Linda - Thank you for speaking from the reimbursement side.  Our utilization
review nurses have rarely had issue in getting a SCN baby certified for more
days, but I'm gong to save your post for physicians that sometimes struggle
what to document in the progress note.  Usually our UR nurses can draw out
of them what they need, but every little bit helps.  I read through the AAP
Policy Statement on Discharge and I don't get what the issue is.  Where did
it say that a baby has to be bottle fed if it cannot breast feed?  It said
the baby needed to demonstrate a minimum of 2 consecutive successful
feedings before discharge.  There was no mention of the method.  Did someone
post a situation that a physician interpreted this statement that a baby
could go ahead and go home "just give it a bottle"?  Or did a certain
insurer use that line?  "Normal" newborns who won't eat aren't normal.
Twist it around - have you ever had a mom that insists on going home very
quickly, but their baby does not feed very well?  We would do every thing in
our power to convince them to stay and work on feeds.  In reading this
policy statement, I don't see many surprises for a normal term baby:  baby
should have stable VS in open crib, feeding ok, have passed urine and
meconium, labs stable, have the state-mandated screenings completed, parents
have a safe home to take them to and have a clue on how to care for them.
Follow up care arranged.  Same thing for sick or premature newborn - just
takes longer than 2-3 days.  Our big issue - and we are going to die on this
hill - is the near term/late preterm baby.  I am tired of trying to make
them "normal" when they are not.  Linda listed a big key - document their
gestational age - and then treat them as such - in the SCN/NICU. Document
accordingly.

--
Sheryl Ward, RNC, BSN, IBCLC
Greenwood, IN
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