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Making Sure Newborns Are Ready to Go Home

Medical guidelines set when it's safe for a baby to leave the hospital

MONDAY, May 3, 2004 (HealthDayNews) -- No mother wants the experience of taking her baby home from the hospital, only to have to return days later because a scary health problem crops up.

But new medical guidelines that appear in the May issue of Pediatrics should help keep that frightening scenario from happening.

The Newborns' and Mothers' Health Protection Act of 1996 says mothers and their infants can stay in the hospital at least 48 hours after delivery; the latest recommendations from the American Academy of Pediatrics (AAP) set medical standards that doctors can use to determine the right time for discharge.

"The guidelines describe when healthy newborns can be discharged from the hospital," said Dr. William P. Kanto, a spokesman for the AAP. "These new guidelines are a response to the older guidelines under which some babies were being discharged too early."

According to the guidelines, mothers and infants should stay in the hospital long enough to identify early problems and to make sure the family is ready and able to care for the baby at home.

The guidelines also define what needs to be done before discharge, Kanto said. These guidelines go beyond the law, and don't use time as the criteria, but rather the things that need to be done to ensure the baby's health outside the hospital, he added.

In addition, discharge should not be based on arbitrary policy set by health insurance companies or hospitals, Kanto said.

The guidelines also recommend that early discharge be limited to single birth, full-term infants. These babies should have healthy weight and normal vital signs. They should be eating well, and urinating and defecating.

Also, there should be nothing abnormal, and no bleeding or significant jaundice. Before leaving the hospital, babies should have hearing tests and the required screening tests and a hepatitis B vaccination, if needed.

Furthermore, the doctor should make sure the mother has help and no environmental and social risk factors. The physician can arrange for proper follow-up care 48 to 72 hours after discharge.

These are minimum criteria that must be met before discharge, and they cannot be met in less than 48 hours, Kanto said. "We consider any discharge before 48 hours an early discharge," he added.

Dr. Marvin Wang, co-director of the newborn nurseries at Massachusetts General Hospital, said, "These recommendations are common-sense measures that most good clinicians already do, but it is nice to see it all spelled out."

Keeping infants for at least 48 hours after birth lets doctors handle the common problems that may occur, such as jaundice, cardiac lesions or gastrointestinal obstructions, and complete necessary tests, Wang said.

"And most importantly, for most families, feeding issues can be dealt with," he added.

"Almost all families who take their baby home before 48 hours go because they want to; it's never the physician or hospital who says you've got to get out of here," Wang noted.

It's up to the doctor to review with the parents the health of the baby before discharge.

Before a baby is released from the hospital, Wang said, the doctor should ask: "How's the baby feeding? Has he peed and pooped? Are you comfortable taking care of the baby? Are you all set up at home? Do you have everything you need? Do you have good follow-up care arranged?"

Wang believes that following these new common-sense guidelines will help reduce the number of babies who need to return to the hospital because they were discharged too early.

More information

The U.S. Labor Department can tell you about the Newborns' and Mothers' Health Protection Act, and the American Academy of Pediatrics can tell you more about early release of newborns.

SOURCES: William P. Kanto, M.D., professor and chairman, department of pediatrics, Medical College of Georgia, Augusta, and spokesman, American Academy of Pediatrics; Marvin Wang, M.D., co-director, newborn nurseries, Massachusetts General Hospital, Boston; May 2004, Pediatrics
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