POLICY STATEMENT Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children

Providing Care for Infants Born at Home Kristi Watterberg, MD, FAAP, COMMITTEE ON FETUS AND NEWBORN

The American Academy of Pediatrics (AAP) believes that current data show abstract that and accredited birth centers are the safest settings for birth in the United States. The AAP does not recommend planned home birth, which Department of Pediatrics, The University of New Mexico, Albuquerque, has been reported to be associated with a twofold to threefold increase in New Mexico infant mortality in the United States. The AAP recognizes that women may Policy statements from the American Academy of Pediatrics benefit choose to plan a home birth. This statement is intended to help pediatricians from expertise and resources of liaisons and internal (AAP) and provide constructive, informed counsel to women considering home birth external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the while retaining their role as child advocates and to summarize appropriate organizations or government agencies that they represent. care for newborn infants born at home that is consistent with care provided Dr Watterberg was responsible for revising and updating the draft for infants born in a medical care facility. Regardless of the circumstances of and responding to all suggestions from internal and external reviewers as well as the Board of Directors; and she approved the his or her birth, including location, every newborn infant deserves health final manuscript as submitted. care consistent with that highlighted in this statement, which is more The guidance in this statement does not indicate an exclusive course completely described in other publications from the AAP, including Guidelines of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. for Perinatal Care and the Textbook of Neonatal Resuscitation. All health All policy statements from the American Academy of Pediatrics care clinicians and institutions should promote communications and automatically expire 5 years after publication unless reaffirmed, understanding on the basis of professional interaction and mutual respect. revised, or retired at or before that time. This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process INTRODUCTION approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial Women and their families may desire a home birth for a variety of reasons, involvement in the development of the content of this publication. including cultural or religious beliefs and traditions, hopes for a more DOI: https://doi.org/10.1542/peds.2020-0626 family-friendly setting, increased control of the process, and decreased Address correspondence to Kristi Watterberg, MD, FAAP. E-mail: obstetric intervention.1 The incidence of home birth has increased over [email protected] the past decade, with the largest increase occurring in white, non-Hispanic PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). women; more than 2% of births to these women now occur at home, with Copyright © 2020 by the American Academy of Pediatrics wide variation in incidence among states.2 However, a woman’s choice to FINANCIAL DISCLOSURE: The author has indicated she has no financial plan a home birth is not well supported in the United States. Problems relationships relevant to this article to disclose. with home birth include wide variation in state laws and regulations, lack FUNDING: of appropriately trained and willing providers, and lack of supporting No external funding. systems to ensure the availability of specialty consultation and timely transport to a . Geography also may adversely affect the safety of To cite: Watterberg K, AAP COMMITTEE ON FETUS AND planned home birth because travel times longer than 15 to 20 minutes to NEWBORN. Providing Care for Infants Born at Home. Pediatrics. 2020;145(5):e20200626 a medical facility have been associated with increased risk for adverse

