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Newborn Handbook

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Newborn Handbook Pediatric Residency Newborn Handbook 2020-2021 1 Table of Contents Topic Page Contact Information 3 Routine Newborn Care 4 Discharge Talk Guidelines 5-7 AAP Recommendations for Healthy Term Newborn Discharge Criteria 8-9 Basic management of maternal labs/risk factors and Medication Refusal 10-11 Routine Vitamin K Prophylaxis 12 Hep B Vaccine Information and Management of Maternal Hepatitis B Status 13 Routine Erythromycin Prophylaxis for Ophthalmia Neonatorum 14 Hearing Screen 15 CCHD Screening 16 Michigan Newborn Screening 17 Breast Feeding 18-19 Infant feeding policy (donor breast milk) 20 Ankyloglossia and Frenotomy 21 Circumcision 22 Car Seat Safety 23-24 Nursery Protocols 25 Locating Policies, Procedures & Protocols 25 NRP (Neonatal Resuscitation Protocol), APGAR Scoring, MR. SOPA 26 Indirect Hyperbilirubinemia 27-30 Hypoglycemia Algorithm 31-32 Hypoglycemia Treatment, SGA & LGA cutoffs, and Pounds to Kilogram Conversion 33 Chorioamnionitis protocol and antibiotic duration, GBS Algorithm 34-35 Temperature Regulation 36-38 On-Call Problems & a note about SBARs 39 Respiratory/Cardiovascular Respiratory Distress 40-41 Cyanosis 42 Heart Murmurs, Cardiac Exam, and CHD 43 FEN/GI/Endo: Newborn Fluid Management and Weight Specific Guidelines for Feeding 44 Bilious Vomiting 45-46 When You’re Asked About the Appearance of Baby Poop 47 Bloody Stool 48 No stool in 48 hours of life and No void in 30 hours of life 49 Maternal Graves’ Disease 50 Renal Management of Antenatal Hydronephrosis 51 HEENT/Neuro Skull Sutures & Fontanels / Extracerebral Fluid Collections/Subgaleal Hemorrhage 52-53 Infant Fall 54 Oral-facial clefts 55-56 Neonatal Seizures 57 Neonatal Abstinence Syndrome 58-60 Infectious Disease Rubella, CMV, HIV 61 Syphillis 62-63 Toxoplasmosis, HSV 64 Recommended HSV management 64-67 Hepatitis C, Varicella 67 Assessing Gestational Age and the Ballard Score 68 Selected Lab Evaluation 69 Transferring to NICU 70 2 Contact Information Resident ASCOM: 76087. Nursery Attending (N1)—ASCOM: 76088. Nursery Attending (N2) – ASCOM: 76089. Mike Visser, PA 616-299-2673 (cell) – ASCOM: 75200. Lisa Norris, NP 616-560-7220 (cell) – ASCOM: 76091. Jenna Houghton, NP 616-335-1523 (cell)—ASCOM: 76086. Karly Hiser, NP 215-990-4288 (cell) –ASCOM: 76357. Attending Cell Home Abeba Berhane 404-857-9334 Lana Gagin 734-239-1197 616-452-8032 Jill Golden 616-368-0677 Miranda Hillard 419-265-9959 Hanna Jaworski 540-521-4510 Cheryl Kuz 616-666-0004 616-447-8898 Phil Paras 616-350-0814 Beth Parker 734-276-1568 Karen VanderLaan 616-250-5019 ShaMelle White 989-213-3390 2 Center Desk (Labor & Delivery) 616-391-1580/fax = 391-2013 3 Center Desk (Labor & Delivery) 616-391-1280 4 Center Desk (OB Special Care) 616-391-1500 6 Center Desk 616-391-1387 Nursery 616-391-3889 7 Center Desk 616-391-1560 Nursery 616-391-3865 8 Center Desk 616-391-1530 Nursery 616-391-1585 NICU 616-391-1523 Academic General Peds Clinic 616-391-8810 (families/scheduling) 616-391-8806 (back line) Interpreter Services 616-391-2175 MSW 616-391-1675 616-479-7090 (pager) 74701 (weekend ASCOM) Lactation Warm Line 616-391-9437 Lab (Blood bank/cord blood) 11853 Prefixes for phone numbers: (479), (267), and (391) – if you receive a page from outside of the hospital and need to figure out how to return the page. 3 ROUTINE NEWBORN CARE 4 Discharge Talk Guidelines Please use terms that parents can understand! FEEDING/VOIDING/STOOLING Feed according to feeding cues 8-12 times in 24 hours Breastfeeding is preferred: maternal antibodies to baby (decreased stomach/ear infections), healthy gut flora, bonding. Avoiding a pacifier for the first 4 weeks may promote more successful breastfeeding. Formula mixing: Put water in first! 1 scoop of formula per 2oz of water. Most babies take about 2 oz per feed in first month. Generic formula is okay to use. Okay (and preferable, as contains fluoride) to use city tap water. If concerned about water source, may boil for 1min and cool 30min. Or, use nursery/bottled water. Breastmilk or Formula ONLY! Baby is at risk for electrolyte imbalances if taking free water/hypotonic solutions before 6 months, unless medically directed. Vitamin D supplement is recommended for all newborns (all breastfed infants and those taking <30oz formula daily) 400 IU/day. Adequate feeding can be measured by appropriate weight gain and good urine output (4-5 wet diapers/day by day 5) Physiologic gastro-esophageal reflux is to be expected. Wide variety in stool patterns, but most stool multiple times per day. Meconium is black and sticky, transitions to yellow and seedy over the first couple of days. Breastmilk Storage Guidelines: Room temperature (up to 77°F) 6-8 hours Refrigerator Up to 5 days (store in the back) Freezer (separate door of a fridge) 3-6 months (store in the back) Deep Chest Freezer 6-12 months Never thaw then