The infant's vital signs are documented as being within normal ranges, with appropriate variations based on physiologic state, and stable for the 12 hours preceding discharge. RecommendationsĬlinical course and physical examination reveal no abnormalities that require continued hospitalization. To accomplish this, a pediatric care provider's decision to discharge a newborn should be made jointly with input from the mother, her obstetrical care provider, and other health care providers, such as nursing staff and social workers, who are involved in the care of the mother and her infant. 19 All efforts should be made to keep mothers and infants together to promote simultaneous discharge. This tool was tested by 22 clinical practice teams during the Safe and Healthy Beginnings improvement project and focuses on risk for severe hyperbilirubinemia, availability of breastfeeding support, and coordination of newborn care. 13, 18 Although no specific clinical tool is currently available to evaluate mothers' or families' perception of readiness for discharge after delivery, the American Academy of Pediatrics Safe and Healthy Beginnings toolkit contains a discharge-readiness checklist that can aid clinicians with preparation of a newborn for discharge. 18 Factors associated with perceived unreadiness for maternal or neonatal discharge, primarily as reported by mothers themselves, include first live birth, maternal history of chronic disease or illness after birth, in-hospital neonatal illness, intent to breastfeed, mothers with inadequate prenatal care and poor social support, and black non-Hispanic maternal race. However, perceptions about the degree of readiness at the time of discharge often differ among pediatric care providers, obstetrical care providers, and mothers. Readiness for discharge of a healthy term infant is traditionally determined by pediatric care providers after a review of the mother's and family members' ability to provide care to a newborn infant at home. 13, 15, – 18 Close follow-up and better coordination of postdischarge care were important factors in decreasing the readmission rates. 16, 17 Other frequently reported risk factors for readmission were Asian race, primiparity, associated maternal morbidities, shorter gestation or lower birth weight, instrumented vaginal delivery, and small size for gestational age. These studies identified jaundice, dehydration, and feeding difficulties as the most common reasons for readmission. In some of these studies, the risk factors for readmission to identify infants who may benefit from either a longer hospital stay or close postdischarge follow-up also were evaluated. 8, 12, – 15 However, the differences in the definition of early discharge, postdischarge follow-up and support, and the timing of readmissions make it difficult to compare the results. In these reports, readmissions after an early discharge varied from no increase to a significant increase. In several large epidemiologic studies, readmission rates were used to assess the adequacy of the newborn hospital length of stay. An inadequate assessment by health care providers in any of these areas before discharge can place an infant at risk and may result in readmission. Criteria for newborn discharge include physiologic stability, family preparedness and competence to provide newborn care at home, availability of social support, and access to the health care system and resources.
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