After giving birth in an uncomplicated delivery, hospital discharge is received 48 hours after the baby is born. In the case of cesarean delivery, discharge is usually given 72-96 hours after birth.
This time in the hospital is important in order to identify problems and to ensure that the mother is sufficiently recovered and prepared to care for herself and her child at home.
In any case, every effort must be made so that mothers and children do not separate and leave maternity together. When can the baby go home? When are you discharged from the hospital?
What is checked before the baby is discharged?
According to the Spanish Association of Paediatrics, leaving the maternity unit must be preceded by checking all the following aspects:
1. Weight is checked
Verify weight and percentage of loss with respect to birth weight, as well as that he has urinated and defecated.
2. Examination and assessment of the newborn
Emphasizing signs such as jaundice, lethargy, irritability, respiratory distress, cyanosis or other changes in skin color, hypotonia, hypertonia, poor suction, etc.
3. Heel test
It is essential that all newborns undergo what is known as a heel prick test or an early detection test for metabolic disorders (phenylketonuria, hypothyroidism, etc.). It is indicated once oral feeding is well established, generally after 48-72 hours and before 7 days of life, so if the patient is discharged early, it must be stated that the test has not been performed and that it must be performed between 5 and 7 days of life.
4. Vaccine if necessary
In newborns at risk (endemic areas, children of mothers with hepatitis B or C), universal immunization against HBV is recommended, which can be started from the neonatal period (0, 2 and 6 months). If the mother is also a carrier of HBV (positive surface antigen), the baby should receive a dose (2 ml) of anti-HBV gamma globulin, preferably in the first 12 hours of life. If such prophylaxis has been performed, breastfeeding is not contraindicated. The vaccine in non-risk newborns can be administered according to the usual schedule at 2, 4 and 6 months simultaneously with other vaccines.
5. Hip ultrasound if there is risk
Ultrasound examination of the hip is recommended in healthy newborns at risk of presenting congenital hip dysplasia (affected brother, first female child in breech, musculoskeletal abnormalities) or abnormal examination of the same.
6. Check hearing problems
Neonatal screening for hearing loss . Two electrophysiological techniques, otoacoustic emissions (OAE) and auditory stem evoked potentials are routinely used as screening tests, both are portable, automated and cheap, making them suitable for screening for hearing loss. Acoustic otoemissions explore the peripheral hearing organ (up to the cochlea), and should be performed on all newborns, even if they are healthy. Those with a family history of deafness, TORCH infection during pregnancy, ototoxic drugs during pregnancy, etc. are at risk of hearing loss. It is desirable that this diagnostic test be extended as a universal screening to all newborns in order to favor early diagnosis of hearing loss and minimize its consequences with an early approach to the deficit.
7. Identify possible problems
Hospitalization of the healthy newborn should be long enough to allow early detection of problems and to ensure that the family is able and prepared to care for the child at home. Factors affecting this decision include the health of the mother, the health and stability of the child, the mother’s ability and confidence to care for her child, adequate support at home, and appropriate access to follow-up care. It is unlikely that all of these criteria will be met before 48 hours. Discharges before 48 hours of life would be limited to singleton infants of 38 to 42 weeks gestation, appropriate for gestational age and meeting the criteria listed above. But it is recommended that newborns from vaginal deliveries stay in the hospital for at least 48 hours and 96 hours for cesarean sections. When discharge is early (<48 hours), the newborn will be reassessed outside the hospital before 48 hours of life have elapsed, especially in relation to jaundice, heart disease, hips, feeding, screening and weight.
8. Solve doubts from parents
Upon discharge, the pediatrician and/or a nurse from the newborn room will review with the parents any doubts they have about the care of the newborn, with special emphasis on feeding, jaundice, bathing, cord care , as well as the signs of illness that should be consulted with the pediatrician. They will be reminded of the first visit to the pediatrician in the following days.