refreeze! https://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm 5 SLEEPING The sleeping area should be a flat, firm surface like a crib or bassinette with a tight fitted sheet and no bumpers, big blankets, toys, etc. Infants should always sleep alone. Thin receiving blankets, swaddles, are safe to use. Swaddles should be used with the wrap under the armpits. BACK to sleep reduces the risk of SIDS. (Until 12 months of age). Give tummy time throughout the day. Pacifiers also reduce the risk of SIDS after breastfeeding is well established. Other ways to prevent SIDS: avoid tobacco smoke (1st, 2nd, 3rd hand), cool to normal room temp. UMBILICAL CORD CARE AND BATHING Keep the umbilical cord clean and dry. (Fold diaper down, no need for alcohol/vaseline, etc). Usually falls off by 2 weeks. Rarely, cord may become infected (omphalitis) – foul smelling with surrounding erythema/swelling/pus. Call doctor if this occurs. Sponge bath is okay, but no soaking until the umbilical cord falls off. Only need a bath 2-3x per week. Avoid baby lotions (can be drying), opt for unscented creams or ointments if desired. CIRCUMCISION CARE Prevent sticking to the diaper by using copious amounts of Vaseline on gauze and covering the tip of the penis. Typically heals in 3-5 days (when skin no longer looks red and raw). During healing, may see white/yellow color on the glans – normal healing. FOLLOW-UP All Babies should have a follow-up appointment within 1-2 days of hospital discharge. Friday discharges are the rare exceptions – make sure parents call for Monday appointment. Some offices have Saturday AM appointments available (i.e. Cherry St). (Physician finder available – only Spectrum doctors on this) 6 SAFETY Never shake a baby. Okay to lie baby in a safe place and “take 5” when overwhelmed. Remind other caregivers! Baby Blues/Postpartum depression: “Baby Blues” are normal and include mood swings/crying spells. This passes quickly. If symptoms continue longer than 2 weeks or Mom has significant anxiety, contact OB or Pediatrician immediately. PPD is common, and effective treatments are available. Don’t put off enjoying your baby! Car seat safety: Rear facing until 2yo. “Pinch test” for tightness. Straps should come out at or below shoulder level. Follow car seat specific height/weight requirements. Carseat safety events are held in the community. Call injury prevention at 616-391-7233 for more information. Sibling rivalry: need to watch young siblings closely as jealousy or improper/rough handling of the baby is common. Parents should try to spend time with sibling when the baby is sleeping. WHEN TO CALL THE DOCTOR Sleeping through >1 feed. Persistently rapid breathing (distinguish from normal periodic breathing), these children often have trouble eating as well. Weak cry/weak movements, abnormal movements Inconsolable crying Worsening jaundice (jaundice should start improving around day 5, though breastfed babies may stay a bit yellow) “Not acting right” Red/pale stool Projectile vomiting or green/red emesis Decreased urine output (less than 3 diapers per day) If you drop your baby Rectal temperature >100.4F. Use rectal thermometer 1.5-2.5cm until metallic tip disappears, hold until beeps with reading. No OTC meds (if you think a newborn is sick, call your doctor). RESOURCES Most offices have 24 nurse or advice lines – don’t be afraid to call! Newborn Channel Online: www.newbornchannelonline.com password: newborn Healthychildren.org for a lot of routine newborn/child questions 7 AAP Recommendations for Healthy Term Newborn Discharge Criteria (2015) 1. Clinical course and physical examination reveal no abnormalities that require continued hospitalization. 2. The infant’s vital signs are documented as being within normal ranges, with appropriate variations based on physiologic state, and stable for the 12 hours preceding discharge. These ranges include an axillary temperature of 36.5°C to 37.4°C (97.7–99.3°F, measured properly in an open crib with appropriate clothing, a respiratory rate below 60 per min and no other signs of respiratory distress, and an awake heart rate of 100 to 190 bpm. Heart rates as low as 70 bpm while sleeping quietly, without signs of circulatory compromise and responding appropriately to activity, also are acceptable. Sustained heart rates near or above the upper end of this range may require further evaluation. 3. The infant has urinated regularly and passed at least 1 stool spontaneously. 4. The infant has completed at least 2 successful feedings. If the infant is breastfeeding, a caregiver knowledgeable in breastfeeding, latch, swallowing, and infant satiety should observe an actual feeding and document successful performance of these tasks in the medical record. If the infant is bottle-feeding, it is documented that the newborn is able to coordinate sucking, swallowing, and breathing while feeding. 5. There is no evidence of excessive bleeding at the circumcision site for at least 2 hours.
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