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    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.

    Recommended: Progress on preemies

    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 

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    • Anonymous
      Yes, finally the AAP stands up to insurers, however, what does a 'successful' breastfeeding look like at 48 hours after birth? I have seen many that are, but many are not - cannot be. Are the parameters of 'successful' left to the clinicians and mother to decide? Also, why are nurse home visits not part of the criteria for discharge at less than 48 hours - and at any age for particular conditions?
    • MARYHJOHNSON
      These recommendations come several years too late for a lot of us trying to safely staff community/rural hospitals. For example, a few years ago, in a Locums assignment that involved covering a hospital after a "Pediatric meltdown" (where all of the private Peds pulled out of taking call), I was told - in no uncertain terms - by an MBA/Unit Manager without a smidgen of medical training - that the doctors were expected to get babies OUT of the hospital at 24 hours - pretty much no matter what. The hospital would collect the regular reimbursement (for 2 days) and "save" on staffing. Apart from being unethical and medically dangerous, it seemed to be fairly illegal to me. Not that anyone in the executive suite - or the "parent company" (and it's a BIG-NAME "parent company") cared. ALL of the Locums bucked the edict - some quietly, and some more openly/defiantly - because it was just bad medicine. After rescuing one "near miss" (an infant with a ductal-dependent cardiac defect - whose duct decided to close right at the 24 hour mark), and making some fairly loud waves about it, I myself found myself sitting before the CMO (a surgeon) being chastised (and threatened with bad references) because I dared speak out about how INSANELY what-was-left-of-Pediatrics at "his" hospital was being managed. Pediatrics in the hospital setting is frequently about much MORE than just drying off the baby. Pediatricians are doctors too. Our specialty has standards and our lives/careers should be about much more than living in fear of being stomped like a bug if we buck a corporate system that is fraught with corruption - where we are always at the bottom of someone else's totem-pole of greed and power.

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