The American Academy of Pediatrics' Committee on Fetus and Newborn has released an update of its 1998 policy, Hospital Discharge of the High-Risk Neonate.1 The policy considers high-risk neonates to fall into 4 categories: (1) the preterm infant, (2) the infant with special healthcare needs or technology, (3) the infant at risk because of family issues, and (4) the infant with anticipated early death. Specific recommendations are made for infant readiness for hospital discharge, family and home environmental readiness, and community and healthcare system readiness.

The policy does not recommend achievement of a specific body weight as a criterion for discharge. Instead, the infant must achieve physiologic stability, as evidenced by oral feeding sufficient to support appropriate growth, the ability to maintain normal body temperature in a home environment, and sufficiently mature respiratory control.1 An evaluation of the neonate's hematologic status should be made prior to discharge because of the high rate of anemia in infants who have undergone neonatal intensive care. All high-risk infants should undergo a car seat challenge prior to discharge. Careful preparation and good follow-up after discharge are necessary to reduce the risk of readmission in these high-risk neonates.

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