less time to perform and was associated with less apparent discomfort for the newborn. Regardless of the method used, the goal is to remove enough shaft skin and inner preputial epithelium so that the glans is exposed suiciently to prevent phimosis. In all techniques: (1) the amount of external skin to be removed must be accurately estimated, (2) the preputial oriice must be dilated to visualize the glans and ensure that it is normal, (3) the inner preputial epithelium must be freed from the glans epithelium, and (4) the circumcision device must be left in place long enough to produce hemostasis before amputating the prepuce (Lerman, 2001).
The risks for bleeding, infection, and hematoma formation are low (Christakis, 2000). Unusual complications include distal glans amputation, acquisition of HIV infection or other sexually transmitted disease, meatal stenosis, penile denudation, penile destruction with electrosurgical coagulation, subsequent epidermal inclusion cyst and urethrocutaneous fistula, and ischemia following the inappropriate use of lidocaine with epinephrine (Amukele, 2003; Neulander, 1996; Nicoll, 1997; Pippi-Salle, 2013; Upadhyay, 1998).
Hospital rooming in places newborns in their mothers' rooms instead of central nurseries. This practice attempts to make all phases of childbearing as natural as possible and to foster early mother-child relationships. By 24 hours, the mother is generally fully ambulatory. hereafter, with rooming-in, she can usually provide routine care for herself and her newborn. n obvious advantage of this is her ability to assume full care when she arrives home.
Traditionally, the newborn is discharged with its mother, and in most cases, maternal stay has determined that of the neonate. From 1970 to the mid-1990s, average maternal postpartum length of stay declined steadily, and many mothers were discharged before 48 hours. The World Health Organization (2014) cites a minimal stay of only 24 hours. Although it is clear that most newborns can be safely discharged within 48 hours, this is not uniformly true. For example, in more than 2.1 million neonates in Canada, Liu and associates (2000) examined readmission rates following initial neonatal discharge. As the length of hospital stay dropped from 4.2 days in 1990 to 2.7 days in 1997, the readmission rate rose from 27 to 38 per 1000. Dehydration and jaundice accounted for most of these readmissions. Using Washington state data, Malkin and coworkers (2000) found that the 28-day mortality rate was increased fourfold in newborns discharged within 30 hours of birth, and the I-year mortality rate grew twofold. Safe discharge for latepreterm newborns has special concerns (Whyte, 2012).
Because of the increased scrutiny regarding short hospital stays, federal legislation-he Newbons' and Mothers' Health Protection Act of 199-was enacted to prohibit insurers from restricting hospital stays for mothers and newborns to less than 2 days for vaginal delivery or 4 days for cesarean delivery. In an analysis of more than 662,000 births in California, Datar and Sood (2006) found that readmission rates declined by 9, 12, and 20 percent, respectively, at 1, 2, and 3 years after the legislation was implemented.
li A, Khadije D, Elahe A, et al: Prophylaxis of ophthalmia neonatorum comparison of Betadine, erythromycin and no prophylaxis. J Trop Pediatr 53(6):388, 2007
American Academy of Pediatrics: Delayed umbilical cord clamping after birth.