Decisions regarding the length of hospital stays for newborns and their mothers became driven by financial reimbursement from third-party payers in the 1990s. The Newborns' and Mothers' Health Protection Act of 1996 and a report from the Secretary's Advisory Committee on Infant Mortality acknowledge the importance of physician assessment in determining the timing of each newborn's discharge. The pediatrician's primary role is to ensure the health and well-being of the newborn in the context of the family. It is within this context that this revised statement addresses the short hospital stay (<48 hours after birth) for healthy term newborns.
Copyright © 2004 by the American Academy of Pediatrics
2004
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Early discharge is referred to as a postpartum hospital stay of ≤ 48 hours, as per the guidelines of American Academy of Pediatrics (AAP). The issue of early newborn discharge has been well studied in medical literature. Advocates of early discharge claim that it is safe and promotes family bonding and attachment, reduces the hospitalization care and patient costs and improves patient satisfaction. Concerns of early discharge can place an infant at risk for significant jaundice, feeding difficulties, hypernatremic dehydration, undetected infections, ductal-dependant cardiac lesions or gastrointestinal obstruction , incomplete immunization, increased re-hospitalization rates, higher post neonatal mortality, incomplete newborn screening, increased parental anxiety, increased maternal infection and depression, and ultimately increased medical cost, all because of the neonate leaving the hospital untimely.
Stopping or not initiating breastfeeding due to a lack of support for breastfeeding practice is also matter of concern, taking into account that the postnatal period can be a critical one for the mother (postpartum blues, family relations issues in the new family context). Moreover, postnatal care gaps may result from non-activation of local services for postnatal counselling, delays in the first visit after discharge at the birth center, or late takeover by the family pediatrician.
All efforts should be made to promote simultaneous mother-neonate discharge and the length of hospital stay should be based on the unique characteristics of each mother-infant dyad, including not only the health of the mother and the neonate but also the ability and confidence of the mother to care for her infant, the adequacy of support systems at home, and the access to appropriate follow-up care
About 5000 babies were followed up during a period from 1983 -2016 in various hospital settings ranging from rural, semi urban, teaching (Medical college) to tertiary hospitals. Initially babies were discharged early and found to have returned back with cephalhematoma, exaggerated jaundice, , signs of umbilical sepsis , umbilical granuloma,diaper rashes , pustulosis, sepsis. Unhealthy practices like inadequate feeding, initiation of formula feeds, use of water, pacifiers, gripe water was noticed on routine follow up.
In view of decreasing rehospitalisation, neonatal morbidity , neonatal mortality, increased consumer court law cases ,patient insistence of accurate diagnosis at discharge (knowledge gained through mobile and internet) , started our own department protocol in consultation with obstetrician discharge for neonates.
Normal term babies delivered by normal delivery discharged at 5th day and normal term babies born by LSCS discharged at 7th day. By which found adequate time for proper counselling of parents on routine baby care and immunization along with importance of adequate breast feeding. During this period detection of congenital anomalies, especially cardiac which usually manifest at a later date was done.
We found decreased incidence of rehospitalisation, and fewer unhealthy practices. Newborns which came on follow up exhibited less signs of disease and good weight gain. This was mainly possible as our hospital has a policy of free obstetric and neonatal care.
References
1. Datar A, Sood N: Impact of postpartum hospital-stay legislation on newborn length of stay, readmission, and mortality in California. Pediatrics. 2006, 118 (1): 63-72. 10.1542/peds.2005-3044.PubMedView Article
2. Maisels MJ, Newman TB: Kernicterus in otherwise healthy, breast-fed term newborns. Pediatrics. 1995, 96 (4 Pt 1): 730-733.PubMed
3. Jackson GL, Kennedy KA, Sendelbach DM, Talley DH, Aldridge CL, Vedro DA, et al: Problem identification in apparently well neonates: implications for early discharge. Clin Pediatr (Phila). 2000, 39 (10): 581-590. 10.1177/000992280003901003.View Article
4. Zimmerman DR, Klinger G, Merlob P: Early Discharge after Delivery. A Study of Safety and Risk Factors. ScientificWorldJournal. 2003, 3: 1363-1369.PubMedView Article
5. Chang RK, Gurvitz M, Rodriguez S: Missed Diagnosis of Critical Congenital Heart Disease. Arch Pediatr Adolesc Med. 2008, 162 (10): 969-674. 10.1001/archpedi.162.10.969.PubMedView Article