nicu-care

name	nicu-care
description	Use when tracking NICU status, pumping schedules, discharge readiness, or preemie-care milestones for Leo and Mia. Governs daily NICU check-in patterns, pump-log management, and family communication during split-home period.
version	1.0.0
author	Hermes Agent
license	MIT
metadata	{"hermes":{"tags":["home-assistant","rocha-family","nicu","twins","preemie","pumping","health"],"related_skills":["family-profile","wellness-coach","health-coach","parenting-coach","family-coordinator"]}}

NICU Care

Overview

Leo and Mia Rocha were born April 16, 2026 — premature (~10 weeks early). Leo was discharged around June 3, 2026 (Day ~48). Mia remains in NICU. This skill governs Hermes's role in supporting the family during the split-home period: one twin home, one twin in NICU.

When to Use

• Pumping schedule reminders and log tracking
• Discharge readiness checklist for Mia
• Proactive wellness monitoring tied to NICU progress
• Pediatric follow-up coordination post-discharge
• Baby-care quality-of-life flags (feeding, weight gain, breathing events)

NICU Status (as of 2026-06-03)

Twin	Status	Location
Leo	HOME ✅	Rocha home — discharged ~June 3
Mia	NICU 🏥	Still inpatient — discharge TBD

Domain Split (Hermes vs OG)

Domain	Owner
Daily NICU log / pump log	OG agent
Proactive wellness monitoring	Hermes
Pediatric follow-up scheduling	Hermes
Pumping reminders (15 min before session)	OG cron
Paula postpartum nutrition	Hermes (via nutrition-chef)
Baby-dog safety coordination	Hermes (via dog-parent)

Preemie Rules (ALWAYS Apply)

• Adjusted age: Leo and Mia are ~10 weeks premature. ALWAYS use adjusted age (chronological age minus ~10 weeks) when assessing milestones.
• No milestone alarmism: Never flag as concern unless adjusted age standard is missed.
• RSV caution: Preemie immune systems are vulnerable. Flag any crowded event, sick visitor, or cold season risk.
• Temperature: Nursery 68–72°F. Non-negotiable for preemie thermoregulation.
• Weight gain: Expect 0.5–1 oz/day as normal pace post-discharge.

Pumping Schedule Context

• Paula Day ~48 post-birth at Leo discharge
• Baseline: ~220 mL/day
• Sessions typically every 3–4 hours
• Pump output = leading wellness indicator (see wellness-coach skill)
• Decline 3+ consecutive days → flag proactively before Paula self-reports

Mia Discharge Readiness Checklist

Track these before flagging Mia's discharge as imminent:

• Off supplemental oxygen
• Maintaining body temperature independently
• All feeds by breast or bottle (no NG tube)
• Consistent weight gain 3+ consecutive days
• Car seat tolerance test passed
• Family CPR/infant care training completed
• Pediatrician follow-up appointment scheduled
• Nursery second space ready (Mia's section)

Leo Post-Discharge Care (Week 1–4)

• First pediatrician visit: within 48–72 hours of discharge
• Weight check at every visit (preemies monitored closely)
• No sick visitors for 4+ weeks minimum
• Adjusted age: use for all milestone tracking
• Vitamin D supplement: confirm with pediatrician

Communication Rules

• Paula: 2–3 lines max. No rapid questions. No TTS. Drip-feed hours apart.
• Hector: Result-first. Include TTS via speak param. Max 5 lines.
• NICU status updates: send Hector only unless Paula explicitly asks.
• Never speculate on Mia's discharge date — only relay what NICU team confirmed.

Cron Reference (Source Pattern)

nicu-care-checkin: 6 7,9,11,13,15,17,19,21 * * *
  → Pumping reminders 15min before session
  → Logs to pumping-log.json (OG domain)

Hermes does NOT duplicate this. Hermes monitors trends, not individual sessions.

Common Pitfalls

• ❌ Stating Mia's discharge date as known — it isn't; say "TBD per NICU team"
• ❌ Using chronological age for milestones — always use adjusted age
• ❌ Alarming Paula about NICU data without context — calibrate against adjusted norms
• ❌ Duplicating OG's pump log tracking — Hermes monitors output trends, not individual logs
• ❌ Forgetting RSV risk window — preemies discharged in spring/summer still need protection

Verification Checklist

• Adjusted age used for all milestone references
• Mia's discharge status not stated as known unless confirmed
• Pump output tracked as trend indicator, not session-by-session log
• Nursery temperature in range (68–72°F) before flagging as ready
• Pediatric follow-ups in family-coordinator/working.md