New guidelines for hospital discharge of newborns

The American Academy of Pediatrics (AAP) has issued a policy statement updating guidelines for releasing healthy term newborns from the hospital. The new guidelines aim to ensure that both baby and mother are ready to go home based on their unique situation.

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Newborns and mothers need to stay in the hospital long enough to identify problems and make sure that the mother is adequately recovered and prepared to take care of herself and her newborn once she leaves the hospital, the guidelines state. The timing may vary based on a number of factors including the baby’s health and stability; the mother’s health and ability and confidence to manage at home; level of support in the home; and access to follow-up care.

The discharge decision should consider input from the mother and her obstetrical care providers and should allow for mother and child to go home together if at all possible, the AAP recommends.

Before discharge the infant should be free of illness or other reason to stay in the hospital as determined by clinical and physical examinations and have completed at least 2 successful bottle or breastfeedings. The parent(s) should have an appropriate car seat for transporting their infant and know how to use it properly.

In addition, family, environmental, and social risk factors need to be evaluated. They include: untreated parental drug or alcohol use; mental illness in a parent; and a history of domestic violence, child abuse, or neglect in the home.

NEXT: Policy statement conclusion 

The authors of the policy statement conclude that the timing of newborn discharge should be up to the provider caring for the mother and baby in consultation with the family “and should not be based on arbitrary policies established by third-party payers.” They note that although a postpartum hospital stay of less than 48 hours for healthy term infants “can be accommodated,” a shortened stay isn’t appropriate for all newborns and mothers.

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Most states and the US Congress have passed legislation guaranteeing payment of benefits for hospital stays as long as 48 hours following vaginal delivery and as long as 96 hours after cesarean delivery. The legislation was a response to the controversy that followed implementation of early newborn discharge in the 1990s.

The AAP encourages hospitals to, if possible, develop processes to prevent early discharge of uninsured or underinsured newborns “for purely financial reasons” and urges establishment of hospital-stay programs for mothers and healthy newborns developed by professional staff in collaboration with community agencies, including third-party payers.