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Chronic Lung Disease discharge planning in Newborn Services

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Criteria for referral to Respiratory Service 

The Respiratory Service are keen to be involved where at discharge:

  1. Severe clinical disease (marked respiratory effort, indraw etc). 
  2. Severe chronic lung disease on chest radiograph. 
  3. Requiring more than 250ml/min of oxygen. 
  4. Right ventricular hypertrophy on ECG 
    1. R wave in V1 and V2 >20mm 
    2. RSR' pattern in V1 with R > R' 
    3. Positive T wave in V1 
    4. Right axis deviation 
  5. Babies without these criteria and who are expected to require home O2 briefly, need not be referred. 

Pre-referral assessment for infants going home on oxygen

  1. Overnight oximetry with printout, preferably current but also two weeks prior to establish trend. 
  2. ECG. 
  3. Early morning capillary gas. 
  4. Current chest radiograph. 
  5. Growth chart. 
  6. Social Work/Homecare or Family Liaison Nurse assessment, usually including a home visit. 
  7. Interim summary of neonatal course. 

Discharge planning

  1. There will usually be a pre-discharge planning meeting approximately two weeks prior to discharge in order to set a discharge date. 
  2. This meeting should include an invitation to the Respiratory Nurse Specialist, General Practitioner, the Consultant Respiratory Paediatrician, Dietitian, other NICU staff including the Neonatal Consultant, Family Liaison Nurse, Visiting Therapist, Social Worker etc as appropriate. 
  3. The Respiratory Consultant may choose not to attend or become involved at this stage if the risk factors for severity are not present (that is, if we anticipate the baby will have minimal problems and come off oxygen relatively quickly following discharge). 
  4. Infants will be not be considered for discharge if they have poor feeding, poor growth, frequent desaturations, instability with feeding. 
  5. Infants being considered for discharge should have had 10 days stability on NICU or PIN. 
  6. Infants who have just come off oxygen should also fulfil these criteria if being discharged. 

Outpatient follow-up for the infant on oxygen

  1. Neonatal paediatrician
  2. Respiratory Paediatrician for severely affected infants or other infants whose progress is not as expected once discharged 
  3. The Homecare Nurses will visit weekly or according to need. 
  4. See the guideline for management of infants on home oxygen.

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Document Control

  • Date last published: 31 August 2017
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years