Healthy newborn hospital care

Do you have questions about what to expect after giving birth? Wondering how long you and the baby will stay in the hospital? What kind of procedures will the baby have? Are they going to ask for your consent for vaccines and procedures?

It is totally normal and expected to have questions and concerns as your due date approaches. The prenatal visit with the pediatrician is a wonderful opportunity to ask all your questions and put your mind at ease. If you haven’t had the chance to meet with the pediatrician don’t worry, I’m about to tell you everything you need to know about the typical hospital course for a healthy newborn.

But first let’s go over a few important definitions:

  • Full term infant- born at >39 weeks of gestation
  • Early term infant- born at 37-38 weeks of gestation

Most babies born at term will have an uneventful hospital stay and require routine infant care at the newborn nursery. Usually the neonatologist is not consulted or involved in the care of a healthy newborn, unless he/she serve also as part of the newborn hospitalist service.


What happens immediately after birth?

Immediately after birth, the team that is present at delivery will quickly assess the baby and identify any obvious signs that would require further evaluation and treatment by the neonatal unit.

They will proceed to stimulate and dry the infant, gently suction any secretions present in the nose and mouth, and provide warmth.

The team will evaluate the baby’s heart rate, breathing, muscle tone, crying, and color, then assign the infant an Apgar score at one and five minutes of age.

The Apgar score is a method used to quickly and accurately evaluate the status of a newborn right after birth. Babies with good Apgar scores typically are healthy and don’t require further intervention.

What is usually required for a good Apgar score?

  • Gestational age (GA) ≥35 weeks
  • Normal breathing and crying
  • Good muscle tone
  • Pink color

Once it is established that the infant is healthy, he/she should be placed with the mother for skin to skin contact. Skin to skin fosters infant-mom bonding and helps with early initiation of breast feeding.

Depending on the hospital set up and policies, the baby will then go to the regular newborn nursery or to mom’s room. Most hospitals are set up to allow the baby to room-in with mom right from birth. Make sure you tour the hospital you are planning on using, so you understand what kind of setup they have.

What is the transitional period?

During the first 4 to 6 hours after birth, your baby’s body will transition from intrauterine to extrauterine life. The nurses will monitor the baby’s temperature, breathing effort, vital signs, muscle tone, and color closely during this period to make sure further interventions and/or evaluations are not in order.

The nurses will be also be measuring the baby’s length, weight, and head circumference. The baby’s footprints will be taken. Also, the nurses will place identification bands on the baby’s wrist and leg. Once the infant has transitioned and is stable, the baby will get the first bath.

When is my baby going to be evaluated by the pediatrician?

The pediatrician should perform a thorough physical exam within the first 24 hours of life to identify any abnormality or medical condition that was not detected during the initial team assessment or transitioning period. At this time, the pediatrician will also review the maternal, family, and prenatal history and identify any risk factor that could alter the course of the hospital admission.


What are the standard newborn preventative measures right after birth?

There are certain procedures that are generally done right after birth to prevent serious problems later. The nurses will ask you for your consent and signature for the hepatitis B vaccine prior to administering it. They will inform you about the different preventative measures discussed below.

Eye ointment:

Erythromycin antibiotic ointment will be applied to the baby’s eyes within 2 hours after birth to prevent gonococcal eye infection. Some babies might experience eye redness after its administration, but this should resolve within the next day or two.

Vitamin K shot:

It is recommended to administer one shot of vitamin K right after birth to promote coagulation and prevent newborn bleeding. This is especially important if you are planning for your baby to have a circumcision prior to discharge.

Hepatitis B vaccine:

The hepatitis B vaccination is usually administered within 24 hours after birth and is recommended regardless of maternal hepatitis B status.

Umbilical cord care:

Antiseptic agents are applied to the umbilical cord as a common practice and an excellent way to prevent umbilical cord infections.  

Blood sugar monitoring:

Healthy term newborns usually don’t have any problems with their sugar levels. However, infants born before 37 weeks, those considered large or small, and those born to diabetic moms are at increased risk for developing low blood sugar.

What are the different newborn screenings done during the hospital stay?

Hearing evaluation:

All babies have a formal hearing test before discharge. If there is an abnormality, the hospital should set the baby up for a follow up hearing evaluation.

Metabolic screening:

You have probably heard of the heel prick or the PKU test. The infant metabolic screen detects disorders that could be detrimental for the baby’s health, and for which there are interventions in place to improve the outcome. Every single state in the United States requires all newborns to be screened prior to discharge. This test is collected typically at 24 to 48 hours of life.

Congenital heart disease:

All newborns are required to have their oxygen level checked by pulse oximetry prior to discharge. The screening should be performed by measuring the oxygen level in the right hand and either foot. The oxygen measurement in the foot is important to detect serious heart defects.

Jaundice level:

Routine jaundice (bilirubin) check is recommended prior to discharge for all newborns.

However, a bilirubin level should be ordered on any infant who seems jaundiced in the first 24 hours of life.


What is the typical length of stay for a healthy newborn?

Most moms are anxious to take their babies home as soon as possible. However, staying the appropriate length of time gives the pediatrician the opportunity to identify any problems that were not identified right after birth. There are several factors that play a role on the length of stay. It is important to take into consideration the mom’s health, the baby’s health, and mom’s ability to care for the baby once home.

After an uncomplicated vaginal delivery, most healthy babies are discharged within 24 to 48 hours. Babies born by cesarean section will typically stay in the hospital for 48 to 72 hours.

Most insurance plans cover infant’s hospital stays up to 48 hours if born by vaginal deliveries, and up to 96 hours for cesarean deliveries.

What are the requirements for discharge home?

  • The newborn should be in good health and have normal vital signs for at least 12 hours before discharge.
  • The infant has wet and dirty diapers.
  • Completion of at least two successful feedings. If breastfeeding, the hospital lactation consultant will help mom and baby achieve this.
  • No evidence of excessive bleeding.
  • Successful training of the mom and family to provide ongoing care at home.
  • Appropriate support system at home.
  • Appropriate and timely follow up.

When should my baby follow up with the pediatrician after discharge?

If the baby was discharged before 48 hours, schedule a follow up visit within the next 24 to 48 hours.

For infants discharged after 48 hours, schedule a follow up visit within the next 3 to 5 days.

Resources:

Up to date: healthy newborn care

AAP: Hospital stay for healthy term newborn