Baylor

Early newborn follow up has become a focus of medical necessity in recent years due to early hospital discharge practices following delivery. Postpartum hospital length of stay has decreased progressively over the last 35 years challenging the primary care provider to ensure the newborn's ongoing health and well-being. Changes in discharge practices have been influenced by social and economic factors including refusal of third party payers to reimburse healthcare services beyond 12-24 hours for uncomplicated vaginal deliveries.

Th ese and other issues led to the signing of The Newborn's and Mothers' Health Protection Act of 1996 and its implementation in 1998. This law prohibits payers from restricting benefits for hospital stays to less than 48hrs forvaginal delivery and less than 96hours for caesarean section delivery. The law emphasizes that the timing of the discharge should be individualized and driven by the provider and the mother, not third party payers.

The American Academy of Pediatrics (AAP) recommends early follow-up (within 48 hours of discharge) for all infants discharged before 72 hours of age. Little information is available on interventions applied at this early visit or early outcomes such as hospitalization or lactation referral.

Ben Taub General Hospital is a publicly funded institution that serves the indigent population of Harris County, Texas. The Newborn Follow-up Clinic was established in 1990 to accommodate those healthy newborns who were discharged home less than 48 hours of age and who might have medical issues which could be identified by early assessment and managed by early intervention. The Clinic is staffed by Texas Health Step Nurse-Clinicians supported by Baylor Pediatric Faculty and operates 8 am-4 pm Monday through Friday. Availability of newborn services in the early postnatal period promotes a safer first week of life.

1. Monitor compliance with established AAP follow up guidelines for infants discharged before 72 hours of age.
2. Identify problems in the early postnatal period that require me`dical interventions(including hospitalizations) or referral.
3. Identify the number of infants who receive serum bilirubin measurements for the assessment of neonatal jaundice.

Other

There is minimal risk in doing this data collection and analysis. The loss of confidentiality is extremely remote. The data collection log will be kept in a secure location by the study adminstrator. The data transcription by the study admistrator to an excel database will not include patient identifiers, only the assigned study number. The investigators will not have access to the patient identifiers during the data analysis.

There are no benefits to be gained by individual subjects