Welcome to the Newborn Nursery
Erin Burnette, NP-CEmily Freeman, CPNP
Jamie Haushalter, CPNP
Objectives• Recognize the important factors in the maternal history and labor/delivery process which
may affect the newborn. These factors include: pertinent social issues, chronic medical conditions in the mother, genetic risk factors, maternal/infant Rh/ABO status, maternal drug use, maternal infection, type of delivery, APGAR scores, etc.
• Develop novice competence in the examination of the newborn infant. This includes recognition of normal and abnormal physical characteristics and estimation of gestational age.
• Develop practical knowledge of the following topics and demonstrate competence in using such knowledge to counsel families about routine newborn care:
– Prevention of cross infection it the nursery– Breast and bottle feeding– Parental counseling in routines of newborn care.– Recognition of psychosocial factors that may affect maternal/infant interaction– Circumcision– Newborn screening
• Verbalize appropriate utilization of protocols for the newborn infant (hypoglycemia, hyperbilirubenemia, DDH, toxicology).
Newborn Orientation Guide
• Schedule, pre-rounding, gathering of information
• Gestational age growth curve/percent-change.com
• Bili curve/Bilitool.com• GBS protocol• Hypoglycemia protocol• Drug screening protocol
Basics• Standard of care is “rooming in”• Try to minimize disruptions to
maternal-infant bonding. • Encourage and promote
breastfeeding• Quiet time
• 2-4 pm
"Happy Crisis" by W. Brown
“Happy Crisis”• Happy Crisis of new parents• You as the Physician• Perception is Reality
– Importance of how you say, as well as what you say
• Your Comfort Zone• You are not the only source. We want
you to ask questions
"Happy Crisis" by W. Brown
FIRST ENCOUNTER“You never get a second chance to make a
first impression.” H&S Commercial• Newborn Exam through the eyes of a
parent• Do your homework:
• Know your patient and parent• Call infant by his/her name
• Clearly Identify Self• Know the Players in the Room
"Happy Crisis by W. Brown
PRESENTATIONKeep it Simple [KISS Principle]• Questions/Concerns without answers
–Yours and theirs–Have a positive definitive plan–Follow thru at expected time re:
hyper- concerns of the new parents.
• Don’t share your concerns unless there is a definitive plan
Neonatal Jaundice• Almost all newborns will develop jaundice in the first few
days of life• All babies are screened using a transcutaneous bilirubin
(TCB) monitor at 18-22 hours of life– If the initial TCB at this time is ≥ 7 nursing will order a neonatal
(serum) bilirubin level (AKA “neobili”) with NBS.– Trust your clinical judgment.
• TCB prior to discharge.
Hyperbilirubinemia
Risk for hyperbiliwww.bilitool.org
SpO2 screening for Critical Congenital Heart Disease
• All infants need to be screened for Critical Congenital Heart Disease (CCHD) prior to discharge.
• Infant’s >18 hours of life need to have a SpO2 level checked in their right hand and either foot.
• Infant passes if >95% and less than 3% difference between hand and foot.
Algorithm
Pulse Ox on Right Hand (RH) and One Foot After 18 Hours of Age
Hypoglycemia Protocol• Late Preterm: 34-36 6/7 weeks; SGA: <2500g; LGA: >4000g; IDM:
medication OR diet controlled. • LIP may ask for protocol to be initiated if infant is LGA or SGA
once plotted on growth chart, or if other risk factors are present. • Goal is 3 consecutive blood glucose levels ≥41 from birth-4hrs or
≥46 after 4hrs of life. • May need to offer hand expressed colostrum, donor breast milk
or formula as medically indicated for treatment of hypoglycemia. • Please see algorithm for s/sx of hypoglycemia or other reasons to
consider initiation of the protocol.
Late Preterm Infant
• Infants between 34-36 6/7 weeks gestation will follow the late preterm infant pathway (review on curriculum website)
• Close monitoring of feedings, jaundice, weight, and temperature during hospital stay.
• No discharge prior to 48 hours.• Special crib card, baby tracker, parent booklet• Parent education
Neonatal Abstinence Syndrome• Toxicology screens should be performed on at-risk infants
(maternal hx of drug use, late/insufficient prenatal care, unexplained IUGR, etc. please refer to Guidelines for Infant Drug Screening)
• Urine and meconium toxicology screens should be ordered and obtained early, most accurate if they are from the first void or stool.
• Infants exposed to opiates in utero are at risk of withdrawal. • Opiate weaning scoring should be obtained every 4 hours• Non pharmacological measures (swaddling, sucking, quiet
environment, etc. should be implemented early)• Morphine needed for 3 scores >8 or 2 scores >12
Breastfeeding
• Breastmilk is best for most infants• True contraindications: HIV positive mother, cocaine
use• Lactation consultants meet with every mother• Mothers should feed when infant demonstrates
hunger cues and/or every 2-3 hours. 8-10 feedings per day.
• Colostrum initially, milk comes in after delivery (timing depends on type of delivery/#of pregnancies)
Daily Tasks• Pre-rounding:
– Filling out a new patient card– Obtaining daily information for interim babies– Discharge information
• Morning report/grand rounds• Walk Rounding with Resident/attending• Noon conference/lunch• Afternoon:
– Education with attending 1300/1500– Admitting of new babies– Follow up of any outstanding issues
NBN Cards
• Gather information on admission from:– Moms chart: webcis for labs, H&P, ultrasound
reports, etc; echart (L&D summary and Intrapartum singleton notes)
– Babys chart: webcis for labs, echart for measurements, vital signs
• On interim days, review/update:– Infant weight, voids/stools, bili checks, lactation
notes, immunizations, hearing test, newborn screen
The Board
• You will find:– Babies name, room #, c/s, birth time– Service (UNC, FP, PHS, etc)– Completion of Hep B, hearing test, NBS, circ….– Other information such as SW consult, formula
feeding, etc.
Don’t hesitate to ask
questions!
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