Early discharge of term neonates: we can do it safely

Discharge of the term newborn is a critical issue in perinatal care. The average length of stay of the mother-infant dyad after delivery declined steadily from 1970 until the mid-1990s (early discharge ≤ 48 hours, very early discharge ≤ 24 hours after birth) [1]. Several subsequent studies [2–5] have reported that too short a hospital stay can place an infant at risk for significant jaundice, feeding difficulties, hypernatraemic dehydration, undetected infections, ductal-dependant cardiac lesions or gastrointestinal obstruction and may result in readmission [6–8]. Stopping or not initiating breastfeeding due to a lack of support for breastfeeding practice [9] 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 counseling, delays in the first visit after discharge at the birth center, or late takeover by the family pediatrician.

The recent pronouncements of scientific societies [10] and the World Health Organization (2013) [11] together with legislation produced in our country (Progetto Obiettivo Materno Infantile 2000, Piano Sanitario Nazionale 2006 - 2008, Conferenza Unificata Stato-Regioni 2010, Raccomandazione n° 16 del Ministero della Salute 2014), can help identify criteria for appropriate and safe discharge of the mother-infant dyad. 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 (Table 1).

Table 1 Criteria to be met before discharge of a term neonate (modified from American Academy of Pediatrics 2015)