Downloaded from www.aappublications.org/news by guest on September 28, 2021 PEDIATRICS Volume 145, number 5, May 2020:e20200626 FROM THE AMERICAN ACADEMY OF PEDIATRICS neonatal outcomes, including and Gynecologists stated, “Although home birth should make her aware mortality.3,4 the College believes that hospitals that some women who plan to deliver and accredited birth centers are the at home will need transfer to Planned home birth in the safest settings for birth, each woman a hospital before birth because of United States has previously been has the right to make a medically unanticipated complications. This reported to be associated with informed decision about delivery.”11 percentage varies widely among a twofold to threefold increase in In addition, “Women inquiring about reports, from approximately 10% to perinatal (fetal or newborn) death planned home birth should be 40%, with a higher transfer rate for or an absolute risk increase of informed of its risks and benefits primiparous women.10,13 The mother approximately 1 to 2 deaths per 11 – based on recent evidence.” In the should be encouraged to see transfer 1000 live births.5 7 These findings statement, the authors reviewed to a hospital not as a failure of the were recently confirmed in appropriate candidates for home home birth but rather as a success of a population-based study by using birth and health care system the system to provide a healthy birth certificates with information components “critical to reducing outcome for both mother and infant. on intended place of birth as well as perinatal mortality rates and actual place of birth, permitting achieving favorable home birth Care of the newborn infant born at analysis of birth outcomes after 8 outcomes” (Table 1). home is a particularly important topic intrapartum transfer to the hospital. because infants born at home are fi This study also con rmed previous If requested, pediatric health care cared for outside the safeguards of fi ndings that infants born at home providers in the United States should the systems-based protocols required in the United States have an be prepared to provide constructive, of hospitals and birthing centers, increased incidence of low Apgar 5,6 informed counsel to women placing a larger burden on health care scores and of neonatal seizures. considering home birth while providers attending home births to There may be an irreducible retaining their role as child advocates remember and perform all minimum increase in adverse in assessing whether the situation is components of assessment and care outcomes with planned home births, appropriate to support a planned of the newborn infant. To assist even in a well-integrated health care home birth (Table 1). In addition to providers, this policy statement system such as that in England. For apprising the expectant mother of the addresses the following specific example, the English National increase in neonatal mortality and areas: resuscitation and evaluation of Institute for Health and Care other neonatal complications with the newborn infant immediately after Excellence recommends that planned home birth (Table 1), the birth and essential elements of care “ practitioners advise low-risk health care provider counseling and follow-up for the healthy term nulliparous women that planning a pregnant woman about planned newborn infant. to give birth in a -led unit (freestanding or alongside) is particularly suitable for them TABLE 1 Planned Home Birth Considerations because the rate of interventions is Potential candidate for home birth lower and the outcome for the • Absence of preexisting maternal disease • fi baby is no different compared with Absence of signi cant disease arising during the • A gestation of 37 1 0/7 to 41 1 6/7 weeks an obstetric unit. Explain that if • A singleton fetus estimated to be appropriate for they plan birth at home there is • A a small increase in the risk of an • Labor that is spontaneous or induced as an outpatient adverse outcome for the baby.”9 Reported risks to the newborn associated with planned home birth in the United States • 5–8 This advice is based on the Increased fetal and/or neonatal mortality • Increased incidence of neonatal seizures5,6,8 Birthplace in England study, which • Higher incidence of an ,4 at 5 min5,6,8 revealed an increase in composite Systems needed to support planned home birth adverse outcomes of intrapartum • The availability of a physician or a certified by the American Midwifery Certification Board stillbirths and early neonatal deaths, (or its predecessor organizations) or whose education and licensure meet the International neonatal encephalopathy, meconium Confederation of Global Standards for Midwifery Education practicing within an integrated and regulated health system aspiration syndrome, brachial plexus • Attendance by at least 2 care providers, one of whom is an appropriately trained individual (see injury, and fractured humerus or text) whose primary responsibility is the care of the newborn infant clavicle.10 • Availability of appropriate equipment for neonatal resuscitation12 • Ready access to medical consultation In a recent statement, the • Access to safe and timely transport to a nearby hospital with a preexisting arrangement Committee on Obstetric Practice of As stated in Guidelines for Perinatal Care, fetal malpresentation, multiple gestation, and previous cesarean delivery are the American College of Obstetricians considered absolute contraindications to planned home birth.

