become quite comfortable..a home away from home…..staff  become family and monitors and equipment become friends.  As a result… leaving the routine  or perceived safety of the NICU suddenly places families into foreign and sometimes frightening territory.

Although each family will have to navigate its own path to become comfortable with the routine and quiet of home as compared to the NICU there are five essential steps on the yellow brick road to home that may help to ease the transition…most of which you can start working on right now. 

First identify your pediatrician..and give yourself time to interview the pediatrician as well as tour the office prior to discharge. Many families have not had a chance to select a pediatrician prior to delivery..and even if they have, their choice may change depending on the needs of their preterm infant at discharge. Many preterm infant require frequent visits after discharge for weight checks, reflux, or anemia and you will want to make sure your pediatrician is within a close traveling distance from your home.  Some questions you may want to consider when interviewing your pediatrician are do they see premature infants in their practice? Are they comfortable with preterm babies on oxygen or monitors?  Do they have separate entrances for well and sick children? and Do they offer the RSV shot or can they arrange for you to receive it if you quailify for it?

In addition to identifying the pediatrician, you want to make sure you have an approved car seat with base. Your premature infant will require a car seat safety evaluation test prior to discharge. Many premature infants go home much smaller than term infants and their breathing and heart rate needs to be stable while sitting upright in the car seat. Your physician and staff will evaluate this prior to discharge. Prior to bringing your car seat to the hospital have your local fire department evaluate it for correct installation in your car. Most fire departments offer this service free of charge.

Find out what type of formula your baby will be going home on at discharge…...most premature infants will be discharged home on breast milk with additional additives or preterm formula. Make sure you know which store carries the formula you will need or the additive you will require to fortify your breast milk prior to discharge. Additionally remember to bring whatever special bottles or nipples you may be using at home for your baby to practice with in the hospital prior to discharge. For many families one of the most frustrating parts of discharge is finding the store that carries your premature formula and getting the baby used to a new nipple or bottle as well as a new routine. Additionally, if your premature infant is going home on medications..remind your physician or practitioner to give you the prescription 2-3 days prior to discharge so that you have time to get the prescription filled and time to practice giving it to your baby prior to discharge.

Finally most neonatal intensive care units offer CPR training prior to discharge as well as the opportunity to spend the night with your baby prior to discharge. Allow yourself time before discharge to arrange to view the CPR video or to schedule CPR training for yourself and all caregivers for your infant. Additionally if your neonatal unit offers the opportunity to spend the night with infant prior to discharge, strongly consider using this option.  Spending then night with your infant will give you the chance to be exclusively responsible for your baby for an extended period of time, to become used to care in some cases without a monitor and to become more comfortable with the typical breathing pattern of a preemie. Often parents notice things over this extended period of time that they did not appreciate during the 3hr visits for feeds.

Identifying the pediatrician, locating the formula, verifying the car seat, filling the prescriptions, taking CPR and spending the night are just a few of the ways you can begin to look ahead and prepare to take your baby home. It may seem like it’s a long time away…but before you know it…your baby will be out of an isolette, into a crib and into your arms and into your home. It’s never too early to start planning for that special day.  

Wishing you a Happy New Year…and reminding you to consider these few tips to make your Baby’s Homecoming and Yours..the Very Best!

Happy Father's Day in the NICU

When I wrote the blog celebrating Mother's Day in the NICU, I had every intention of dedicating a similar blog to Dad's in the NICU on their special day as well. But here it is July 12th almost a month after Father's Day and I am just getting around to it. First let me apologize to Dad's everywhere....please know that you have a special place in my heart and I have carried this message in my head for the past three weeks.....I guess it's true that Dad's are often the last to get recognized. My husband always says.....there's way more attention given to Mom's on Mother's Day than Dad's on Father's Day and wives or girlfriends on Valentine's Day than husbands or boyfriends...I must admit it's sad but true...even Mom's get more attention on Valentine's day when Dad's may not. So let me go on record by saying that even though June 19th has come and gone..as far as I am concerned every day is Father's Day!!


Father's in the NICU are some of my favorite people...they constantly fulfill two roles...they want to be and have to be strong for the Mom's but at the same time they show incredible tenderness in the face of what for many is the most fragile of human lives. I recently attended a delivery and was reminded by a Dad what a gift it is for me to be there to see a new soul enter the world and not to ever take that for granted. I was standing in my usual spot in the delivery room, near the warmer in what seemed like the zillionth delivery of my life and listening to a mom push and finally deliver her baby. I heard the OB sharing what a beautfiul baby it was and coaxing this new and tentative Dad into his first official Daddy duty...cutting the umbilical cord which he did with impressively steady hands. Finally the nurse brought the baby to my team and we begin to dry her and encourage her already healthy cry and obviously well working lungs.


