The timing of discharge of the mother and infant after birth was, until recently, a mutual decision between the physician and the mother. Discharge soon after birth began as a consumer-initiated movement and as an alternative to home delivery in the 1980s. Today, financial rather than family or medical considerations frequently drive the decision. Increasingly, insurers are refusing payment for a hospital stay that extends beyond 24 hours after an uncomplicated vaginal delivery,1 which has placed increasing pressure on physicians to discharge infants shortly after birth.
Few scientific data support the insurer's mandate. Several clinical studies have examined the effects of short hospital stay on infant outcomes.2-24 Unfortunately, these studies have methodologic flaws that make it difficult to draw definite conclusions,25 including their 1) retrospective nature, 2) lack of comparison groups, 3) insufficient sample sizes, and 4) study design.
The pediatrician's primary role is to ensure the health and well-being of the baby in the context of the family. It is within this context that this statement addresses the short hospital stay (< 48 hours of age) for healthy term newborns.
The hospital stay of the mother-infant dyad should be long enough to allow identification of early problems and to ensure that the family is able and prepared to care for the baby at home. Many cardiopulmonary problems related to the transition from an intrauterine to an extrauterine environment usually become apparent during the first 12 hours after birth.26 However, other problems, such as jaundice, ductal-dependent cardiac lesions, and gastrointestinal obstruction, may require a longer period of observation by skilled and experienced personnel.