When Is Hospital Discharge Too Soon?

Low-Risk Mothers and Infants

Your baby is at low risk of complications if you meet the following general criteria:

• The prenatal, delivery, and post-delivery course is unremarkable. If there have been no problems up to this point, it is unlikely they will start now. There are some exceptions to this, such as infection and jaundice, but not many.
• You had a singleton birth at 38 to 42 weeks gestation with normal growth. Some babies born at less than 38 weeks can also go home shortly after delivery. Some multiples born at this gestation are also ready for discharge at one to two days. However, babies born at 37 weeks or less often have feeding problems that only resolve with time. In these situations, it is better to wait a few days rather than go home and have difficulties.
• Your newborn has had a normal physical exam. This exam is critical and should include a careful look by a physician or nurse practitioner (preferably the same doctor who will see the baby as an outpatient will also see the baby in the hospital). A circumcision site should not bleed for at least two hours after the procedure. Jaundice should not be present in the first 24 hours and should not be prominent at discharge.

A Checklist for Discharge

Before the baby goes home, the following should have been accomplished:

• The newborn is feeding successfully. This means that the child must nurse or take a bottle at all feedings and be taking enough volume to prevent dehydration. The feedings should also show signs of improvement if they are not going well.
• The baby urinates regularly and has passed at least one stool.
• The newborn's temperature, heart rate, breathing rate, and blood pressure are normal in an open crib.
• Metabolic screening tests have been done as required by state law. If these are obtained before the child is 24 hours old, they need to be repeated at several days of age.
• The initial hepatitis B vaccine is administered or scheduled.
• The mother has been trained in feeding her baby, skin care, recognizing signs of illness, and infant safety.
• A source of health information and treatment is available to the mother and infant.
• Laboratory tests are normal (infant's blood type and antibody test if indicated and maternal blood tests for syphilis and hepatitis B).
• The primary care doctor for the mother and baby is aware of discharge. A follow-up appointment for the infant should be made for two to three days after discharge.
• The family has a car seat for transporting their new baby home.

Discharge from the hospital is something best resolved between the parents and the physicians for the mother and infant. If you are uncomfortable with a discharge plan, speak directly with your doctor about your concerns. Whenever you go home, you will need a source of health information and someone to call in case of problems. After you go home, you will likely think of questions to ask. This is not only normal, it is the sign of a parent who is genuinely concerned. Write down your questions and call your clinic to get answers.