Discharge from the Hospital (Chapter 20)

Learning Objectives

After completion of this chapter the participant should be able to:

• Describe the indications for the discharge of a NYI from hospital.
• Describe the elements of the discharge of a NYI from hospital.
• List discharge planning advice for family.

Planning of discharge from the hospital is as important as diagnosis and treatment. The NYI has to remain in hospital while receiving oxygen for respiratory instability, IV treatment, if feeding has not been established, or body temperature cannot be maintained.

Indications for Discharge

• Patient stable and has improved.
• Baby gaining weight for three (3) consecutive days.
• Established lactation in a mother.
• Ability to breastfeed or cup feed satisfactorily.

Counsel the mother on:

• Diagnosis and care given.
• Treatment if ongoing and how to administer it.
• Exclusive breastfeeding of the infant at home for six (6) months.
• Importance of keeping the NYI warm including KMC if < 2000g (3).
• Danger signs and when to present immediately to the nearest healthcare facility.
• Upcoming vaccinations.
• Importance of attending any follow-up appointments (e.g., KMC, physiotherapy, audiology ophthalmology and surgical).

Providing Follow-Up Care

• Infants who are discharged from the hospital should return for follow-up in relation to the present problem as needed.
• Plan the routine follow-up with their local provider depending on the weight, age, and HIV exposure status of the NYI – write clearly the purpose of the follow-up, e.g., to do HIV DNA PCR.
• Discuss where and when the NYI will receive their next scheduled immunisation.
• Discuss where the mother will access care if the NYI has a danger sign.

Record Keeping

• Ensure the infant’s immunisation status and record is up-to-date.
• Ensure the HIV exposure status is recorded.
• Communicate with the health personnel who referred the infant or who will be responsible for follow-up care.
• Clearly document in the health passport: date of birth, birth and discharge weight, mode of delivery, APGAR scores, date of admission, date of discharge, diagnosis, most recent investigations done, treatment given, ongoing treatment, counselling given and reason for follow-up.
• Documentation must be signed together with a printed name and the health facility for follow-up should be clear.
• If referred from another health facility, complete the feedback form.
• Ask the mother to attend the local facility as soon as possible and to show the passport / feedback form to the local healthcare team.