March 2012

We recognize that your decision to go home early may be based on many considerations including your personal preference, your personal finances, your insurance company’s decision to limit payment for uncomplicated deliveries, and your obstetrician’s determination that you personally are doing well. Discharge at 24 hours has become more routine. However, the transition from the protected environment that your infant knew while inside your body to the outside world is a process that will not be complete for several days.

The first three to five days of life are most critical. Many heart murmurs cannot be heard until the third or fourth day. Jaundice may occur early or late. Certain infections show no signs or symptoms until the infant is three to four days old. Therefore, in order to more closely observe newborn infants, we recommend that his/her hospital stay be at least two days. This also gives you an opportunity to rest, relax, and quietly “get to know” your new child.

The latest guidelines for Perinatal Care, written by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, states that there is “an element of medical risk” in the early discharge (less than 48 hours) of a newborn. We feel that it is important for you to be aware of this risk in making an informed decision to take your baby home early.

Should you choose to request discharge prior to 48 hours, nurses in the nursery will no longer be monitoring your infant and you will have to assess your infant for complications that can arise during the first few days. We, along with the nurses at the hospital, will try to provide you with the information you need to care for your newborn infant during this critical period. In addition, we want to see your baby in the office
48 to 72 hours after discharge. Please call (480) 839-9097 to make the appointment.

Many babies sleep a lot for the first 24 hours after birth and begin to awaken and become more alert by the third day. Their appetite increases about the same time and by the third day most infants are eating 6-8 times in a 24 hour period. Breast fed infants may nurse more often. If your baby does not appear to be interested in eating at least 6 times a day or if you are changing less than 6 wet diapers a day, please call.

Prior to discharge your infant has urinated and had a bowel movement, so we know that the “plumbing” is working. You will see approximately 6 wet diapers in a 24 hour day. By the third day, you will see more than one and as many as 10-12 bowel movements a day. Initially these will be dark, greenish black, and thick, but they will become more yellow, watery and runny by the third day.

Jaundice (a yellow color of the skin, or the whites of the eyes) is common in newborns. It usually peaks on the 3rd or 4th day of life. It is caused by the breakdown of extra red blood cells that are no longer necessary. Part of these broken down cells become bilirubin, a yellow compound that causes the yellow color. Usually there is no problem. However, certain illnesses can occur that increase the breakdown of red blood cells or that interfere with the breakdown of bilirubin by the baby’s liver. Even without such problems, the level of bilirubin can rise to harmful levels. This is one reason that we want to see your child in the office 48 to 72 hours after discharge. If his/her color looks yellow to you in the meantime, please call. We may need to see him/her earlier.

If your infant is a boy and has been circumcised, you will see the head of the penis somewhat red and swollen until healing is complete. However, if there is a large amount of bleeding from the circumcision that occurs after you are home, or if the entire penis looks red and swollen, please call.
It is normal for the hands and feet of newborns to look blue at times and to feel cool to the touch. However, if you notice a persistent blue color around the lips, please call the office.

Many infants have rashes over the first few weeks of life. The most common rash looks like little red raised bumps similar to “flea bites”. Sometimes it will be blotchy, with a little whitish or yellowish head. This is normal, and will go away within a few days or a week or so. However, rashes that look like a blister and appear to be filled with fluid may not be normal. If your infant develops a blistering rash, please call.

Most problems that occur during the transition period produce similar symptoms. These are:

  • Fast breathing (over 60 times per minute when sleeping)
  • Poor color (pale or bluish color)
  • “Grunting” sound with each breath
  • Poor feeding
  • Weak cry
  • Fever (over 100.5 °F) or low temperature
  • Poor muscle tone – “floppy”
  • Irritability or unable to get comfortable

If you notice any of the above with your infant, call or bring your infant back to the hospital for immediate evaluation.

As infants make the transition from intrauterine life to extrauterine life, many changes occur. Most of the time this happens without difficulty but problems with your child’s adjustment or transition can produce the symptoms listed above. The three major areas in which problems occur are infection, metabolic abnormalities, and circulation/breathing.

At birth, the flow of blood through the heart and lungs changes dramatically. Occasionally, an infant is born with a structural defect of the heart that causes no problem during the pregnancy but major difficulties after birth. Sometimes these defects are not apparent until the baby is several days old. If problems develop, the signs are usually rapid breathing, poor color, poor feeding, and persistent fussiness. If any of these occur, call us, or bring your infant back to the hospital.

Newborns are very susceptible to severe infection. The birth process is stressful and presents many opportunities for infection to occur. These infections can be in the skin, the lungs, the gastrointestinal tract, the coverings of the brain or directly in the blood. Infection in a newborn rarely presents with a fever. Usually the temperature is low – 96°F or lower rectally. Once established, an infection can spread very rapidly in an infant. The signs and symptoms described above, such as poor color and tone, decreased activity, fussiness, and change in breathing patterns can all be seen with an infection. If you think that your child may have a serious infection, take him/her immediately back to the hospital for evaluation.

During pregnancy, the placenta maintains normal levels of many chemicals in the body. After birth, the infant must do this alone. Rarely, infants have “inborn errors of metabolism” which usually means the absence of an enzyme which interferes with normal chemical processes and allows the build up of toxic chemicals. This may result in extremely poor responsiveness, like a coma, or the opposite, extreme irritability or convulsions. Any of the symptoms mentioned earlier may occur. These problems are rarely even suspected on the first day of life since toxins have not had time to accumulate. If you feel your infant might be having any of these problems, please bring him/her back to the hospital or to the office for evaluation.

It is very important to get as much rest as possible and to relax and enjoy your new baby. Do not have visitors, if possible; but if you do, do not let them hold and handle your infant. Tired, overstimulated and stressed infants can behave like the sick infants described above.

Call as soon possible to make the follow up appointment (between 8:00 A.M. and 5:00 P.M. Monday through Friday). If your newborn shows the pattern of signs and symptoms described above, call immediately, or bring your infant back to the hospital for evaluation.

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East Valley Children's Center 3200 S. George Drive, Tempe AZ 85282 ( map )
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Office Hours: By Appointment Only. M-F 8:00 a.m. to 5:00 p.m. Evenings & Saturdays on urgent basis only.