Downloaded from www.aappublications.org/news by guest on September 28, 2021 2 FROM THE AMERICAN ACADEMY OF PEDIATRICS ASSESSMENT, RESUSCITATION, AND be monitored closely in the conditions associated with CARE OF THE NEWBORN INFANT transitional period. Temperature, prematurity, including respiratory IMMEDIATELY AFTER BIRTH heart rate, skin color, peripheral distress, poor feeding, As recommended by the American circulation, respiration, level of hypoglycemia, and Academy of Pediatrics (AAP) and consciousness, tone, and activity hyperbilirubinemia. the American Heart Association, should be monitored and recorded at • Monitoring for early-onset sepsis: there should be 2 care providers least once every 30 minutes until the As recommended by the Centers ’ present at every birth, at least infant s condition has remained stable for Disease Control and 1 of whom has the primary for 2 hours. Infants who receive Prevention and the AAP, all responsibility to care for the extensive resuscitation (eg, positive- pregnant women should be newborn infant.12 Situations in pressure ventilation for more than 30 screened for group B 12 which both the mother and the to 60 seconds ) should be Streptococcus colonization at 35 newborn infant simultaneously transferred to a medical facility for to 37 weeks’ gestation.19 Women require urgent attention are close monitoring and evaluation. who are colonized should be infrequent but will, nonetheless, Additionally, any infant who has given an intrapartum antibiotic occur. Thus, of the 2 care providers respiratory distress, continued (penicillin, ampicillin, or who should attend each birth, at least cyanosis, or other signs of illness cefazolin) at least 4 hours before 1 should have the appropriate should be immediately transferred to delivery. If the mother has received training, skills, and equipment to a medical facility. this intrapartum treatment and perform a full resuscitation of the both she and her newborn infant infant in accordance with the CARE OF THE NEWBORN INFANT remain asymptomatic, they can principles of the Neonatal remain at home if the infant can be Subsequent newborn care should Resuscitation Program.12,14 To observed frequently by an adhere to that described in Guidelines facilitate obtaining emergency experienced and knowledgeable for Perinatal Care as well as the AAP assistance when needed, the health care provider.20 If the statement regarding care of the well operational integrity of the telephone – mother shows signs of newborn infant.15 17 Although or other communication system intraamniotic infection a comprehensive review of these should be tested before the delivery (chorioamnionitis) but the infant guidelines would be far too lengthy to (as should every other piece of appears completely well, the include in this statement, a few medical equipment), and the weather infant also can remain at home as practice points are worthy of specific should be monitored. In addition, long as he or she is observed mention. access to safe and timely transport to frequently by an experienced and • fi – a medical facility should be available, Transitional care ( rst 4 8 hours): knowledgeable health care and a previous arrangement with that The infant should be kept warm provider. A quantitative estimate facility should be in place. Examples and should undergo a detailed of the risk of newborn infection of guidelines and forms for maternal physical examination that includes (as can be obtained from use of and infant transport, developed by an assessment of gestational age the sepsis risk calculator at https:// the Home Birth Summit organization, and intrauterine growth status as neonatalsepsiscalculator. can be found at http://www. well as a comprehensive risk kaiserpermanente.org) may help homebirthsummit.org. assessment for neonatal conditions guide the decision to transfer the that require additional monitoring infant to a medical facility.21 If the Care of the newborn infant or intervention. Temperature, heart infant does not appear completely immediately after delivery should and respiratory rates, skin color, well, the infant should be adhere to practices described in peripheral circulation, respiration, transferred rapidly to a medical 15,16 Guidelines for Perinatal Care and level of consciousness, tone, and facility for further evaluation and should include provision of warmth, activity should be monitored and monitoring in accordance with initiation of appropriate resuscitation recorded at least once every AAP guidelines.20 measures, and assignment of Apgar 30 minutes until the infant’s • Glucose screening: Infants who scores. Although skin-to-skin contact condition is considered normal and have intrauterine growth with the mother is the most effective has remained stable for 2 hours. A restriction or whose mothers way to provide warmth, portable newborn infant who is determined warming pads should be available in to be ,37 weeks’ gestational age have diabetes should be delivered case a newborn infant requires by physical assessment18 should be in a hospital or resuscitation and cannot be placed on transferred to a medical facility for because of the increased risk of the mother’s chest. The infant should continuing observation for hypoglycemia and other neonatal

