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Preparing for Discharge - Before Taking Baby Home

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The time has finally come to take your little one home, but before you can go, many tasks must be completed. What are these tasks you ask? Let's take a look.If you are opting to circumcise your son, most circumcisions are performed the day of discharge from the hospital by your OB-GYN, pediatrician or pediatric surgeon, depending on your hospital’s policies. Some physicians choose to circumcise babies on the first day of life, but this is not a common practice. There are some instances which the procedure will be postponed for a later date. Some reasons include: penis is too small to perform the procedure, presence of penile defects such as hypospadias, or the presence of other health concerns. 
 
 
Circumcision is completely optional and requires a signed informed consent from you. The doctor performing the circumcision should come and explain the procedure and potential risks to you. These risks include (but are not limited to) injury to the penis, infection and potential loss of blood. To learn more about the risks vs benefits of circumcision, read: Circumcision- What's Your Decision?
 
Your nurse will show you how to care for your baby’s newly circumcised penis which should be continued until the penis is healed, typically after 7-10 days. You can also review our article: Circumcision Care & Care of the Uncircumcised Penis for more information. The nurse will observe the site for bleeding, signs of infection and watching for your baby to urinate after the circumcision. Be sure to notify your nurse or pediatrician (once discharged from the hospital) if excess bleeding, signs of infection, or no wet diapers are noted.
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The law requires a newborn metabolic screening (also known as PKU or newborn screen) on every newborn after 24 hours of life. Some states will repeat this test again at 1-2 weeks of life. This test screens for a multitude of metabolic abnormalities (ex. thyroid function, sickle cell disease, phenylketonuria, galactosemia, etc.). There are over 50 conditions that can be screened for; however, many states only for screen for a core panel of 29 treatable disorders  Learn more about your states testing procedure and the disorders screened here. For a fee, you can request additional testing to be preformed if you desire more extensive testing not performed by the state test. Be sure to discuss additional testing availability with your pediatrician or obstetrician before your due date. Read Newborn Screen (PKU) to learn more about newborn metabolic testing. 
 
Prior to discharge, your baby will be assessed for jaundice. Jaundice is the yellow discoloration of the skin and high levels can be very dangerous for a newborn. Bilirubin levels are drawn on any baby that appears to be jaundice (especially within the first 24 hours after birth) or on those babies whose blood type differs from mom’s blood type. Babies born to mothers with an O blood type or with Rh negative blood factor are at higher risk for jaundice. Bilirubin levels vary depending on factors such as gestational age, baby’s age in hours when level was drawn, and the presence of risk factors. Most facilities screen every baby before discharge regardless of the presence of risk factors. 
 

phototherapy

If your baby’s bilirubin level is high enough, your baby will be placed under phototherapy. Phototherapy uses blue lights to help eliminate excess bilirubin from your baby’s bloodstream. During phototherapy, your baby will remain in an isolette (to prevent heat loss) or a crib, dressed only in his/her diaper (to maximize exposure to the bililights), and with eyes covered (to protect eyes) until feeding time. The goal is to maximize exposure time to the bililights to assist in the excretion of bilirubin from the bloodstream. Frequent feedings and/or formula supplementation help flush out the bilirubin from the blood and into to the urine and stool. Once phototherapy has been discontinued, a follow-up bilirubin level (often referred to as the rebound bilirubin) is drawn to ensure safe levels of bilirubin prior to discharge from the hospital. Some pediatricians will also request an earlier follow-up visit to ensure jaundice has not worsened. Learn more about Jaundice and Your Newborn here.
 
A hearing test will be performed on your baby prior to discharge. Most hospitals use a machine that tests your baby’s brain responses to sound (called ABR-Auditory Brainstem Response). This test is conducted while your baby sleeps and is safe and painless. Babies who fail the hearing test will need to be retested on an outpatient basis. Just because a baby fails the hearing test at the hospital does not mean that he/she has hearing loss. Other causes include:  fluid present in the baby’s ear, noise in the testing room, and/or movement of the baby during the test. There are also instances in which a baby passes the first hearing screen and loses hearing later due to illness, injury, medications, and/or heredity. Be sure to let your baby’s nurse know if there is a history of hearing loss in your or the father’s immediate family. Learn more about newborn Hearing Tests...

Be sure to bring your car seat to the hospital, have it installed in your car, and know how to use it. Nurses no longer secure your newborn in the car seat for liability reasons. Local car seat technicians can check your installation and show you how to use your seat. Find a local technician in your area by visiting www.seatcheck.org. It is always a good idea to have your car seat inspected before your delivery date.

 
If your baby was born premature (less than 37 weeks gestation) or weighed less than 2500 grams (approximately 5 pounds 8 ounces) at birth, a car seat test is required to ensure that your baby can ride safely in a reclined position. During a car seat test, your baby is secured into his car seat by you or your spouse and monitored for a minimum of 90 minutes for apnea (cessation of breathing), bradycardia (drop of heart rate below 100 beats per minute) and desaturations (drop in oxygen saturation < 90%). If your baby fails the car seat test, a retest will be done and if needed, arrangements for a car bed will be made
 
You will need to pack a going home outfit for your baby. Be sure to bring clean clothes, a hat and blankets for your baby for discharge. Prior to discharge, many hospitals provide an opportunity to have your baby’s picture taken so be sure to bring a picture perfect outfit. Don’t want a pay for pictures?...no problem! Pictures are completely optional.

Once you and your baby have been discharged by the doctor, discharge instructions will be reviewed with you which can take some time t complete. This is a great time to ask any last minute questions that you may have.

The final step of the discharge procedure is the removal of one of baby’s ID bands and the removal of the security alarm. Once that is completed and all the necessary paper work is reviewed and signed, you will be free to go home. Remember to follow-up with your pediatrician within the recommended time-frame.

Now the real fun begins! Say goodbye to sleep…

 
 

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