Section 216-RICR-40-10-4.10 - Appendix A: Universal Perinatal Screening ProtocolA. Discharge after Delivery of a Normal Newborn 1. A perinatal hospitalization is unique in that proper medical care involves two patients at the beginning of a crucial long-term relationship. The medically necessary care of the mother and infant at birth includes the assessment, documentation and management of patient needs in the domains of maternal health, infant health and development and nurturance. Early perinatal discharge is only appropriate if an assessment is complete, all significant patient needs have been addressed and a mechanism is in place to ensure follow-up. Discharge of mothers and infants should be coordinated so that the pair leave the hospital together, unless the medical condition of one requires a significantly longer hospital stay.2. The following risk factors shall be evaluated and appropriate follow-up care plans and/or referrals documented in the medical record prior to discharge. a. Maternal Health (1) The mother has stable vital signs, is ambulatory, eating and voiding;(2) The uterus is firm, the perineum intact or sutured and there is no significant active post-partum bleeding;(3) Post-partum exam and lab work completed, treatment and instructions given; (4) Rhogam and/or rubella vaccine given, if required;(5) Other maternal health problems documented and addressed.b. Infant Health && Development (1) Successful feeding x 3, voiding and defecating;(2) Vital signs stable for at least 12 hours;(3) Physical examination completed;(4) Metabolic, hemoglobinopathy, Level 1, and hearing screening and other lab work completed;(5) Eye prophylaxis, hepatitis B vaccine and Vitamin K given as required;(6) Other infant health and development issues documented and addressed, parent instructions given, follow-up appointments arranged;(7) Birth certificate completed.c. If the infant weighs less than 2,500 grams or has a 5-minute APGAR score less than seven, or if the mother is known to have a risk factor (e.g., diabetes, streptococcal carrier, hepatitis or illicit drug use) for early post-natal complications, discharge in less than 48 hours after birth may be contraindicated.d. Nurturance: (1) There is a responsible adult available to assist the mother and infant at home for at least twenty-four hours;(2) There is a telephone in the home, and a caregiver who speaks the mother's language is available to provide telephone assistance;(3) The home is reasonably safe, food, and heat if needed, is available;(4) Appointments for follow-up care are complete, including home visits, family support referrals and primary care visits;(5) If the mother is under 17 years of age, has less than a high school education, has other impairments, a history of neglect or other significant risk for poor nurturance or developmental problems such as those identified by Universal Level 1 Newborn Screening, appropriate family support arrangements have been completed.216 R.I. Code R. § 216-RICR-40-10-4.10