Downloaded from www.aappublications.org/news by guest on September 28, 2021 PEDIATRICS Volume 145, number 5, May 2020 3 complications. If, after birth, an early days of breastfeeding. found at https://wisconsinshine. infant is discovered to be small or Nomograms providing hour- org/home-births/.25,26 fi large for gestational age or an speci c expected weight loss in the • Provision of follow-up care: fi infant has required resuscitation, rst postnatal week can be found at Documentation of , he or she should be screened for https://www.newbornweight.org/. delivery, and immediate postnatal hypoglycemia, as outlined in the • Screening for hyperbilirubinemia: course, in addition to prompt, 22 AAP statement. If hypoglycemia Infants whose mothers are Rh- comprehensive communication , (glucose level 45 mg/dL) is negative should have cord blood with the follow-up care provider, is fi identi ed and persists after sent for a Coombs direct antibody essential. Completion of forms such feeding, the infant should be test; if the mother’s blood type is O as those found on the AAP Bright transferred promptly to a medical and she is Rh-positive, the cord Futures Web site (https:// facility for continuing evaluation blood may be tested for the infant’s brightfutures.aap.org) can help and treatment. blood type and sent for a direct provide such communication. A • Eye prophylaxis: every newborn antibody test, but it is not required, knowledgeable and experienced infant should receive prophylaxis provided that there is appropriate health care professional should against gonococcal ophthalmia surveillance, risk assessment, and examine all infants within 24 hours neonatorum, as directed by local follow-up.24 All newborn infants of birth and subsequently within laws and regulations. should be assessed for risk of 48 hours of that first evaluation. • Vitamin K: Every newborn infant hyperbilirubinemia and undergo The initial follow-up visit should should receive a single parenteral bilirubin screening between 24 and include infant weight and physical 48 hours after birth. The bilirubin examination, especially for jaundice dose of vitamin K1 oxide (phytonadione [0.5–1 mg]) to value should be plotted on the and hydration. If the mother is fi prevent vitamin K–dependent hour-speci c nomogram to breastfeeding, the visit should hemorrhagic disease of the determine the risk of severe include evaluation of any maternal newborn. Oral administration of hyperbilirubinemia and the need history of breast problems (eg, pain 24 vitamin K has not been shown to be for repeat determinations. or engorgement), infant elimination as efficacious as parenteral • Universal newborn screening: patterns, and a formal observed administration for the prevention Every newborn infant should evaluation of breastfeeding, of late hemorrhagic disease. undergo universal newborn including position, latch, and milk transfer. Results of maternal and • Hepatitis B vaccination: For all screening in accordance with neonatal laboratory tests should be medically stable infants weighing individual state mandates. A list of reviewed; clinically indicated tests, .2000 g at birth who are born to conditions for which screening is such as serum bilirubin, should be hepatitis B surface antigen performed in each state is performed; and screening tests (HBsAg)–negative mothers, the first maintained online by the National should be completed in accordance dose of vaccine should be Newborn Screening and Genetic with state regulations. The administered within 24 hours of Resource Center (available at documentation provided by the birth. Only single-antigen hepatitis http://genes-r-us.uthscsa.edu/ health care professional attending B vaccine should be used for the resources/consumer/statemap. the birth should include whether birth dose, following proper htm). tests and vaccinations usually storage and handling requirements • Hearing screening: the newborn performed as part of hospital for immunizations. Infants born to infant’s initial caregiver should protocols have been completed or mothers who are HBsAg-positive or document arrangements for scheduled. whose HBsAg status is unknown screening the infant’s hearing. should also receive hepatitis B • Pulse oximetry screening: CONCLUSIONS immune globulin, as guided by Screening for congenital heart 23 current recommendations. disease should be performed by The AAP does not recommend • Assessment of feeding: A trained using oxygen saturation testing, planned home birth. However, the caregiver should evaluate at least 1 ideally between 24 and 48 hours’ AAP recognizes that women may session of breastfeeding, including postnatal age. Earlier screening can choose to plan a home birth. The AAP observation of position, latch, and be performed, although the concurs with the American College of milk transfer. The mother should be incidence of false-positive screen Obstetricians and Gynecologists encouraged to record the time and results may be increased. Helpful statement that “for quality and safety duration of each feeding, as well as information for oximetry screening reasons, the College specifically urine and stool output, during the for planned home births can be supports the provision of care by

Downloaded from www.aappublications.org/news by guest on September 28, 2021 4 FROM THE AMERICAN ACADEMY OF PEDIATRICS midwives who are certified by the Regardless of the circumstances of his Karen Marie Puopolo, MD, PhD, FAAP American Midwifery Certification or her birth, including location, every Dan L. Stewart, MD, FAAP fi Board (or its predecessor newborn infant deserves health care RADM Wanda D. Bar eld, MD, MPH, FAAP organizations) or whose education that adheres to the guidelines and licensure meet the International highlighted in this statement and LIAISONS Confederation of Midwives Global more completely described in other Yasser El-Sayed, MD – American College of – Standards for Midwifery Education. AAP publications.15 17 Continuing Obstetricians and Gynecologists The College does not support efforts by all health care clinicians Erin L. Keels, DNP, APRN, NNP-BC – National provision of care by midwives who do and institutions should promote Association of Neonatal Nurses Meredith Mowitz, MD, MS, FAAP – Section on ”11 not meet these standards. communications and understanding Neonatal Perinatal Trainees and on the basis of professional Early Career Neonatologists In the case of a home birth, as interaction and mutual respect. Michael Ryan Narvey, MD, FAAP – Canadian advocates for children, the AAP Paediatric Society – recommends that provisions for the Tonse N.K. Raju, MD, DCH, FAAP National Institutes of Health potential resuscitation of a depressed Kasper S. Wang, MD, FACS, FAAP – Section on LEAD AUTHOR newborn infant and immediate Surgery neonatal care be optimized in the Kristi Watterberg, MD, FAAP home setting. Thus, each delivery STAFF should be attended by 2 care providers, at least 1 of whom has the COMMITTEE ON FETUS AND NEWBORN, Jim Couto, MA primary responsibility for the 2018–2019 newborn and has the appropriate James J. Cummings, MD, FAAP, Chairperson training, skills, and equipment to Ira S. Adams-Chapman, MD, FAAP ABBREVIATIONS perform a full resuscitation of the Susan Wright Aucott, MD, FAAP AAP: American Academy of Jay P. Goldsmith, MD, FAAP infant in accordance with the Ivan L. Hand, MD, FAAP Pediatrics principles of the Neonatal Sandra E. Juul, MD, PhD, FAAP HBsAg: hepatitis B surface antigen 12,14 Resuscitation Program. Brenda Bradley Poindexter, MD, MS, FAAP

