Neonate: Myelomeningocele/Myeloschisis — Preparing a Thorough and Complete Discharge for the Infant with MMC — Clinical Pathway: ICU

Neonatal Myelomeningocele/Myeloschisis Clinical Pathway — ICU

Preparing a Thorough and Complete Discharge for the Infant with MMC

Follow-up Appointments

  • Encourage parent to complete the Follow-up Appointment document if not done so prior to admission
  • If infant is discharged to an area without a formal Spina Bifida program, email consult attendings for recommendations in infant’s home area
  • Check with social work that insurance is all set so that appointments can be made
  • Verify long-distance Spina Bifida Programs includes Neurosurgery. If not, a separate Neurosurgery follow up appointment is required
  • Verify that Neurosurgery follow up appointment is made within one month of discharge
  • If infant needs casting, Orthopedics appointment should be made within 1 week
  • Verify that parents have identified a Pediatrician and have scheduled an appointment following discharge
  • Determine follow up intervals for each subspecialty and put this information in the discharge summary

Discharge Paperwork

  • Complete radiology request form once studies are complete and fax to 215-590-4783 or e-mail to rra@chop.edu.
  • Families should be given two copies of a CD if following up at an OSH. Sometimes the Spina Bifida Clinic as well as the Neurosurgeon each want a copy.
  • Call 215-590-2584 to ensure form was received and to obtain timeline for completion.
  • CDs can be picked up on the 3rd floor of the Main Hospital, Radiology Department.
  • If following-up at CHOP, but parents live a distance away from CHOP, give one copy of a CD to the family in case of emergency and they need to present to an OSH.
  • Fax a copy of the discharge summary:
Outside Follow-up
  • Pediatrician, Spina Bifida Clinic
  • If needed:
    • Urology
    • Neurosurgeon
    • Orthopedics
CHOP Follow-up Pediatrician

May also need to fax copies of operative report
Include signs and symptoms of increased ICP in discharge summary. If applicable, include VP shunt specific discharge instructions.

Discharge Scripts

  • Notify Case Management of need for supplies, fortifiers, and/or special formulas
  • Give parents scripts ASAP so Case Management can get prior authorization to have them filled
  • Give one amoxicillin script for a 14-day supply with 5 refills to get family to their Urology appointment at 2-3 months of age

Additional Discharge needs

  • Verify hearing screen was performed
  • Order first Hepatitis B vaccine prior to discharge
  • Notify General Surgery and Urology that a circumcision is requested by the family

Discharge Teaching

  • Give parents all Patient Family Education documents they might require at time of discharge
  • MMC folder is found in the Surgery APN office and should be given to families prior to discharge
  • Parents should understand importance of application of thick layer of diaper cream at home with each diaper change to help prevent diaper rash

Call and give sign-out to the Pediatrician if a Tele-Signout is not scheduled. Sign-out should also be given to an outside Spina Bifida Program.