Preparing to leave the NICU

Most babies go to one of the following places when they leave Montreal Children’s NICU:

Home

Babies are ready to go home when:

• They can breathe by themselves and don’t need their breathing or heart rate to be monitored.
• They can drink milk by the breast, bottle or a feeding tube and are gaining weight. If your baby is going home with a feeding a tube, you will need to learn how to use the feeding tube.
• They can stay warm in a regular crib.
• Any medical problem they had in the NICU is gone or can be managed at home

Sometimes babies are not ready to go home, but they don’t need the high level of intensive care at the Montreal Children’s Hospital NICU.  If this is the case, your baby will be transferred to either the Pediatric Medicine Ward at the Montreal Children’s Hospital or a NICU/Nursery at a hospital near your home.

Pediatric Medicine Ward at the Montreal Children’s Hospital

Your baby will have their own room with a bathroom, a window and a couch for parents to sleep. Babies who go to the Pediatric Medicine Ward.

• Are 35 weeks corrected gestational age or older
• Weigh 2kg or more
• Don’t need any help to breathe or need only oxygen through small nasal prongs (“low flow”)
• Continue to need daily care by a pediatrician or other healthcare providers at the Montreal Children’s Hospital

NICU/Nursery at Another Hospital

Each hospital is a little different. If you have a hospital preference, please let your baby’s NICU team know. In general, babies who go to a NICU/Nursery at another hospital:

• Don’t need any help to breathe
• Continue to need daily care by a doctor and nurse

It’s never too early to prepare for life at home with your baby. This is true even if your baby is going to the Pediatric Ward or another hospital before going home. Below are the main items that are important to get ready before going home:

Medication

• Know what medicine your baby will need to take at home
• Learn how to prepare and give your baby the medicine. Your baby’s nurse can teach you.
• Find a pharmacy close to your home.
• Get the prescription filled before going home. The NICU can fax the prescription to your pharmacy if you provide us with the fax number.

Milk

• Know what type of milk your baby will feed at home.
• Learn how to prepare your baby’s milk if your baby is not exclusively breastfeeding. The nutritionist or nurse can teach you.
• Get any formula you need before going home. If your baby requires a special formula, you may need a prescription. Talk to your baby’s NICU team.
• Take home the breast milk that you stored in the NICU.
• If your baby is going home with a feeding tube, learn how to use the feeding tube. Your baby’s nurse can teach you.

Family doctor/Pediatrician

• Every baby should have a primary care provider before leaving the NICU. This is usually a family doctor, a pediatrician or a midwife. The doctors in the NICU don’t provide primary care after your baby leaves the NICU.
• You are responsible for finding a primary care provider for your baby. We can provide you with a list of doctors in your area and a consult form. Ask your baby’s NICU team for the list and consult.
• You can also find a family doctor at Québec Family Doctor Finder | Gouvernement du Québec (quebec.ca)
• You will be given a summary of your baby’s stay in the NICU. Give a copy of this document to your baby’s primary care provider.

Follow-up appointments

• Make sure we have the right phone number(s) to reach you for any follow-up appointments your baby needs. Talk to the unit coordinator at the front desk.
• A CLSC nurse will see every baby that leaves Montreal Children’s Hospital within one week. They will check your baby’s weight and make sure your baby is doing well at home. The CLSC will call you to schedule an appointment. You will need to sign a CLSC referral consent form.
• Know what other follow-up appointments your baby needs. Sometimes you will know the time and date of these appointments before you leave the NICU. Other times, you will be called at home with the appointment date and time.

Car seat

• If you are taking your baby home in a car, you must have a car seat. (You can use a stroller or carrier if you are taking public transportation.) Bring your car seat to the NICU before going home. Your baby’s nurse will help you make sure your baby is safe in the car seat.
• Read your car seat manual and install your car seat in your car safely before you go home.
• For more information about choosing and installing the car seat in your car, please visit Choosing the right seat at the right time – SAAQ (gouv.qc.ca)

Bringing your baby home after the NICU is a big milestone! It will look different for every baby and family. Here are a few key items to remember:

Safe sleep

• Depending on why your baby is in the NICU, your baby might need to sleep on their side or tummy in the NICU. We might use blanket rolls or pillows to keep your baby in a good position. This will change when they go home. At home, the safest way for your baby to sleep is on their back in their own crib with only a sleep sack or light swaddle.
• Your baby will practice sleeping on their back before going home. Your baby will only go home when they are ready to sleep on their back.
• Very few babies who are in the NICU need a breathing monitor at home (example: babies who go home with oxygen). Please do NOT buy a breathing monitor for home. There is NO evidence that home monitors decrease the risk of Sudden Infant Death Syndrome (SIDS). Monitors that you buy can give you a false sense of reassurance or make you worry for no reason. There are better ways to protect your baby from SIDS:
• Always put your baby to sleep on their back in their own crib
• Keep pillows, blankets and stuffed animals out of the crib
• Sleep in the same room as your baby
• Do not smoke
• Breastfeed

Crying

• Sometimes babies cry because they are hungry, cold, tired, have a dirty diaper or in pain. Many times babies keep crying even when you have tried everything to calm them down. This is normal. Remember, crying won’t hurt your baby but it can be hard to listen to.
• When you can no longer stand to listen to your baby cry:
  • Lay your baby down gently in their crib
  • Step away and leave the room
  • Call someone (partner, friend)
  • Check on your baby every 15 minutes
  • WAIT until you have calmed down to pick your baby up again
• Never shake a baby. You can cause brain damage or even kill your baby.
• If you are feeling angry or overwhelmed, there is a free, confidential parents’ helpline: 1-800-361-5085

When to see or call a doctor?

• The doctors in the NICU cannot give you advice or care for your baby after your baby leaves the NICU.
• If you have a concern about your baby’s health after they leave the NICU, you should call your baby’s primary care provider (family doctor/pediatrician) or speak to an Info-Santé nurse: just dial 8-1-1
• Common reasons to take your baby to the doctor or Emergency Room right away
  • Rectal temperature 38.0^oC (100.4^oF) or higher, and your baby is less than 3 months old (3 months corrected age if born early)
  • Hard to wake up or much sleepier than usual
  • Vomiting a lot
  • Has trouble breathing or breathing very fast
  • Is pale or has abnormal color
  • Has other symptoms that are worrying you

The Neonatal Follow-Up Clinic provides developmental assessment and long-term follow-up until the child is of school age. Children followed by this clinic comprise of any infant that requires comprehensive, multidisciplinary coordination of care. These patients have potential neuro-developmental and medical sequelae associated with specific conditions that happened during the newborn period