While guidelines from professional organizations purport to not define the legal standard of care a health care provider must follow, they are often some of the best evidence of what a doctor should do in a given circumstance.

In late April, The American Academy of Pediatrics issued guidelines as part of a study regarding the hospital stay of healthy term newborn infants.

You can read the full study here:

[Hospital Stay for Healthy Term Newborn Infants][1]

The study aimed to identify specific criteria that should be met to ensure that discharge and subsequent follow-up are appropriate. These guidelines provide information in evaluating potential lawsuits in the event complications do arise for the mother or infant.

The study was initiated because perceptions of readiness often differed among pediatric care providers, obstetrical care providers, and mothers.

The average hospital stay following delivery has declined steadily from 1970 until the mid 90’s. Early discharge was implemented in the 90’s but in response to the resultant debate, most states and US Congress enacted legislation that ensured up to 48 hours hospitalization for vaginal delivery and 96 hours for cesarean delivery.

A post-delivery hospital stay of the mother and her healthy term newborn infant should be long enough to allow identification of any health problems of mother or child, and to ensure that the mother is sufficiently recovered and prepared to care for herself and her newborn at home.

Specific to observing the infant for health concerns, many neonatal cardiopulmonary problems become apparent the first 12 hours after birth. Other neonatal problems such as jaundice, ductal dependent cardiac lesions, and gastrointestinal obstruction may require a longer observation period.

The study identified the following 17 criteria for newborn discharge as outlined below. Input from the child’s healthcare provider should be complimented with input from mother and obstetrical care provider. This is just a summary of the criteria, they are expanded upon in the study linked above:

1. The clinical course and physical examination reveal no abnormalities that require continued hospitalization.
2. Vital signs are documented as being within normal ranges.
3. Urinated regular and passed at least 1 stool spontaneously.
4. 2 successful feedings
5. No evidence of excessive bleeding at circumcision site for at least 2 hours (if applicable).
6. Clinical significance of jaundice, if present, has been determined and appropriate management or follow-up has been instituted.
7. Infant has been adequately evaluated and monitored for sepsis
8. Maternal and infant laboratory tests are available and have been reviewed.
9. Initial hepatitis B vaccine has been administered as indicated by infant’s risk status.
10. If mother has not previously been vaccinated she should receive TDAP immediately after infant is born.
11. Newborn metabolic, hearing, and pulse oximetry screenings have been completed per hospital and state regulations.
12. Mother’s knowledge, ability and confidence to provide adequate care are documented by the fact that training and information has been received in a variety of areas.
13. A car safety seat appropriate for the infant’s maturity and medical condition has been obtained and is available and the mother has demonstrated to trained hospital personnel proper use.
14. Family members or other support are knowledgeable about lactation, recognition of jaundice and dehydration, and are available to the mother and infant.
15. A physician directed source of continued health care for mother and infant has been identified. Instructions to follow in the event of an emergency have been provided.
16. Family, environmental, and social risk factors have been assessed, and the mother and her other family members have been educated about safe home environment.
17. For newborns discharged before 48 hours after delivery, an appointment should be made for the infant to be examined by a health care provider within 48 hours of discharge.

The study concludes that adopting standardized processes such as pre-discharge checklists may facilitate more uniform implementation of the recommendations across the full spectrum of health care settings where care for newborn infants is provided.

[1]: http://pediatrics.aappublications.org/content/early/2015/04/21/peds.2015-0699.full.pdf “Hospital Stay for Healthy Term Newborn Infants”