Who Is at Risk?

High-Risk Infant Follow-up

Isabell B. Purdy, PhD, NNP, CPNP; Mary Alice Melwak, PhD, CPNP


NAINR. 2012;12(4):221-226. 

In This Article

Abstract and Introduction


Plans for discharge home from the neonatal intensive care unit (NICU) should begin with identification of which infants are at-risk for developing disability or early demise. As much as possible, this article serves as an evidenced-based review for identifying vulnerable infants in the NICU who are at higher risk for morbidity or early mortality. This article draws on the American Association of Pediatrics recommendations that highlight the responsibilities of the NICU team to recognize risk, plan discharge, and assist with transitioning care post discharge. Nurses, as professional team members, are ideal for identifying at-risk status, devising individualized discharge plans, and assuring referrals to high-risk infant follow-up (HRIF). HRIF programs bridge care pre and post NICU discharge to assure that infants with complex issues and special needs reach optimal health and developmental levels.


For several decades neonatal intensive care units (NICUs) have adopted advanced technologies and treatments to promote survival and earlier discharge of sicker and more complex babies. However, preparing for discharge home begins with identification of which infants are at risk for developing disability or early demise. The purpose of this article is twofold; first, to help nurses recognize which infants are at highest risk for hospital readmission and early death post discharge from NICU. Updates on factors that influence risk are based on current evidence in the literature and presented in the Red Flag Checklist in Table 1. Second, this article presents the goals of the American Association of Pediatrics (AAP) and points out how nurses can work with families to prepare families to be able to care for these infants beyond the NICU setting.[1,2] Many NICUs have a high risk infant follow-up (HRIF) clinic or refer to one, as these clinics offer a bridge to transition care between NICU, the home, and the community. Identifying who is at risk in NICU, early family preparation and assisting with referrals to HRIF and appropriate resources are vital elements in pre-discharge planning for at-risk infants to promote optimal survival post discharge.