Birth and early care: what happens in the first days after birth

Newborn · Healthcare · Reviewed 20 June 2026 · All articles

The hours and days immediately after birth are packed with medical checks, paperwork, and a lot of firsts. For parents giving birth in Italy, the public health system covers the entire hospital stay through the Servizio Sanitario Nazionale (SSN), meaning there is no direct cost for the mother or the newborn during this period. Understanding what happens, and when, helps you feel less overwhelmed when you are also adjusting to having a new baby in your arms.

This article walks through the typical Italian postnatal hospital stay, the routine checks performed on your newborn in the first 24 to 72 hours, the two national screening programmes (metabolic and hearing), what you receive at discharge, and the steps to take in the first two weeks at home.

How long does the hospital stay last

After an uncomplicated vaginal birth in an Italian public hospital (ospedale pubblico or presidio ospedaliero), the standard length of stay is 3 to 4 days. After a caesarean section, the stay is typically 4 to 5 days, to allow adequate recovery from the surgery and to ensure the wound is healing well before discharge. Both durations are fully covered by the SSN under the DRG (Diagnosis Related Group) reimbursement system, with no co-payment (ticket) charged to the mother or the newborn for the birth admission itself.

In some well-resourced hospitals, particularly in larger cities, early discharge at 48 hours after a vaginal birth may be offered when mother and baby are both well and when appropriate follow-up at home or in a day-hospital setting is available. However, this is the exception rather than the rule, because all the national newborn screening tests need to be performed at specific time windows within the first 48 to 72 hours of life. Leaving before all tests are completed is not generally recommended.

Private clinics (case di cura private) can offer slightly shorter stays and more comfortable facilities, but the screening procedures they are required to perform are identical to those in the public system. The SSN also covers birth in accredited private facilities for patients who choose them.

Routine checks in the first hours after birth

As soon as your baby is born, a neonatologist or experienced midwife (ostetrica) carries out a rapid initial assessment. In the Italian system, this follows well-established international protocols.

Apgar score. The Apgar score is assigned at 1 minute and again at 5 minutes after birth. It rates five signs: heart rate, breathing effort, muscle tone, reflex response and skin colour. Each sign scores 0, 1 or 2, giving a maximum of 10. A score of 7 to 10 at 5 minutes is considered reassuring. A lower score at 1 minute may prompt additional support, and the midwife or neonatologist will explain what is being done and why. Most babies who score low at 1 minute improve significantly by the 5-minute assessment.

Vitamin K injection. Italy follows the recommendation of the Ministero della Salute and the ISS (Istituto Superiore di Sanita) to offer intramuscular vitamin K (phytomenadione) to all newborns shortly after birth. Vitamin K is needed for blood clotting, and newborns are born with very low stores. Without supplementation, a small number of babies develop haemorrhagic disease of the newborn, which can cause serious bleeding including in the brain. The intramuscular dose is the most reliable method. Parents may request oral vitamin K instead, though this requires multiple doses and carries a slightly higher risk of incomplete protection; discuss the options with your neonatologist if you have questions.

Eye prophylaxis. Antibiotic eye drops or ointment are applied to the newborn's eyes to prevent neonatal conjunctivitis from bacteria that can be present in the birth canal. In Italy, erythromycin ophthalmic ointment or povidone-iodine drops are commonly used. The drops are routine and do not cause lasting discomfort.

Physical examination. Within the first 24 hours, the neonatologist performs a full physical examination of your baby. This covers the head and fontanelles, eyes, mouth (checking for cleft palate), heart and lungs, abdomen, hips, genitalia, spine and skin. The hip examination (Ortolani and Barlow manoeuvres) screens for developmental dysplasia of the hip, which is treatable when caught early. Any finding that needs further assessment is explained to the parents the same day.

Weight, length and head circumference. These are measured at birth and again at discharge. Weight loss of up to 10% in the first few days is normal as babies lose excess fluid; the neonatologist monitors this and advises on feeding if weight loss is greater than expected.