POTENTIAL CONFLICT OF INTEREST: The author has indicated she has no potential conflicts of interest to disclose.

REFERENCES 1. Zielinski R, Ackerson K, Kane Low L. United States 2000 to 2004. J Perinatol. Available at: https://www.nice.org.uk/ Planned home birth: benefits, risks, and 2010;30(9):622–627 guidance/cg190. Accessed December 2, opportunities. Int J Womens Health. 2018 6. Cheng YW, Snowden JM, King TL, 2015;7:361–377 Caughey AB. Selected perinatal 10. Brocklehurst P, Hardy P, Hollowell J, 2. MacDorman MF, Declercq E. Trends and outcomes associated with planned et al; Birthplace in England characteristics of United States out-of- home births in the United States. Am Collaborative Group. Perinatal and hospital births 2004-2014: new J Obstet Gynecol. 2013;209(4):325.e1- maternal outcomes by planned place of information on risk status and access 325.e8 birth for healthy women with low risk to care. Birth. 2016;43(2):116–124 7. Chang JJ, Macones GA. Birth outcomes : the Birthplace in England national prospective cohort study. BMJ. 3. Ravelli AC, Jager KJ, de Groot MH, et al. of planned home births in Missouri: a population-based study. Am 2011;343:d7400 Travel time from home to hospital and J Perinatol. 2011;28(7):529–536 adverse perinatal outcomes in women 11. American College of Obstetricians and at term in the Netherlands. BJOG. 2011; 8. Snowden JM, Tilden EL, Snyder J, Gynecologists’ Committee on Obstetric 118(4):457–465 Quigley B, Caughey AB, Cheng YW. Practice. Committee opinion No. 669: Planned out-of-hospital birth and birth planned home birth. Obstet Gynecol. 4. Paranjothy S, Watkins WJ, Rolfe K, et al. outcomes. N Engl J Med. 2015;373(27): 2016;128(2):e26–e31 Perinatal outcomes and travel time 2642–2653 from home to hospital: Welsh data from 12. Wyckoff MH, Aziz K, Escobedo MB, et al. 1995 to 2009. Acta Paediatr. 2014; 9. National Institute for Health and Care Part 13: neonatal resuscitation: 2015 Excellence. Intrapartum Care for American Heart Association guidelines 103(12):e522–e527 Healthy Women and Babies. London, update for cardiopulmonary 5. Malloy MH. Infant outcomes of certified United Kingdom: National Institute for resuscitation and emergency attended home births: Health and Care Excellence; 2014. cardiovascular care (reprint).

