1. Discharging the Healthy Newborn
Patricia B. Gotsch M.D.
St. Luke’s Family Medicine Residency Program
Bethlehem PA

2. Objectives
Review issues that should be discussed with new parents prior to taking their newborn home
Discuss evidence (or lack thereof) for current recommendations

3. American Family Physician March 2006

4. Categories for Discussion
Feeding/nutrition
Elimination
Cord/skin/diaper care
Safety
Danger signs
Followup/contact info

5. Evidence?

6. SORT A = consistent, good quality patient oriented evidence
B = inconsistent or limited quality patient oriented evidence
C = consensus, disease oriented evidence, usual practice, expert opinion, or case series

7. Breastfeeding Lactation consultant/class Good reference book
Network of nursing moms
ENCOURAGEMENT!

8. Breastfeeding Proper technique Frequency
How to tell if infant is getting adequate feedings
Avoiding alcohol, drugs

9. Formula Feeding Iron fortified formulas recommended
Studies have shown no increase in GI side effects
Oski, Pediatrics 1980;66:168-70
Nelson, Pediatrics 1988;81:360-64

10. Formula Feeding Do not change formula without discussing with provider
Hot soapy water sufficient for bottles/nipples
Temperature of formula
No bottle propping

11. Feeding Practices Water not necessary/may be harmful
Solids generally introduced at 6 mos
No honey until 12 months
Avoid cows milk under age one
Supplement with vitamin D 200 IU for <500 cc daily formula or breastfed (AAP Guidelines)

12. Elimination Chart/log to look for adequate output
Breast vs bottle stools
“Constipation”
Juice for constipation (NASPGN 2000 recs)(C)

13. Cord Care
One study demonstrated faster cord separation with saline and natural drying than alcohol
Dore, J Ob Gyn Neo Nursing 1998;27:621-7

14. Neonatal Rashes
Erythema toxicum

15. Birthmarks

16. Genital Care Males – circumcision care; care of uncircumcised penis
Females – proper cleansing technique; vaginal d/c
Diaper rash

17. Danger Signs Temperature instability Cyanosis Poor feeding Lethargy
Excessive irritability
Respiratory difficulty

18. Jaundice

19. Safety
Car seat rear facing until one year of age/ 20 lbs

20. Sleeping Safety
AAP Task Force on Infant Sleep Position and SIDS Recommendations 2000 (C)

21. Sleeping Safety
Sleep site; avoiding excess bedding/stuffed toys etc

23. Fighting infection

24. Followup Guidelines for Perinatal Care 1997 (C)
d/c <24 hrs = see within 48 hrs
d/c hrs = see within 96 hrs
d/c after 48 hrs = see within 120 hrs

25. Contacts
Hospital advice line if available
Office contact

26. Advice for Followup

27. Delivering the Information
Who?
How?
Use of checklists

28. Above all…ENJOY!!