A basic premise of early hospital discharge of newborns at <24 hr of age is that term and near-term pregnancies without obstetric risk factors are associated with a low incidence of early neonatal problems. Published studies of the incidence of neonatal problems following early discharge are limited by small sample size and implementation under circumstances not readily applicable to public facilities serving urban populations. To determine the frequency of early neonatal problems in potential candidates for early discharge, 7078 mother-infant pairs were prospectively evaluated over 13 months at Parkland Memorial Hospital, a large public facility. Maternal data were collected to verify a low incidence of obstetric risk factors(gestational age, diabetes, hypertension, Cesarean section, etc). Neonatal data were collected on 14 predefined neonatal problems identified between transfer from the Admission Newborn Nursery at 4 hr of age and discharge from the hospital. 7.8% of the 7078 newborns developed one of the predefined neonatal problems. The most common identified problems were tachypnea (30.1% of infants with problems), temperature instability (22.8%), dusky spells(16.8%), and jaundice (9.6%). The frequency of problems as a function of postnatal age were; 40.8% at ≤12 hr, 29.2% at > 12 hr and ≤24 hr, 13.6% at >24 hr and ≤36 hr, and 16.4% at >36 hr. Of newborns with predefined problems, 29.7% were transferred to a higher level of care including 3.8% admitted to the NNICU. 45% of all infants with predefined problems received one or more therapies (O2, antibiotics, phototherapy, etc), while the remainder warranted only observation. Babies with predefined problems had an EGA of 39.5±1.1 wk and a BW of 3.4±0.5 kg. In this large cohort of near-term and term newborns without obstetric risk factors and other qualifying criteria, the time of recognition of neonatal problems is greatest proximate to birth, but 30% of predefined problems occur after times used for early discharge (i.e., 24 hr of age).
