MANAGEMENT OF NICU GRADUATE
NICU GRADUATE BLOG When we left the hospital with Roxy, we were informed we would have an appointment card mailed to us with the date and time for her NICU Graduate Clinic checkup. Roxy s first checkup was in March of this year and I was a little scared of what to expect, but I really just knew that my baby was going to be fine and they wouldn t find anything wrong. At the appointment, all went well for a while. We went through the usual weighing and height check, head circumference, etc. Most of the people we saw had treated Roxy during her stay in the NICU so they were telling us how great she looked and how big she had gotten. However, my first what moment came when I was told that I needed to watch what my preemie was eating so that she
did not get too heavy. I m thinking, six months ago we wanted her to gain weight, thankful for every ounce, and now I m not supposed to let her eat what she wants? Fast forward about a half-hour and two other doctors later. We were discussing my preemie s growth and the doctor looks up and says, She had a brain bleed, right? Um, not that I m aware of. The doctor said that he thought she had and that they would want to do an MRI to make sure there was no long lasting scar tissue. However, I had requested and received a complete copy of the medical records from my preemie s stay at the NICU and that night I looked. Sure enough, she had a Grade I brain bleed. How could my baby have been diagnosed with a brain bleed and I not be told about it? My husband seems to think that with everything that went on I forgot about it or didn t hear the doctor/nurse when they told me but that seems impossible to me. Everytime they told me a new term or condition, I went home and googled it to find out more about it. I still feel it was NEVER spoken in my presence.
TECHNOLOGY AND COMMUNICATION A MODERN DAY PARADOX Technology in healthcare has grown at an unprecedented pace during the 21st Century alone as has digital/electronic communication No level of technology replaces the human element Back to basics: ALL healthcare professionals must communicate not only with each other but with the families of new babies
THE NEW WORLD The doctors are no longer G-d s Classified information is available for the general public Transparency Accountability Great Expectations - Anything can be fixed On Demand World - Instant gratification
DR. BENJAMIN SPOCK
THE RELATIVITY SCALE Each baby s situation is the most important one in the unit Our Level 1 is another person s Level 3 Never minimize parental concern 95% of the job is reassurance
OWNERSHIP NICU handles the production Pediatrician has a lease Parents have a lifetime...
FROM THE BUBBLE TO THE REAL WORLD Discharge planning Home logistics Shifting of fears and gears You now have a normal baby ICU Syndrome withdrawal
ORGANIZING MEDICAL FOLLOW-UP Primary Care provider Specialists Developmental Screening Therapy: PT/OT/Speech Therapy/Feeding Therapy $$$$$ and more $$$$$ How are the parents coping How are siblings and family balance
PART II: ROLE OF THE PEDIMAGICIAN Coordinating transition of care from Neonatologist Direct medical care Coordinating subspecialty follow-up and ongoing therapies and developmental screenings
COORDINATE TRANSITION OF CARE Be in contact with Neonatologist and parents during NICU course - facilitate transfer of information Communication throughout decreases confusion EHR facilitates transparency
DIRECT MEDICAL CARE Knowledge of existing problems Awareness of potential future problems Developmental screening
Lactation/Nutritional resources COORDINATION OF ONGOING CARE Subspecialty referrals -Pulmonary -GI -Cardiology -Neurology -Surgery PT/OT/ Feeding therapy
PART III: INITIAL VISIT 48-72 hours after NICU discharge Review feeding and growth Newborn screening results Vaccination status Parental adjustment And finally.clinical exam
FOLLOW-UP VISITS Growth-Adjust until 18-24 months (Progress and velocity are key) Immunization - As per chronological age (HBV/Synagis/TDaP/FLU) Feeding difficulties (Greater when < 28 weeks GA)
SCREENINGS Hearing -F/U OAE by 1 yr recommended Vision - ROP -Increased risk if BW < 1500 Gm matured -4-6 weeks after birth and Q1-3 weeks until retinal vessels have fully -For VLBW graduates @9-12 months and 2-3 years Neurodevelopment
PLAGIOCEPHALY
This image cannot currently be displayed. (6) DEVELOPMENTAL/NEUROLOGIC - CORRECTION < 24 MONTHS PART IV: PREMATURITY ASSOCIATED CONDITIONS (1) PULMONARY -BPD/RAD/RSV (2) APNEA -Monitoring/Rx Therapy (3) SIDS (4) GERD - Episodic v. Disease (5) ANEMIA
SUMMARY INITIAL VISIT - 48-72 hours after discharge - Review NICU course - Review Rx - Review feeding/growth - Psychosocial/Family issues - Future appointments
SUBSEQUENT VISITS -Growth & Development -Screenings VACCINES -Based on chronological age SCREENINGS -Hearing/Vision/Developmental
CATCHING UP
THE GRADUATES