Transcript Welcome to the Newborn Nursery

Welcome to the Newborn
Nursery
Erin Burnette, NP-C
Emily 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/percentchange.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”
• 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
PRESENTATION
Keep 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
"Happy Crisis by W. Brown
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 hyperbili
www.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!