Downloaded from www.aappublications.org/news by guest on September 28, 2021 PEDIATRICS Volume 145, number 5, May 2020 5 Pediatrics. 2015;136(suppl 2): Watterberg K, eds. Guidelines for 22. Adamkin DH; Committee on Fetus and S196–S218 Perinatal Care, 8th ed. Elk Grove Village, Newborn. Postnatal glucose 13. Lindgren HE, Rådestad IJ, Hildingsson IL: American Academy of Pediatrics; homeostasis in late-preterm and term – – IM. Transfer in planned home births in 2017:409 478 infants. Pediatrics. 2011;127(3):575 579. Reaffirmed June 2015 Sweden–effects on the experience of 17. Benitz WE; Committee on Fetus and birth: a nationwide population-based Newborn, American Academy of 23. Committee on Infectious Diseases; study. Sex Reprod Healthc. 2011;2(3): Pediatrics. Hospital stay for healthy Committee on Fetus and Newborn. 101–105 term newborn infants. Pediatrics. 2015; Elimination of perinatal hepatitis B: 14. American Academy of Pediatrics; 135(5):948–953 providing the first vaccine dose within American Heart Association. Preparing 18. Ballard JL, Khoury JC, Wedig K, Wang L, 24 hours of birth. Pediatrics. 2017; for Resuscitation. In: Wiener GM, Eilers-Walsman BL, Lipp R. New Ballard 140(3):e20171870 Zaichkin J, eds. Textbook of Neonatal Score, expanded to include extremely 24. American Academy of Pediatrics Resuscitation, 7th ed. Elk Grove Village, premature infants. J Pediatr. 1991; Subcommittee on Hyperbilirubinemia. IL: American Academy of Pediatrics; 119(3):417–423 Management of hyperbilirubinemia in 2016:17–32 19. Baker CJ, Byington CL, Polin RA; the newborn infant 35 or more weeks 15. American Academy of Pediatrics Committee on Infectious Diseases; of gestation [published correction Committee on Fetus and Newborn; Committee on Fetus and Newborn. appears in Pediatrics. 2004;114(4): American College of Obstetricians and Policy statement—recommendations 1138]. Pediatrics. 2004;114(1):297–316 Gynecologists Committee on Obstetric for the prevention of perinatal group B Practice. Care of the Newborn. In: 25. Oster ME, Aucott SW, Glidewell J, et al. streptococcal (GBS) disease. Pediatrics. Lessons learned from newborn Kilpatrick SJ, Papile LA, Macones GA, 2011;128(3):611–616 Watterberg KL, eds. Guidelines for screening for critical congenital heart Perinatal Care, 8th ed. Elk Grove Village, 20. Benitz WE, Wynn JL, Polin RA. defects. Pediatrics. 2016;137(5): IL: American Academy of Pediatrics; Reappraisal of guidelines for e20154573 – management of neonates with 2017:347 408 26. Miller KK, Vig KS, Goetz EM, Spicer G, suspected early-onset sepsis. J Pediatr. 16. American Academy of Pediatrics Yang AJ, Hokanson JS. Pulse oximetry 2015;166(4):1070–1074 Committee on Fetus and Newborn; screening for critical congenital heart American College of Obstetricians and 21. Kuzniewicz MW, Puopolo KM, Fischer A, disease in planned out of hospital Gynecologists Committee on Obstetric et al. A quantitative, risk-based births and the incidence of critical Practice. Neonatal Complications and approach to the management of congenital heart disease in the Plain Management of High-Risk Infants. In: neonatal early-onset sepsis. JAMA community. J Perinatol. 2016;36(12): Kilpatrick S, Papile LA, Macones G, Pediatr. 2017;171(4):365–371 1088–1091

Downloaded from www.aappublications.org/news by guest on September 28, 2021 6 FROM THE AMERICAN ACADEMY OF PEDIATRICS Providing Care for Infants Born at Home Kristi Watterberg and COMMITTEE ON FETUS AND NEWBORN Pediatrics originally published online April 20, 2020;

Updated Information & including high resolution figures, can be found at: Services http://pediatrics.aappublications.org/content/early/2020/04/16/peds.2 020-0626 References This article cites 22 articles, 8 of which you can access for free at: http://pediatrics.aappublications.org/content/early/2020/04/16/peds.2 020-0626#BIBL Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): Fetus/Newborn Infant http://www.aappublications.org/cgi/collection/fetus:newborn_infant_ sub Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.aappublications.org/site/misc/Permissions.xhtml Reprints Information about ordering reprints can be found online: http://www.aappublications.org/site/misc/reprints.xhtml

Downloaded from www.aappublications.org/news by guest on September 28, 2021 Providing Care for Infants Born at Home Kristi Watterberg and COMMITTEE ON FETUS AND NEWBORN Pediatrics originally published online April 20, 2020;

The online version of this article, along with updated information and services, is located on the World Wide Web at: http://pediatrics.aappublications.org/content/early/2020/04/16/peds.2020-0626

Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. Pediatrics is owned, published, and trademarked by the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2020 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

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