From the side I heard the slightest sniffle, then a whisper....." Hello Baby Girl.....I love you soo much....and I can't wait to change your first diaper....." I looked in to the face of a Dad, a Father......and I saw pure love, genuine tenderness, and shining adoration...and I smiled....yep another Daddy's girl in the making. NICU Dad's do cry in the delivery room....they also cry in the NICU....they pray in the NICU, they hold Mommy's hand, they hug Mommy's shoulders, they wheel her wheelchair back and forth from Mom's room to the NICU, they bring breast milk to the NICU from home....they get updates for Mom....they go to work and drive mom to the hospital every day while on maternity leave....they figure out how to use their large hands to lift a one pound bundle and change a diaper or take a temperature and every now and then they manage to get a nap while kangarooing the tiniest of humans on their chests...skin to skin, heart beat to heart beat...father to child...and for that and so much more we appreciate them.


But as I shared in the Mother's Day Blog....you don't have to be a NICU Dad to be celebrated on Father's Day. The same traits we see in NICU Dad's we see in all awesome Father's. They are protectors and providers, they know how to have fun, they are troop leaders and team captains, they are movie buddies and confidantes, they give the family security, they make time for their children, they make time for Mom, they love with sacrifice, and they are committed to creating a world that their child can thrive in...and their dreams can come true. So if you know a Dad like that....then thank them....they may be macho on the outside...but they want to know that they are appreciated too...that every now and then they got it right...so for now...we can tell them...and then later....the kids that make them Father's can tell them too..and I am sure that's the best Father's Day present of all!

Special Families..... Special Babies

One of the hardest things about being in the NICU is dealing with the question of why....which of course you can't really deal with because no one ever really knows why.

We can explain medical conditions and it makes us feel better but do we really know why? We can talk about prenatal care....but what if you did get prenatal care? Then why? We can talk about risks for prematurity...but why does someone else have the same risk factor and end up with a baby that avoids the NICU? Why do term babies end up in the NICU? Why are there problems at birth that didn't show up on the sono? Why do some babies go home healthy and others go home with challenges? As you know the list goes on and on...and unfortunately it is infinitely longer than the answers.

I have been in practice 10 years and out of medical school 15 years. I have been to tons of lectures, done tons of research and spent tons of money on my education. I have taken care of thousands of babies and still it doesn't matter...because none of us really knows why. And that's the question parents seem to ask themselves the most in those first few days.,weeks... months and sometimes years later. And truthfully it's a question I have too.

At one of those many lectures I attended I had the opportunity to hear a mom speak about her child who was born with a serious chromosome defect and only lived until she was 9 months of age.... a miracle in itself because the doctors had said she wouldn't live past 24 hours. What she said was this............"God could have chosen anyone in the world to be this child's Mom and Dad...and he chose us...Why Me?........ Why Not Me?... we are forever grateful for the privilege of having held her, cared for her and to this day loving her."

Those words have stayed with me..........."Chosen".....I never really thought about it that way..............but it's true. And they provided me great comfort as I thought about my own son...who was full term and healthy but with significant learning disabilities............."God could have chosen anyone in the world to be his mom and dad ...but he chose us ....trusted us...Why Us? Why Not Us?"

So now whenever I meet a special new life in the NICU.....I think...... I was chosen to work today....to experience this life....experience this family....to treasure this moment.....I am grateful for the opportunity....and look forward to another chance to learn...to grow....to share.

Special Families..... Special Babies... Chosen Journeys...Appointed Moments...it's all in a day's work in the NICU and you know what.....out of the NICU too!

Why Neonatology?

I've wanted to start a blog for years....to connect with those special people chosen for NICU journeys and to connect with those people trying to help those people chosen for NICU journeys. Although I have been a neonatologist for 10 years..........there's one question that always seems to make me pause........cause my voice to crack...and bring tears to my eyes. It's a simple enough question, "What do you do for a living?" We all answer this question over and over...again and again...and most of us know the answer. It's not that I don't know what I do...I do know...it's that most people understand what I do...what they really want to know is Why I do.

A neonatologist is a pediatrician that specializes in the care of premature infants and sick term infants. Usually when I say that...the next comment i s, "Why?? How sad....I couldn't do that." To that I say.....I was originally led to neonatology because my sister was a preemie and I was fascinated that she had spent the first three months of her life in a plastic box called an incubator. But the longer I live... the more I realize those seeds were planted by God.....this isn't just a job it's a ministry and for that I am grateful. Every time I am in the delivery room....and look into a precious baby's face....I remember we are created in His Image. I think I am looking at His Image. To feel a little chest moving, to see a little heart beating to watch a baby receive what truly is the breath of life... what a gift.

What's more...unfortunately and yes sadly, sometimes the gift is short....and then not only do I get to see His image but I get to see the faces of angels. I am reminded again how precious life is, how precious families are and how precious children are. What a privilege it is to care for them and their families....and I don't take it for granted. I recognize that we will not be able to save every baby...but we can save the human spirit...and that's what it's all about..............and that's why I do Neonatology!