[Early complications and management of newborns during the first month of life]

Objective: To describe early complications and management of newborns during the first month of life.

Methods: This systematic evidence review is based on Pubmed search, Cochrane library and experts recommendations.

Results: There is no optimal time for maternity discharge for low risk newborn in regard of the literature. It depends more on the organisation of the post-discharge follow-up (professional consensus). Extreme hyperbilirubinemia expose to neonatal mortality and severe neurodevelopmental impairment for survivors (level of evidence: 1). Neonatal hyperbilirubinemia occurs in almost all newborns and may be benign if its progression is monitored (transcutaneous bilirubinometer, capillar or venous bilirubin level) at least 24hours after any early discharge (professional consensus). Asymptomatic newborns with high risks of neonatal sepsis have to be closely monitored during the first 48hours of life (professional consensus). Clinical assessment (heart murmure and femoral pulse) at least 24hours after any early discharge and at any clinical examination almost up to 1 month after birth is recommended to detect possible congenital heart disease (professional consensus). Serial clinical examination of the hips by a trained clinician in the periodic health examination of all infants until they are walking independently is recommended (professional consensus). Neonatal screening blood tests are recommended between 60 and 84hours of life in every newborns, can be advanced between 48 and 60hours if necessary but never before 48hours of life (professional consensus). Neonatal screening of deafness is recommended in every newborns and has to be assessed before maternity discharge (professional consensus). All these data have to be reported in the newborn personal medical file (professional consensus).

Conclusion: Early discharge has to be prepared during the prenatal period in order to ensure care continuity at home and to avoid any severe neonatal outcome.