Discharge and follow-up

It is very important that you discuss with your healthcare experts in the Neonatal Intensive Care Unit (NICU) on all planned steps in advance and ensure that you can be prepared for this exciting moment. For sure, the hospital has several administrational criteria or information for you before discharge. You should plan a safe journey from hospital home and what you need for that, e.g. a car seat for your baby.

If your baby is going home, it might have some special needs like oxygen, a special preterm infant supplementation or formula, a special medical drug or equipment. Make sure you have everything at home before you leave the hospital. You can also organise a service provider, who can support you at home with necessary advice or material.
Make sure you have an emergency number for urgent questions with your preterm born baby and all contact details for check-ups, therapy or medical advice after discharge.

You should wear a mask when you are going out with the baby. It is also recommended that family members who are not living in the same household wear a mask when they come and visit you and the baby. It is important to follow on the national regulations on social distancing and visiting policies. Generally, it is recommended to have not too many visitors after discharge with a preterm born baby to avoid any kind of infections, e.g. Influenza or Respiratory Syncytial Virus (RSV).

(Source: Babycenter, Healthline)

Here you find more information about the World Health Organization’s recommendations on how to put on a mask correctly:

• Before putting on a mask, clean hands with alcohol-based hand rub or soap and water
• Cover mouth and nose with mask and make sure there are no gaps between your face and the mask
• Avoid touching the mask while using it; if you do, clean your hands with alcohol-based hand rub or soap and water
• Replace the mask with a new one as soon as it is damp and do not re-use single-use masks
• To remove the mask: remove it from behind (do not touch the front of mask); discard immediately in a closed bin; clean hands with alcohol-based hand rub or soap and water

(Source: WHO)

It is not recommended for babies and toddlers up to the age of two years to wear masks, because they are not able to remove the mask on their own. Please ask the paediatrician or healthcare professional, if they have special recommendations for protecting your child from COVID-19.
(Source: ACOG, CDC)

If your child shows COVID-19 symptoms or is ill, you should call the emergency room first to ask for advice. Symptoms could be fever or shortness of breath. The healthcare experts will guide you on the next steps and how to behave in the situation. Try to stay calm.
Most children with COVID-19 have mild symptoms, and most respiratory infections in children are caused by other viruses (including so-called endemic corona viruses, which account for many common colds).

(Source: UNICEF)

It is recommended to avoid cancellations, because medical treatment, like vaccinations or important follow-up appointments are needed. With the necessary protection midwifes, nurses and medical experts can provide the best support to you and your baby. Please make sure to talk to the medical expert team and ask them for advice. If you need to leave the house in order to keep the appointment, ask close family members for their support to transfer you and the baby to the appointment and try to avoid public transportation.

(Source: BAPM)

In some countries, it is recommended to use telephone or digital follow-up appointments wherever possible as an alternative to personal appointments. The healthcare professional finally decides whether the appointments will be changed to a digital alternative or if there are other options. It is important to ensure hygiene protection aspects during the personal visits and treatment. Unless you are advised otherwise, you should continue with arranged follow-up appointments.
If your follow-up is cancelled, ask for a new appointment. If that is not possible, try to get an appointment at a different healthcare facility. Follow-up appointments are very important for your child’s health and development.

(Source: BAPM)

Timely check-ups and vaccinations are crucial to protect your child’s health. Therefore, it is important to get all recommended vaccinations for your preterm born baby. Please talk to the healthcare expert who is in charge of vaccinations for babies. Many healthcare professionals are offering a digital way to contact them for many issues and concerns.
Some may be able to come home to you and give your baby a vaccination there. If not, most of them are taking measures to separate ill and well babies so that they can provide safe physical exams in a clean and disinfected space.
Note that for some very preterm babies, a vaccination scheduled to take place prior to due term delivery might require the baby to be placed in a neonatal unit because of the risk for apnoea and bradycardia (sudden drop in heart rate and oxygen saturation) during the first 36 hours after the shot.

(Source: Babycenter)

It is not recommended to postpone the therapy because it is an important support for your baby’s development. Please talk to your medical doctor and physiotherapist about the current situation and what alternatives can be offered. Your physiotherapist might also be able to show you some exercises for your baby via video call or explain them to you on the telephone.

Please talk to your healthcare professional, who is responsible for your baby first and ask for advice. Furthermore, you can contact the public health institution or the health insurance in your town, region or country or if available, your national or regional parent organisation.

Home delivery of anything from food to hardware appears to work quite well in the COVID-19 crisis, so there is no reason to believe that the supply of oxygen to your home should not work. If you have concerns about the provision of oxygen, please talk to your healthcare team before discharge about their emergency plan. If your oxygen at home runs low or you have problems with the oxygen tank and your service provider for medical equipment is not available, please call the hospital emergency immediately and wait for their instructions how and where to enter the hospital.

