Criteria for discharge from the hospital with premature babies

The article was professionally consulted with Specialist Doctor II Cao Thi Thanh - Pediatrician - Department of Pediatrics - Neonatology - Vinmec Hai Phong International General Hospital.

Premature babies often have a number of health problems. Therefore, the baby will be nurtured and monitored at the hospital for a while. And when meeting certain physical and health standards, premature babies can be discharged from the hospital.

Premature birth is a baby born before 37 weeks of gestation or before 259 days from the first day of the mother's last menstrual period. About 12% of all babies are born preterm. Gestational weeks will be rounded off. For example, a baby born at 28 weeks 4 days is counted as 28 weeks premature, or more specifically, 28 4/7 weeks. Babies born before 28 weeks are extremely preterm; from 28 to less than 34 weeks is preterm, from 34 to less than 37 weeks is late preterm.
Risk factors for premature birth may originate from the mother or from the fetus and appendages. Maternal causes include: cleft uterus, short cervix, history of cervical cone, vaginal infections, urinary tract infections, periodontitis, uterine fibroids, congenital uterine malformations , have a history of premature birth,... Causes of children and their appendages include multiple pregnancy, pregnancy after IVF, amniotic fluid infection, premature rupture of membranes, growth retardation, birth defects, placenta previa Due to being born before the time when the organs in the body are fully functional and anatomical, premature babies have to face many risks and complications. and have difficulty in nutrition. The child's genital organs are not yet developed, easily cold, vulnerable, susceptible to infections and have many other serious and long-lasting health problems such as:
Respiratory: Respiratory failure (weak breathing), apnea , underdeveloped lungs, chronic lung disease; Cardiovascular: Having ductus arteriosus, bradycardia, unstable blood pressure; Digestion: Not able to suckle, difficult to eat, indigestion, necrotizing enterocolitis; Kidney: Immature; Blood, metabolism: Easily anemic, so often need blood transfusion, jaundice; Neurological: Cerebral hemorrhage, preterm encephalopathy, convulsions; Eyes: Retinopathy of prematurity.

Premature babies can develop as well as full-term babies if they follow the right care principles such as:
Respiratory monitoring and oxygen therapy: Premature babies are at risk of respiratory failure due to surfactant deficiency, easy to present episodes of apnea. Without close monitoring and early detection for treatment, the child is at risk of death. The typical clinical symptoms of respiratory failure usually appear within 4 hours after birth including tachypnea, moaning, chest indrawing or intercostal muscle contraction, cyanosis. Therefore, it is necessary to monitor and support breathing for premature babies; Prevention of hypothermia: Premature babies under 2kg should be cared for by the kangaroo method (putting the baby in skin-to-skin contact on the mother or caregiver's chest) as soon as they are born, continuously throughout the day and night. . The goal of this method is to prevent hypothermia, keep the baby's core body temperature at 36.5 - 37 degrees Celsius, and the feet are warm and pink. If it is not possible to take care of kangaroos, you should use an incubator for the baby; Attention to nutrition: Most premature babies are still able to breastfeed directly. If the baby cannot suckle, feed the premature baby by expressing breast milk into a cup and feeding it to the baby with a spoon. For children who cannot eat with a spoon such as choking, not swallowing,... they need to feed through a nasogastric tube. Breastfeeding should be encouraged. Mothers who do not have milk or have a contraindication to breastfeeding can use milk from a breast milk bank if available. Formula should only be used when none of the above methods are possible. At the same time, it is necessary to monitor the amount of milk each day the baby sucks to calculate the correct amount of fluid according to the baby's needs. In particular, it is necessary to provide trace elements daily when children tolerate breast milk well; Ensure sterile environment: The environment around premature babies must ensure sterile principles. Adults should limit contact with children if not necessary, practice hand hygiene when in contact, examine and perform procedures on children. Discontinue parenteral nutrition as soon as the infant is getting better, to avoid infection.

Premature babies are discharged from the hospital when they meet the basic requirements to maintain a stable health and avoid possible problems. Important criteria include:
Pink skin, ability to breastfeed or eat enough milk without respiratory failure; Increase 10-15g of body weight per day for 3 consecutive days; Body temperature stable at room temperature; The child has had no episodes of severe apnea and bradycardia for 5 days; The mother or caregiver is guided and capable of taking care of the child on her own; It is recommended to schedule a follow-up visit once a month for the first 3 months. Then re-examination every 3 months for the first year.

After being discharged from the hospital, premature babies need to be carefully cared for at home with the following important notes:
Keep the surrounding environment clean: Premature babies are susceptible to infections, so parents need to clean the room. baby in daily with disinfectant solutions such as Dettol or Savlon; do not let people with fever, cold, cough or other infections come into contact with your baby; ask people in contact with children to wash their hands, disinfect, wear masks and wear clean clothes; Personal hygiene and baby massage: Use massage oils suitable for baby's skin (coconut oil is recommended); bath the child daily with a sponge with warm boiled water; should apply moisturizing oil to the child 2 times a day in cold weather; taking care of children by kangaroo (skin-to-skin) method to keep the body warm, stabilize breathing, help children sleep well and develop both mentally and physically; Adjust the room temperature: Keep the baby's room temperature at a stable level. In the cold season, you should keep the room warm with a heater (note that the heater should be placed at least 2m away from the baby's car). In the hot season, it is necessary to ensure that the child's room is cool and ventilated; Breastfeeding: Should feed the baby directly. If your baby has problems sucking or swallowing, aids can be used to help your baby drink milk. Parents should feed the baby every 2-3 hours, ensuring the amount of milk recommended by the doctor. Do not breastfeed while the baby is sleeping, but need to wake the baby up to feed. When breastfeeding, the mother should raise the baby's head slightly higher than the belly to avoid overflowing milk. At the same time, the baby should burp after each feed by patting the baby's back; See a doctor: Follow up on time or take your child to see a doctor when there are unusual, uncontrolled conditions such as fever, jaundice, repeated vomiting, rapid breathing, chest constriction, abdominal distension, navel red, loose stools,... At the same time, children should be vaccinated according to the designated schedule. Infants should also be monitored and assessed weekly for weight gain and milk tolerance until their weight reaches 3 kg and full gestational age. Parents need to be especially careful when taking care of premature babies. If you follow the above tips correctly, your baby will develop as well mentally and physically as a full-term baby.
Vinmec International General Hospital has successfully received and treated many cases of premature babies, especially extremely premature babies (born 24 weeks premature, weighing only 600 grams)
Treatment and health care for children Premature birth is one of the extremely complicated and high-risk techniques.. At Vinmec International General Hospital, preterm births are organized methodically under the coordination of many specialties: obstetrics and gynecology. , anesthesiology and especially neonatology, pediatrics. This helps to reduce the risks and increase the effectiveness of treatment for health problems that premature babies may have.
Thanks to that, the technique of treating premature babies at Vinmec has achieved extremely positive effects, saving the lives of many seemingly hopeless premature births.