Transitioning Newborns from NICU to Home: Family Information Packet

Appendix A. Family Information Packet

Managing Breathing Problems

How Can I Manage My Child's Breathing Problems at Home?

  • Visit the NICU often, and help care for your baby as much as possible in the hospital.
  • Learn how to use equipment: pulse oximeter, oxygen tank, nasal canula.
  • Know the signs of difficulty breathing.
  • Learn CPR.
  • Learn how to give your child's medicines.
  • Plan ahead for extra help at home.
  • Schedule routine followup doctor visits.
  • Wash your hands frequently.
  • Avoid crowds.
  • Have your child immunized.

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Crib Safety

What is SIDS?
  • "SIDS" stands for Sudden Infant Death Syndrome.
  • Sudden, unexplained death of an infant less than 1 year old.
What should I know about SIDS?
  • Babies sleep safer on their backs.
  • Babies should be placed on a firm sleep surface.
What can I do to lower my baby's risk of SIDS?
  • Babies should be put on their backs to sleep for nap and at night.
  • Keep toys, objects, and loose bedding out of your baby's sleep area.
  • Do not allow smoking around your baby.
  • Do not allow your baby to overheat during sleeping.
What about "tummy time"?
  • Daily tummy time is necessary for normal development.
  • Make sure your baby spends several hours on their tummy when they are awake and someone is watching.

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Bronchopulmonary Dysplasia (BPD)

What is Bronchopulmonary Dysplasia (BPD)?
  • Type of chronic lung disease.
  • Common in babies born early.
  • Damaged lung tissue causes breathing and health problems.
  • Lungs trap air, fill with fluid, and produce extra mucus.
What Causes BPD?
  • Being born early.
  • Having a virus called RSV (ask your Health Coach for a fact sheet about RSV).
  • Having a heart condition.
  • Being on a ventilator.
  • Lack of nourishment.
  • Fluid in the lungs.
What are the Symptoms of BPD?
  • Grunting.
  • Breathing heavily.
  • Flaring nostrils.
  • Sucking in air.
  • Tiring easily.
  • Pale or grey skin.
How is BPD Diagnosed?
  • If your baby still needs oxygen at 36 weeks old.
  • If your baby has been on a ventilator.
How is BPD Treated?
  • BPD is treated with oxygen to control fluid in the body and medicine to relax the airway.
  • Treatment does not cure BPD.
  • Treatment helps your baby breathe better.
  • Lungs will eventually heal.
  • Your baby needs nutrients for healthy growth.

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Respiratory Syncytial Virus (RSV)

What is Respiratory Syncytial Virus (RSV)?
  • A common virus that affects babies and infants.
  • Leading cause of two lung infections: pneumonia and bronchitis.
Symptoms of RSV
  • Starts out like a cold with fever or runny nose.
  • Can also include:
    • Coughing.
    • Problems breathing.
    • Fast breathing.
    • Not eating well.
How is RSV Spread?
  • Contact with someone who is coughing or sneezing.
  • Enters the body through the eyes, nose, or mouth.
How to Prevent the Spread of RSV?
  • Wash your hands before and after handling a baby.
  • Avoid exposing your baby to others with cold symptoms.
  • Cover coughs/sneezes and throw away used tissues.
  • Keep your baby away from crowded areas.
  • If your baby is at high risk for RSV, talk to your doctor about a monthly shot that can help lower the risk of a baby getting severe RSV.
  • Your baby may be eligible for palivizumab (brand name: Synagis®), a treatment given to prevent and reduce RSV.
  • The shot, given monthly during RSV season, reduces the chance of your baby getting pneumonia and bronchitis.
  • Babies may still get RSV but will be less sick.

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Newborn Feeding

Bottle Feeding

  • Feed your baby ONLY infant formula and breast milk for their first 4 to 6 months.
  • Feed your baby at least every 3 hours, day and night.
  • Before each feeding, warm the breast milk or formula to room temperature by placing the bottle in warm water; do not leave cold bottles on the counter to warm up.
  • Never heat breast milk or formula in a microwave oven.
  • Throw away any remaining breast milk or formula after each feeding.
  • When traveling, keep the breast milk or formula cold in a cooler.
Formula Preparation

Infant formulas are available in 3 ways:

  • Ready to Feed
    • Do not add water.
  • Liquid Concentrate
    • Add sterile water.
  • Powder
    • Add sterile water.
To make Sterile Water:
  • Boil water for 2 minutes.
  • Cover the pot.
  • Let water cool to room temperature.
Formula Storage and Use
  • Store prepared formula in a refrigerator.
  • Use formula in 24 to 48 hours.
Bottle Cleaning
  • Clean bottles and nipples by washing with hot, soapy water or on top rack of dishwasher.
  • Allow bottles and nipples to air dry.

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Breastfeeding Your Baby

Breastfed babies have:
  • Fewer ear infections.
  • Lower chance of asthma, food allergies, and dental cavities.
  • Protection against diarrhea, stomach, and lung infections.
  • Better nervous system development and higher IQ levels.
  • Lower risk of some childhood cancers.
  • Lower chance of becoming over weight.
Mothers who breastfeed have:
  • Lower risk of pre-menopausal breast cancer.
  • Lower chance of osteoporosis later in life.
  • Quicker return to pre-pregnancy weight.
  • Food source for their babies even during emergencies.
  • Lower chance of becoming pregnant before menstruation returns.

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Gastrostomy Tube (G Tube or Button)

Giving medicines and feeding if your baby has a gastrostomy tube
  • Clear the G tube or button as your health care provider showed you.
  • Check for placement of the G tube or button.
  • Slowly push in liquid medicine or feeding with a syringe.
  • If the pharmacist says it is ok, pills and capsules may be dissolved in 10 to 20 cc of warm tap water.
  • All medicines and feedings should be flushed in with 5 to 10 cc of warm tap water.
  • Ask your baby’s doctor, nurse, or pharmacist how to measure the tap water.
It is important to use the specific tube adapter made by the manufacturer of your button.
  • In fluid restricted babies flush medicines with ONLY 1 to 5 cc of warm tap water.
  • Vent the tube after feeding to remove excess air or fluid and reduce leaking.
Protecting the G Tube or Button
  • Snap t-shirts and onsies work best to prevent babies from pulling on the tube or button.
  • You may also use a sticky wrap or stretchy dressing.

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Current as of December 2013
Internet Citation: Transitioning Newborns from NICU to Home: Family Information Packet: Appendix A. Family Information Packet. December 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/nicu_toolkit/nicu-packet-apa4.html