Neonatal metabolic and endocrine screening

Italy has run a national newborn metabolic screening programme since the 1990s, and it was significantly expanded by Legislative Decree 269 of 2016, which mandated the screening neonatale esteso (expanded newborn screening) across all Italian regions. The test is performed free of charge and is offered universally to every newborn in the country, regardless of whether the birth occurs in a public or accredited private facility.

What is the heel-prick test. Known informally as the test di Guthrie (a name that has persisted from the original phenylketonuria screening), the expanded version involves taking a small blood sample from the baby's heel, usually between 48 and 72 hours after birth. The blood spots are collected on a filter-paper card and sent to a regional reference laboratory. The test now screens for more than 40 conditions, including:

For almost all of these conditions, early detection before symptoms appear is what makes treatment effective. A positive result on the screening test does not mean your baby has the condition: it means further diagnostic testing is needed. The laboratory contacts the neonatologist or paediatrician promptly if a result needs follow-up, and families are called within days. The vast majority of positive screens turn out to be false positives on confirmatory testing.

Timing matters. The test is performed after 48 hours of life so that metabolites have time to build up to detectable levels in conditions like PKU. Testing too early can produce false-negative results. If a baby is discharged before 48 hours for any reason, the test must be completed at a community health centre (consultorio or distretto sanitario) within the correct window.

Newborn hearing screening

The newborn hearing screening programme (programma di screening audiologico neonatale) was mandated nationally in Italy by the Piano Nazionale di Prevenzione and by ministerial guidance from the Ministero della Salute. The test is performed before discharge, usually on day 2 or 3 of life, and is painless and quick.

Otoacoustic emissions (OAE). A small, soft probe is placed in the baby's outer ear canal. The device sends brief clicking sounds and measures the tiny sounds (otoacoustic emissions) that the inner ear produces in response. A healthy cochlea reflects these sounds back; a baby with significant hearing loss in that ear will not produce detectable emissions. The test takes only a few minutes and can be performed while the baby is asleep or settled.

Automated auditory brainstem response (AABR). Some units also perform AABR, particularly for babies with risk factors for hearing loss (family history, neonatal intensive care, certain medications). This test uses small electrodes on the scalp to measure the brainstem's electrical response to sounds. It takes slightly longer but provides additional information.

What happens if a retest is needed. A "refer" result (meaning no clear pass) on first screen is common and does not mean your baby has a hearing problem. Fluid in the ear canal from the birth, a restless baby, or background noise can all affect the result. A retest is offered within 2 to 4 weeks, and if the result is still unclear, the baby is referred to an audiology centre for full diagnostic assessment. Early identification and fitting of hearing aids or cochlear implants, where needed, dramatically improves language and communication outcomes.

Jaundice monitoring during the hospital stay

Physiological jaundice (ittero neonatale fisiologico) is extremely common, affecting up to 60% of term newborns. It appears when the liver is still developing the capacity to process bilirubin, the yellow pigment produced when red blood cells are broken down. Jaundice typically appears on day 2 or 3 of life, peaks around day 3 to 5, and fades by the end of the second week.

During the hospital stay, midwives and neonatologists monitor bilirubin levels visually and, when needed, with a transcutaneous bilirubinometer (a small device placed against the skin). If levels rise above treatment thresholds, phototherapy (light therapy, known as fototerapia) is started. The baby lies under blue-spectrum lights for several hours, which convert bilirubin in the skin into a form the body can excrete. Phototherapy is effective and does not require any medication. High bilirubin levels that are left untreated can in rare cases cause brain damage (kernicterus), so monitoring is taken seriously.

Breastfed babies have a slightly higher rate of jaundice than formula-fed babies. The ward ostetrica will work with you to ensure feeding is going well, since frequent feeding helps the body clear bilirubin more quickly. If your baby is still visibly yellow at discharge, your paediatrician will check again at the first home or clinic visit.

