When Can Babies Leave the NICU? It’s Complicated

Newborns enter the neonatal intensive care unit (NICU) for all sorts of reasons. We’ve talked quite a bit about premature babies in these blogs, but there are all sorts of other reasons as well: babies with birth defects, trouble breathing, and severe jaundice are just a few of the groups that may enter the NICU even when full-term.

Nobody disputes the need for a unit that has special equipment and trained staff to ensure the health of our littlest patients. Indeed, we’ve made lots of strides in that last few decades in being able to help sicker infants. Lately, however, a question has arisen (and it’s not the first time) regarding our special-care newborns: How long do they need to stay there?

Researchers recently made another attempt to answer that question and reported their findings in this month’s journal Pediatrics. Although a lot of what they did focused on the financial costs of remaining in the NICU (which can be very expensive, as anyone who has had to foot even a small fraction of the bill will tell you), there are other aspects of that care and its effects on infants and families that warrant discussion. Let’s start out by examining some of the reasons babies might stay in the NICU.

NICU Goings-On

When we think of “intensive care,” our mind often goes to tubes. Lots of them. Tubes to breathe, tubes to deliver fluids and medications, even tubes to take things out of the body. But even patients who don’t need that level of support often need to be there. Babies in the NICU, for example, may need to be monitored closely for infection due to increased risk. Premature babies often don’t have brains that are developed enough to signal them to breathe. While they do get there eventually, they need to be watched and, sometimes, treated, even if they just stop breathing for under a minute. Sometimes, jaundice needs special treatment not available in a community hospital. Finally, NICUs have specialized staff that can teach parents what to do after discharge.

With all that NICUs do and do well, it’s worth reexamining the question of why we might even be looking at when to move babies out, and where. Aside from the financial issues—which, in reality, most families don’t directly face, since insurers generally cover costs and emergency insurance is usually available for our sickest babies—there are other considerations. Some families might prefer to deal with a familiar provider, rather than a team of less familiar specialists. Some might be put off by all the lights, tubes and beeps of a NICU, especially if their baby has reached a point where he doesn’t need any of that. And some may live in an area like mine, several hours from the nearest NICU, where a day drive to see their little one isn’t practical.

Examining the Options

Most hospitals with a NICU do have a “step-down” unit. There, the baby can be monitored for problems and is close by increased support should it be necessary. At the same time, the area is a little less daunting, and it’s easier for parents to visit.

Going one step further, if the hospital has a regular labor and delivery service, chances are they have a well-baby nursery. Again, services are nearby, and there is more room for breastfeeding and just being with the baby.

Finally, and especially if your local hospital is a ways away from the specialty hospital that has the NICU, there is always the possibility of transporting a baby who is stable, but still needs a little more time in the hospital. Generally, babies who would be considered for this would:

  • Be breathing well on their own (or with minimal oxygen).
  • Have no episodes of stopping breathing.
  • Be feeding well by breast or bottle.
  • Not have a dangerous level of jaundice.
  • Not need care from a specialist for other problems.
  • Be at a hospital that is comfortable watching and caring for babies that need a little more attention than most.

We haven’t talked much about babies that would formerly be in the NICU, but are now discharged to home. The discharge weight, for example, has decreased over the years (assuming they’re aren’t other problems that keep the newborn in the hospital). Nor have we talked about COVID-19 concerns: the risks of being in a hospital with affected patients versus the risk of being home in communities with a circulating virus.

Regardless of what’s recommended for your baby, there are things you can do. Make sure you are informed of your baby’s status by the NICU staff—and make sure the staff informs your children’s pediatrician about what’s going on! Ask questions about what’s best for your baby as well as what’s being done. And regardless of where your little one is at the moment, it’s never too early to prepare yourself and your home to keep her safe once she’s discharged.

Stan Sack
Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.

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