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Discharge Instructions: Taking Your Premature Baby Home From the NICU

Woman securing baby in carrier.
A car seat that supports the head helps prevent airway problems.

Most preemies are ready to go home when they are:

  • Able to maintain a stable body temperature in an open crib

  • Breathing on their own

  • On complete breastfeeding or bottle feeding

  • Taking in enough calories to gain weight

What should I do before I bring my baby home?

  • Make sure you have a car seat appropriate for preemies. This means a rear-facing car seat with a 5-point harness that fits snugly. The car seat should be small enough to support and restrain the baby safely. You may be asked to bring your car seat to the hospital a few days before discharge so it can be checked to be sure it’s right for your infant. Babies who are born more than 3 weeks before their due date should have a period of testing their breathing, heart rate, and oxygen levels in the car seat before they leave the NICU. If special positioning is needed in the car seat, the nurses will show you how to do this. 

  • Schedule a visit with your baby’s healthcare provider.

  • If your baby will be using any equipment at home, make sure to discuss it with your home healthcare specialist before discharge.

  • Take a class to learn infant CPR.

Special safety issues for preemies at home

Once they are ready to go home, preemies are much like other young babies. But you may need to be extra careful about certain things:

  • Protect your baby from infections. Breastfeeding or bottle feeding expressed milk provides more immune protection but doesn't prevent all infections. You should wash hands often with soap and water. So should anybody else who takes care of your baby. Limit contact with visitors, and don't go to crowded public areas. If people in the household are ill, try to limit their contact with the baby.

  • Make your house and car no-smoking zones. Anybody in the household who smokes should quit. Visitors or household members who can’t or won’t quit should smoke only outside, away from doors and windows.

  • If your baby has an apnea monitor, make sure you can hear it from every room in the house.

  • Feel free to take your baby outside, but don't have long exposure to drafts or direct sunlight.

When to call the healthcare provider

Call the NICU if you have questions about the instructions you were given at discharge. Call your pediatrician or healthcare provider if your baby:

  • Has a fever (see Fever and children, below)

  • Has a temperature below 97.5°F (36.4°C)

  • Is not interested in feeding or is feeding poorly

  • Has fewer than 6 wet diapers per day

  • Is having trouble breathing and looks blue or pale

  • Is abnormally grouchy

  • Is listless and tired

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

  • Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

  • Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

  • Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

  • Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

  • Mouth (oral). Don’t use a thermometer in your child’s mouth until he or she is at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell him or her which type you used.

Below are guidelines to know if your young child has a fever. Your child’s healthcare provider may give you different numbers for your child. Follow your provider’s specific instructions.

Fever readings for a baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher in a child of any age

  • Fever of 100.4°F (38°C) or higher in baby younger than 3 months

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

Online Medical Reviewer: Donna Freeborn PhD CNM FNP
Online Medical Reviewer: Heather Trevino
Online Medical Reviewer: Liora C Adler MD
Date Last Reviewed: 3/1/2020
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