Discharge documents and birth registration

Before you leave the hospital, you will receive several important documents:

Birth registration. In Italy, the birth must be registered at the ufficio anagrafe of the local comune (town hall). The deadline is 3 days if the registration is done by the father or by a person present at the birth, or 10 days if done by the mother. Many Italian hospitals have an anagrafe office on-site or a dedicated service on the maternity ward that assists parents in completing the declaration (dichiarazione di nascita) before they go home, which is by far the most convenient option. You will need identification documents and, if the parents are not married, both parents need to be present or provide authorisation. The comune issues the birth certificate (estratto di nascita) and the codice fiscale (tax identification number) for the baby, which is needed to register with a paediatrician.

Choosing a paediatrician. The pediatra di libera scelta is the paediatrician you register with through your local ASL (Azienda Sanitaria Locale). Every child resident in Italy is entitled to a free, SSN-covered paediatrician until the age of 14. Lists of available paediatricians in your area are available from the ASL office or, increasingly, through regional health authority websites and apps. Ideally, choose before leaving hospital. The first visit is usually booked within 7 to 10 days of discharge and includes a weight check, a feeding assessment, a check of the jaundice, and a review of any pending screening results.

Breastfeeding support on the ward

Italy has a network of UNICEF Baby-Friendly hospitals (ospedali amici dei bambini), and even facilities that have not achieved full accreditation are expected to follow the Ten Steps to Successful Breastfeeding as a framework. On the maternity ward, the ostetrica (midwife) is the primary person who supports breastfeeding in the first days. Skin-to-skin contact immediately after birth is standard practice and helps initiate feeding. Rooming-in (keeping the baby in the mother's room rather than a central nursery) is the norm in most Italian hospitals.

Colostrum, the thick early milk produced in the first 2 to 3 days, is present in small quantities and is exactly what a healthy term newborn needs. Many mothers worry that they are not producing enough, but the healthy newborn stomach is very small and colostrum is highly concentrated. If you have concerns about feeding, ask to speak with an ostetrica or, where available, a consulente in allattamento (lactation consultant).

If formula supplementation is medically recommended (for example, if weight loss is significant or blood sugar is low), this should be discussed with you and documented. You are entitled to ask questions and to understand the clinical reason before agreeing.

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Frequently asked questions

How long is the hospital stay after a vaginal birth?

After an uncomplicated vaginal birth, the standard stay in Italian public hospitals is 3 to 4 days. This is covered in full by the SSN with no co-payment for the mother or newborn. If mother and baby are both well and the neonatologist agrees, some units allow discharge after 48 hours, but the standard is 72 to 96 hours so that all screening tests can be completed.

Is the neonatal metabolic screening test compulsory?

The expanded neonatal metabolic screening (screening neonatale esteso) is free and offered universally to all newborns in Italy. It is not compulsory by law, but participation is very strongly recommended by the Ministero della Salute and the ISS. The heel-prick test checks for more than 40 conditions where early treatment prevents serious harm. Parents may decline, but this should be discussed with the neonatologist.

What documents do I receive when leaving the hospital?

At discharge you receive a clinical summary for the newborn (scheda di dimissione ospedaliera neonatale), a vaccination record booklet (libretto delle vaccinazioni), and in many regions the first pages of the libretto sanitario pediatrico. You also need to register the birth at the local comune within 3 days if done by the father or a person present at the birth, or within 10 days at the hospital registry office. The hospital often assists with this registration directly from the maternity ward.

When should I choose a paediatrician?

Ideally, choose your pediatra di libera scelta before leaving the hospital, or within a few days of discharge. Registration is done through the local ASL office or in many regions online. The first visit is usually within 7 to 10 days of discharge and is covered by the SSN at no cost. The paediatrician takes over from the hospital neonatologist and manages all routine checks, vaccinations and referrals throughout childhood.

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