Dawn,

The criteria for discharge of a premature infant from the NICU are as
follows:
1. Baby must be able to maintain his temperature outside of the isolette.
2. Baby needs to  be able to take all feedings by breast or bottle and must
be gaining wt.
3. Infant should be free of apnea/bradycardia for some specified amount of
time (in our unit I think it is 3-4 days now--used to be longer). A last
resort is to send the baby home on an apnea monitor, but we are doing this
much less frequently these days  because of the great anxiety it can cause
parents.

Reflux can indeed lead to apneic episodes, especially in the premature baby,
but you are right, it doesn't always.  In my experience, in infants who have
reached the age where they would have outgrown apnea of prematurity, apnea is
most often caused by reflux.  Meds help this.   In the situation you
describe, one of the twins went home in a very timely fashion. This leads me
to believe that there is something real keeping the other baby in the
hospital.  Parents should certainly request a team conference where they can
meet the decision makers in their baby's care.

Questions to ask:

1. What is keeping baby in the hospital?
2. Is baby feeding well and gaining wt?
3. Does the baby have reflux ? Have they done a test to confirm this?
4. Does the baby have apnea/bradycardia and is this related to reflux or to
feeding--if not what do they think is causing it?
5. What *are* the criterion for discharge?

A team conference can be very helpful. As well as bringing the players
together, it helps them  to get on the same page as far as a plan for the
baby. One of the most frustrating things for parents of a baby in the NICU is
conflicting information and plans. I would advise the parents to write down
all of their questions so they won't forget  them and to persist (without
getting angry) until they recieve answers to their satisfaction.  It is
sometimes helpful for parents to rehearse their questions.
They may also want to bring a nurse or a social worker with them who can act
as their advocate.

One last thing:  Often with premies the light bulb for feeding literally
turns on overnight.  My guess is this baby is still a slow feeder, but if he
is off gavage he must be feeding well enough.  Is he?  Also,  at a certain
point we take our premies off scheduled feeds and allow a modified demand
schedule. This can often turn things around by allowing baby to feed when he
is hungry, rather than forcing him to feed when he is not.

Kathy Boggs, RN, IBCLC
Mountain View, CA

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html