You should be aware of the fact that both are severe illnesses. They both spread the same way as COVID-19. Someone who is infected coughs or sneezes, sending droplets containing the virus into the air. You can get ill if the droplets land on you, or if you touch a surface that has the virus on it and then put your fingers in your nose, mouth, or eyes. Please ask your paediatrician or healthcare professional on prevention, immunisation or vaccination opportunities for your baby and all family members. However, the measures meant to halt the spread of the SARS-CoV-2 virus (which causes COVID-19) are also very effective in preventing the spread of any other respiratory viruses. After the introduction of the lock-down measures, the RSV season ended prematurely.

(Source: Web MD)

The European Foundation for the Care of Newborn Infants (EFCNI) interviewed Professor Andreas Stahl, Director and Chair of Ophthalmology, University Medicine, Germany, Greifswald on relevant recommendations regarding ROP in times of COVID-19.

“Follow-up appointments are essential to ensure the long-term stability of an eye at risk of ROP. We strongly advise to keep up the outpatient screening visits after discharge from the hospital, even if it may be very difficult in some situations. Unfortunately, the risk for sight-threatening ROP does not end with discharge from the hospital but poses an ongoing threat to the visual function of these babies. Screening intervals and appointments should be followed according to the established screening guidelines – also after discharge from the hospital”.

(Source: EFCNI)

It is normal that you feel lonely and miss friends or other parents to chat or exchange. You can get in contact with your local or national parent organisation. They can introduce you to parents who are in a similar situation or maybe offer parent chat groups or classical self-help groups – like they used to do before COVID-19 – but now in a digital way. Some of the parent organisations offer webinars and organise online get-togethers. Via video chat or texting you can reach out to parents and exchange experiences. You might also know some parents from your time in the Neonatal Intensive Care Unit (NICU), which you can get in touch with.

Note: You might also want to contact a psychologist, social workers, or special trained healthcare professionals that can help you. Your mental health matters.

Doctor Dietmar Schlembach, Chair Clinic for Obstetric Medicine, Vivantes Clinics, Berlin-Neukoelln, Germany answered the question in an interview with the European Foundation for the Care of Newborn Infants (EFCNI):

“Please accept that and explain that to your family – especially your parents. Older people are at increased risk for severe form of the disease and at higher risk for dying because of the infection. If I would become grandpa, I would like to see my grandchild too, but even more I would love to see this child, when it grows up and actively recognises me. On the other hand, I would hope for your baby, that it may get to know its grandparents at an older age and not just as a nursling and avoid to be told, that the grandparents died, because they (were) visited by potentially infected relatives. Please, there’s enough social media possibilities to become acquainted with each other and I am asking you to use these possibilities. Not doing so, might be a matter of life and death”.

(Source: EFCNI)

Professor Christoph Bührer, Medical Director Department of Neonatology, Charité Berlin, Germany gave a valuable answer in a recent interview with the European Foundation for the Care of Newborn Infants (EFCNI):

“If a COVID-19 infection turns into pneumonia, anybody with a chronic lung condition (such asthma, cystic fibrosis, or former preterm infants who had bronchopulmonary dysplasia) will have more trouble coping with the disease. These people may need more medical help than somebody who is completely healthy. As COVID-19 and flu (notably H1N1) have similar attack rates, adults and adolescents born very preterm are advised to get vaccinated against influenza.”

(Source: EFCN in collaboration with Professor Christoph Bührer, Medical Director Department of Neonatology, Charité Berlin)

As all respiratory viral infections are transmitted by tiny droplets in the air, COVID-19 precautions are effective against all of them: Face masks, hand washing, social distancing. Avoid mass gatherings, including large family reunions.
RSV is common from November to March, but it creates symptoms severe enough to warrant hospital admissions only in infants. There is a passive vaccination available for very preterm infants with some kind of bronchopulmonary dysplasia who experience the first RSV season of their life. Flu, on the other hand, is rather dangerous for elderly people, for whom active immunization is highly recommended. Elderly people are also the most vulnerable to COVID-19 (shrugged off by the vast majority of children) and therefore in desperate need for a vaccine.

(Source: EFCNI in collaboration with Professor Christoph Bührer, Medical Director Department of Neonatology, Charité Berlin)

CDC and the STIKO do not recommend the vaccine for persons under the age of 12 years, pending the results of further studies. None of the vaccines which are currently available or are being developed have been tested in younger children, so nobody can tell whether they would be harmful or beneficial for newborn infants.

(Source: CDC, STIKO)