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When can this infant be discharged home? Could this procedure have been done as an outpatient after discharge?
Due to the risk of incarceration of the hernia, many of these procedures are scheduled just prior to discharge home from the NICU. After the procedure, the infant is monitored in the NICU for postoperative apnea for 24 hours and if there are no apneic events they are dis-charged home.
Recently, there has been increasing pressure to reduce length of stay. Many of these patients are now discharged home and brought back as outpatients for their hernia repairs. Current recommendations for postoperative admission vary depending on the gestational age at birth. In the full-term infant, the current recommendation is to monitor for postoperative apnea if they are less than weeks post-conceptual age. In the preterm infant, these recommendations can vary from 50 to 60 weeks post-conceptual age and are institution-specific. The risk for incarceration of the hernia while waiting beyond this timeframe must be weighed against the risk of postopera-tive apnea and the need for overnight admission to the hospital. These risks vary and depend on other variables, including post-conceptual age, gestational age, hemoglo-bin concentration, and home apnea monitoring. Each case is unique and must be reviewed on a case-by-case basis to determine the proper treatment course.
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