Guidelines for discharge vary across hospitals from discharge at calculated delivery date to early discharge at about 34 weeks of age with care support at home from the neonatal intensive care unit (NICU), especially, if additional treatment such as oxygen or ventilator treatment is needed.
Going home is usually determined by the overall development, the stage of adaption, and the current health status of the baby. There are different requirements for discharge such as control of breathing without apnoea, no signs of illness, sufficient feeding skills, weight gain, and independent control of body temperature. Parents should also feel well-prepared for taking over the responsibility to care for their baby at home. A plan for regular contacts with the NICU, home visits or other follow-up care services (e.g. medical check-ups, lactation counselling, …) should exist before leaving the hospital as well as an enrolment in a follow-up programme for the development of preterm infants.
At home feeding is still crucial for the optimal growth and development of a preterm infant. Parents need to continue with adequate nutrition to ensure the optimal supply of nutrients suited for the infant’s age. Feeding frequency and duration varies across babies and even across the day. Breastfeeding and milk production are regulated by supply and demand depending on the infant’s needs. Preterm babies often prefer to drink little but more often. Healthcare professionals recommend to continue the monitoring of growth and weight gain at home so that the feeding can be adapted to the changing nutritional requirements of the baby.
A healthcare professional (nurse, midwife, lactation specialist) informs parents about good signs for sufficient milk intake. As good orientation are six to eight wet nappies with pale urine and at least two soft stools in every 24 hours in the first weeks.
Expression of milk may also be necessary at home and mothers may have to store and prepare the milk for their babies.
Sterile bottles, pump parts, and breast shields should be used. The manufacturer’s instructions for cleaning and sterilising the equipment should be followed carefully. It is important to clean the pump after every use.
If frozen stored mother’s milk is used to feed the baby, it has to be thawed slowly in a refrigerator and should be used in the next 24 hours. The milk should not be refrozen. Milk must be warmed carefully at a low temperature using warm running water or a special bottle warmer. It should be refrained from using microwaves or the use of boiling water in order to avoid damaging the active ingredients of breast milk.
Sometimes, supplements are also continued at home. Healthcare providers will usually support the parents by consulting and instructing them to be well prepared for caring for their baby at home. Sometimes special trainings for parents of preterm infants are provided.
Introducing solids, returning to work and weaning off the breast
At around six months of age, the baby will start showing an interest in solid food. However, breastfeeding should continue while introducing solids. Over time, breastfeeding will gradually be replaced by solid foods. It is important to provide tiny quantities of solid food in the beginning, and gradually increase them. The amount of milk the mother produces will also gradually decrease until it is fully replaced by solid food.
Women returning to work can express and store breast milk and feed it to the baby in a bottle.