Going home with a premature infant

Going home with a premature infant
As the time for discharge approaches, parents are encouraged to be more
involved in the care of their infant. Most families have had contact with a social
worker and their psychosocial needs assessed. At most hospitals there is a
discharge planner who assists the family in the transition to home. Sometimes,
in the case of sick or frail infants, a home visit from hospital staff is arranged
after discharge. Most hospitals with a Level 3 neonatal nursery have some form
of follow-up clinic, available to infants born weighing less than 1000 grams. If
the infant was born weighing less than 1000 grams the family are given an
appointment for follow up in a few weeks or months time. However, for most
families, there is no home visit; rather, families are encouraged to link in with
their local early childhood centre and other support services in their area and a local paediatrician.

Sometimes, infants are transferred from a hospital with a Level 3 nursery to
a feeder hospital where the mother was initially booked to have her baby and
which is closer to the family home. However, this transition is sometimes
difficult for families as it feels like another wrench, perhaps mirroring the
premature birth if it is done suddenly, without appropriate preparation of the
parents.
For most families, discharge of their premature baby from hospital is a time
of high anxiety. Parents often express it in terms of ‘it takes several hospital staff
to look after the baby one day and the next it is left to just us’. It is believed that
parents who have been involved in their baby’s care have more confidence in
their ability to care for their infant at home.
EXAMPLE: LISA, ANDREW AND ROBERT, CONTINUED
The second night was much easier for Lisa and Andrew. Robert again slept in
between feeds and so did they. The staff had explained that the noises Robert
made were normal and would reduce as he matured and he had longer periods of deep sleep. Lisa had been at the hospital every day since Robert was born. She had
been expressing milk and spending time by his isolette. In the last few weeks she
had been able to hold him and care for him. Lisa was getting to know Robert, how he liked to be stroked, which movement and touch seemed to help him settle. She
and Andrew had bathed him twice in the past week. Lisa in particular was
beginning to feel more confident in understanding Robert’s needs and felt she was ready to take Robert home.
In addition to the initial period premature infants spend in hospital there is a
high rate of repeat hospitalisations in their early years, which puts additional
psychosocial stress on the families. Using figures from the United States,
readmission rates for all VLBW infants vary from 10 to 38 per cent. This is, on average, two and a half times higher than for full-term infants (McCormick,
Shapiro & Starfield, 1980). Thus, families of premature infants have ongoing
difficulties of separation, anxiety about the well-being and prognosis of their
infant, and the psychosocial issues of parenting away from home.