While in the hospital, new parents should be taught how to feed, bathe, and dress their newborn and become familiar with the newborn's activities, cues, and sounds.
Before hospital discharge, clinicians should discuss with parents the routine aspects of care regarding the umbilical cord, circumcision, weight, and urine and bowel movements. Infants who do not pass meconium in the first 24 hours should be reassessed.
Routine Care and Observation of the Newborn
Neonates can be bathed (if the parents wish) once their temperature has stabilized at 37° C for 2 hours.
Umbilical cord
The umbilical cord clamp can be removed when the cord appears dry, usually at 24 hours.
Circumcision
hypospadias, or any other abnormality of the glans or penis (because the prepuce may be used later in plastic surgical repair). Circumcision is usually delayed until at least after the first void; not voiding within 12 hours of the procedure may indicate a complication.
Circumcision should not be done if the neonate has hemophilia or another bleeding disorder.
Weight
Most neonates lose 5 to 7% of their birth weight during the first few days of life, primarily because fluid is lost in urine and insensibly and secondarily because meconium is passed, vernix caseosa is lost, and the umbilical cord dries.
Urine and bowel movements
In the first 2 days, urine may stain the diaper orange or pink because of urate crystals, which are a normal result of urine concentration. Most neonates void within 24 hours after birth; the average time of first void is 7 to 9 hours after birth, and most void at least 2 times in the 2nd 24 hours of life.
A delay in voiding is more common among male neonates and may result from a tight foreskin; a male neonate’s inability to void may indicate posterior urethral valves. If an infant has been circumcised, lack of voiding within 12 hours of the procedure may indicate a complication.
Meconium
If meconium has not been passed within 24 hours, the clinician should consider evaluating the neonate for anatomic abnormalities, such as imperforate anus, Hirschsprung disease, and cystic fibrosis (which can cause meconium ileus).
Hospital Discharge of the Newborn
Neonates discharged within 48 hours should be evaluated within 2 to 3 days to assess feeding success (breast or formula), hydration, and jaundice (for those at increased risk).
Follow-up for neonates discharged after 48 hours should be based on risk factors, including those for jaundice and for breastfeeding difficulties, and any identified problems.
