- Meeting abstract
- Open Access
Early discharge of term neonates: we can do it safely
Italian Journal of Pediatricsvolume 41, Article number: A42 (2015)
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) . 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  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  and the World Health Organization (2013)  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).
Datar A, Sood N: Impact of postpartum hospital-stay legislation on newborn length of stay, readmission, and mortality in California. Pediatrics. 2006, 118 (1): 63-72. 10.1542/peds.2005-3044.
Maisels MJ, Newman TB: Kernicterus in otherwise healthy, breast-fed term newborns. Pediatrics. 1995, 96 (4 Pt 1): 730-733.
Jackson GL, Kennedy KA, Sendelbach DM, Talley DH, Aldridge CL, Vedro DA, et al: Problem identification in apparently well neonates: implications for early discharge. Clin Pediatr (Phila). 2000, 39 (10): 581-590. 10.1177/000992280003901003.
Zimmerman DR, Klinger G, Merlob P: Early Discharge after Delivery. A Study of Safety and Risk Factors. ScientificWorldJournal. 2003, 3: 1363-1369.
Chang RK, Gurvitz M, Rodriguez S: Missed Diagnosis of Critical Congenital Heart Disease. Arch Pediatr Adolesc Med. 2008, 162 (10): 969-674. 10.1001/archpedi.162.10.969.
Liu S, Wen SW, McMillan D, Trouton K, Fowler D, McCourt C: Increased neonatal readmission rate associated with decreased length of hospital stay at birth in Canada. Can J Public Health. 2000, 91 (1): 46-50.
Graven MA, Cuddeback JK, Wyble L: Readmission for group B streptococci or Escherichia coli infection among full-term, singleton, vaginally delivered neonates after early discharge from Florida hospitals for births from 1992 through 1994. J Perinatol. 1999, 19 (1): 19-25. 10.1038/sj.jp.7200099.
Habib HS: Impact of discharge timings of healthy newborns on the rates and etiology of neonatal hospital readmissions. J Coll Physicians Surg Pak. 2013, 23 (10): 715-719.
Renfrew MJ, McCormick FM, Wade A, Quinn B, Dowswell T: Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev. 2012, 5: CD01141-
Benitz WE, Committee on Fetus and Newborn, American Academy of Pediatrics: Hospital Stay for Healthy Term Newborn Infants. Pediatrics. 2015, 135 (5): 948-953. 10.1542/peds.2015-0699.
World Health Organization: WHO Recommendations on postnatal care of the mother and newborn. Geneva World Health Organization. 2013
Romagnoli C, Barone G, Pratesi S, Raimondi F, Capasso L, Zecca E, et al: Italian guidelines for management and treatment of hyperbilirubinaemia of newborn infants > 35 weeks’ gestational age. Ital J Pediatr. 2014, 40 (1): 11-10.1186/1824-7288-40-11.