AAP policy addresses appropriate discharge timing for healthy term newborns

1. Timing of discharge for a healthy, term infant should be evaluated by the clinician caring for the infant-mother dyad and should be decided after consulting with family, other providers and staff. Timing should never be based on third-party payer policies.

2. To determine if an infant-mother dyad is appropriate for discharge, both infant and mother preparedness must be assessment. Infant assessment includes addressing vital signs, evaluation for current or potential complications, and appropriate anticipatory guidance. Maternal assessment includes addressing her health, preparedness for caring for herself and her newborn, and helping establish a supportive medical home.

Policy Rundown: The American Academy of Pediatrics (AAP) has reviewed and addressed issues regarding the discharge of healthy term infants in an effort to decrease readmission and provide safe, appropriate continuity of care for both mothers and their infants. The hospital course should be long enough to establish that the term newborn is healthy. This includes evaluation of vital sign stability, assessment of infant physiology, jaundice, Coombs testing and vaccination against hepatitis B. Infants should receive a hearing evaluation, pulse oximetry test, and metabolic disease panel in-line with state regulations prior to discharge. The infant must be urinating adequately and have had at least 1 stool spontaneously. Mothers should be observed feeding their newborns, whether by bottle or breast, by trained professionals, and conditions should be optimized to establish appropriate infant latch, swallowing, and satiety. Mothers should be given information and training on the benefits of breastfeeding, newborn skin and genital care, signs of illness, infant safety and the importance of hand hygiene. The tetanus/diphtheria/pertussis vaccine should be given to previously unvaccinated mothers and offered to any adults or teens in close contact with the infant. A car seat meeting Federal Motor Vehicle Safety Standard 213 must be obtained, and the mother must be trained and observed on proper infant positioning and car safety by appropriate personnel. Prior to discharge, a physician must be identified for the newborn and an appointment should be scheduled for 48 hours after discharge. The AAP supports deferral of discharge to accomplish the previous task, as it is critical to maintain early assessment for issues such as dehydration, jaundice, and sepsis, parental wellbeing, and to answer questions. Finally, the family, environmental, and social risk factors must be assessed and addressed to ensure a safe and supportive environment in which the mother and infant can thrive. There is much to accomplish prior to discharging a mother and her healthy, term newborn. As such, length of stay must be determined based on the specific needs of the mother-infant dyad via collaboration among family, responsible clinicians and staff. Through collaboration with other agencies, institutions should establish guidelines that facilitate the implementation of these recommendations.

Click to read the policy published in Pediatrics

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