New Guidelines and Recommendations for NICU Discharge Preparation and Transition Planning

The Bottom Line

The National Perinatal Association (NPA), an interdisciplinary organization of professionals, parents, and advocates, has developed guidelines and recommendations for Neonatal Intensive Care Unit (NICU) discharge preparation and transition to home for infants admitted to the NICU and their families.

Context

Preterm birth, defined as birth before 37 weeks of pregnancy, continues to be common in the U.S. In 2020, 1 in 10 babies was born preterm, putting babies at higher risk for many health risks and concerns. Preterm birth rates disproportionately affect certain racial groups. Black women, in 2020, had preterm birth rates of 14.4%, while rates for White and Latinx women were 9.1% and 9.8% respectively.

Most preterm infants are admitted to the NICU before they are discharged home to their families. According to guidance from the American Academy of Pediatrics, infants should be deemed physiologically stable enough to be cared for at home before discharge, and parents or caregivers should be prepared to care for their infant at home.

Ensuring that caregivers are equipped with the proper skills, knowledge, emotional support, and confidence to care for their baby in the home setting, can help reduce the infants’ risk of subsequent readmission. However, the guidance for what should be included in a comprehensive discharge planning program for the family has been limited.

Study Objective

In the absence of national guidelines, the NPA has created NICU discharge recommendations to help guide health care providers and families when an infant is ready to be discharged home from NICU care. These recommendations are “general and adaptable while also being specific and actionable.”

The Details

The NPA guidelines are divided into five sections. Each section includes an introduction, text of the guidelines, and the recommendations in a table format. Sections may also include more descriptions or details to support the guidelines.

1. Basic information: Includes information about developing clear criteria for NICU discharge, creating a discharge planning team, and a discharge planning process, including discharge planning timing, meetings, goals, and educational philosophy.
2. Anticipatory guidance: Provides guidance on how to help families develop a realistic idea of what to expect when they are at home with their infant and how to take care of their child at home. It includes guidance on family life, typical infant behavior, soothing a crying baby, emergency planning, parental mental health, and paying for a NICU stay. 
3. Family and home needs assessment: Provides guidance on developing a process to assess a family’s needs and helping them connect with appropriate resources in the community. It outlines how to evaluate the various needs of families, including examples of open-ended questions to ask, and creating a transition plan that includes the medical, physical, psychosocial, and mental health needs of both the family and the infant.
4. Transfer and coordination of care: Outlines steps for the transfer of care from the NICU to the primary care provide or medical home, and community providers. 
5. Other important considerations: Discusses a few specific areas to consider when discharge planning. It includes suggestions for helping families who are: limited in their English proficiency; those in active military; lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) headed; disabled; or culturally or philosophically distinct in ways that need to be considered in NICU discharge transition planning.

Findings

Pull Quote

“Going home from the NICU should be a time of joyous celebration. Hopefully these guidelines will ensure that discharge planning and teaching occur in a timely, organized, and consistent manner, thereby improving family and staff satisfaction as well as patient care.”