We recognize a decision to go home early may be based on considerations such as personal preference, finances, insurance benefits or your obstetrician’s determination of your physical health. Discharge at 24 hours has become 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 their hospital stay be at least two days. This also give you an opportunity to rest, relax and quietly “get to know” your new baby.

The latest guidelines for perinatal care from the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists states there is “an element of medical risk” in the early discharge (less than 48 hours) of a newborn. At EVCC 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 chose 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 baby 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 infant during this critical period. Additionally, we will 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 in a day, call our office.

Prior to discharge your infant has urinated and had a bowel movement, so we know that the “plumbing” is working. You should see approximately 6 west 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 whites of the eyes) is common in newborns and usually peaks on the 3^rd or 4^th day of life. It is caused by the breakdown of extra red blood cells. Some of these cells become bilirubin, a yellow compound that causes the color. Usually there is no problem. However, certain illnesses can occur that increase the breakdown of red blood cells or interfere with the breakdown of bilirubin by the liver. Even without problems the level of bilirubin can rise to harmful levels. This is one reason why we want to see your baby in the office 48 to 72 hours after discharge. If their color looks yellow to you in the meantime please call as we may suggest you bring the baby in to the office.

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 after you are home, or if the entire penis looks red and swollen, please call the office.

It is normal for the hands and feet of newborns to look blue at times and to feel cool to the touch but if you notice a persistent blue color around the lips call the office.

Many infants have rashes over the first weeks after birth. The most common rash looks like little red, raised bumps similar to “flea bites.” In some cases it will be blotchy, with a white or yellow head. This is normal and will go away within a few days or  weeks. Rashes that look like a blister and appear to be filled with fluid may not be normal. If your infant develops a blistering rash, call our office.

Most problems occurring during this transition period produce similar symptoms. Such as:

• Fast breathing (over 60 times per minute when sleeping)
• Poor color (pale or bluish hue)
• “Grunting” sound with each breath
• Poor feeding
• Weak cry
• Fever (over 100.3°F taken rectally) or low temperature (less than 97.0 degrees taken rectally)
• Poor muscle tone – “floppy”
• Irritability or unable to get comfortable

If you notice any of the above with your baby, call or take them to the hospital for immediate evaluation.

As babies 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 take your baby 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, lungs, gastrointestinal tract, covering of the brain or in the blood. Infection in a newborn rarely presents with a fever. Usually the temperature is low – 97.0 °F or lower, rectally. Once established, an infection can spread very rapidly. The signs and symptoms described above, such as poor color and tone, decreased activity, fussiness and change in breathing patterns can all be indicators of infection. If you think your infant may have a serious infection, take them immediately to the hospital.

During pregnancy the placenta maintains normal levels of many chemicals in the body.  After birth the infant’s body must do this on its own. Rarely, babies have “inborn errors of metabolism” usually meaning the absence of an enzyme thus interfering with normal chemical processes and allowing the buildup 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 take them to the hospital or bring them 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, limit the handling of your baby as over stimulated and stressed infants can exhibit the behaviors described above.

Call as soon as possible to schedule your follow-up appointment (between 8 am and 5 pm, Monday through Friday). If your newborn shows the pattern of signs and symptoms in this section, call immediately or take your baby to the hospital for evaluation.