DRAFT STATEMENT (7/18/95): WASHINGTON CHAPTER OF THE AMERICAN ACADEMY OF PEDIATRICS, FETUS & NEWBORN COMMITTEE

The optimal care given to a parent and newborn includes:

1. Prenatal care throughout pregnancy
2. Prenatal childbirth education classes to include discussion of problems that may occur in the first few days of life, i.e. feeding difficulties, jaundice, stooling patterns, etc.
3. Adequate support system within the home
4. A nursery stay long enough to allow identification of early problems, initiation of successful breast feeding, and time for parents to understand their new responsibilities

An optimal nursery stay is NOT time dependent, but in many cases may be greater than 24 hours.

The following are Suggested Guidelines to improve the safety with which primary care providers may discharge newborns at less than 24 hours of age:

• Only infants delivered at term of appropriate birth weight, and found to be normal on examination should be considered for discharge at less than 24 hours. A nursery stay of at least 12 hours should be required.
• All infants need to be examined by a qualified practitioner. The findings of the exam should be forwarded to the practitioner of record at time of discharge.
• The infant should be able to maintain thermal homeostasis.
• The infant should be able to feed normally, and parents should have access to lactation consultation. Education as to normal newborn well-being should be given and should include feeding, stooling, voiding, sleep position, and signs of acute illness. The education would be best acquired prenatally prior to the added stresses of new parenthood.
• All state required newborn screening tests should be obtained.
• Maternal testing for syphilis and hepatitis surface antigen, and any interventions should be documented.
• Initial hepatitis B vaccine should be administered.
• Cord blood of all type O positive mothers should be saved so that the mother- baby studies could be done quickly as needed.
• A primary care practitioner trained in the care of newborns needs to be identified prior to discharge.
• Follow-up care directed by said practitioner must be obtained no later than 72 hours post discharge. Agreement to seek such care should be documented.
• The correct usage of an approved infant care seat must be documented.

REFERENCES

Review

• Brittan JR, Brittan HL, Beebe SA: Early discharge of the the term newborn: A continued dilemma. Pediatrics. 1994; 94:291-295.

Guidelines

• American Academy of Pediatrics, Committe on Fetus and Newborn, American College of Obstetricians and Gynecologists, Committee on Obstetrics Guidelines for Perinatal Care, Elk Grove Village, IL, American Academy of Pediatrics 1983: 91-92.

Safety of Early Discharge (after first 6 hours)

• Brittan HL, Brittan JR: Efficacy of early discharge in a middle class population. Am. J. Dis. Child. 1984;138:1041-1046.
• Yanover MJ, Miller MD: Perinatal care of low-risk mothers and infants: Early discharge with home care. N. Eng. J. Med. 1976; 294:702-705.

Early Discharge

• Hellman LM, Kohl SG, Plamer J: Early discharge in obstetrics. Lancet 1962; 2:227-232.
• Yanover et al (see above)
• Waldenstrom IJ, Sundelin C, Lindmark G: Early and late discharge after birth. Health of mother and infant in the postpartum period. Upsala J. Med. Sci. 1987; 92:301-314.
• Patterson PK: A comparison of postpartum early traditional groups. Q. Rev. Bull. 1987;13:365-371.
• Norr KF, Nacion KW, Abraham R: Early discharge with home follow-up, impacts on low income mothers and infants. J. Obs
• tet. Gynecol. Neonat. Nurs. 1988; 22:133-141.
• Pittard WB, Geddes KM: Newborn hospitalization, a closer look. J. Pediatr. 1988; 112:257-262.
• Conrad PD, Rosenberg AA: Safety of newborn discharge in less than 36 hours in an indigent population. Am. J. Dis. Child. 1989; 143:98-101.
• Carty EM, Bradley CF: A randomized, controlled evaluation of early postpartum hospital discharge. Birth 1990; 17:199-204.
• Hurt H: Early discharge for newborns -- when is it safe? Contemp. Pediatrics 1994; 11:68-88.

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