pabnmqwertenmqwertyuiopasdfghjk lzxcvbnmqwertyuiopasdfghjklzxcvbn mqwertyuiopasdfghjklzxcvbnmqwert yuiopasdfghjklzxcvbnmqwertyuiopasNeonatal Unit dfghjklzxcvbnmqwertyuiopasdfghjklzHandbook xcvbnmqwertyuiopasdfghjklzxcvbnm qwertyuiopasdfghjklzxcvbnmrtyuiop Christchurch Women’s Hospital asdfghjklzxcvbnmqwertyuiopasdfghj klzxcvbnmqwertyuiopasdfghjklzx cvb Nicola Austin Clinical Director nmqwertyuiopasdfghjklzxcvbnmqwe Jill McKie rtyuiopasdfghjklzxcvbnmqwertyuiop Adrienne Lynn Bronwyn Dixon asdfghjklzxcvbnmqwertyuiopasdfghj Maggie Meeks Kiran More klzxcvbnmqwertyuiopasdfghjklzxcvb nmqwertyuiopasdfghjklzxcvbnmqwe rtyuiopasdfghjklzxcvbnmqwertyuiop asdfghjklzxcvbnmqwertyuiopasdfghj With many thanks to past consultants and all the registrars who have klzxcvbnmqwertyuiopasdfghjcontributed substantially to this handbook and to the care of babies inklzxcvb the NICU. nmrtyuiopasdfghjklzxcvbnmqwertyu Updated November 2015 Any versions prior to this may not contain accurate information and should be discarded [Type text] GLN 0001 iopasdfghjklzxcvbnmqwertyuiopasdf ghjklzxcvbnmqwertyuiopasdfghjklzx 2 TABLE OF CONTENTS HAND HYGIENE………………………………………………………………………………………………………….5 RESUSCITATION AND ADMISSION GUIDELINES ................................................................................................... 5 LABOUR WARD ATTENDANCE .................................................................................................................................................... 5 COMMUNICATION FOR NEONATAL ATTENDANCE AT DELIVERIES .............................................................................................. 6 CAESAREAN SECTION CATEGORISATION .................................................................................................................................... 7 VAGINAL DELIVERY CATEGORISATION ...................................................................................................................................... 8 PREPARATION FOR RESUSCITATION ............................................................................................................................................ 9 NEOPUFF ................................................................................................................................................................................... 10 MECONIUM ASPIRATION ........................................................................................................................................................... 11 CORD GASES AND PLACENTAL PATHOLOGY ............................................................................................................................ 11 DRUGS FOR RESUSCITATION .................................................................................................................................................... 12 TERM (≥ 37 WEEKS) NEWBORN RESUSCITATION ALGORITHM .................................................................................................. 13 PRETERM (< 37 WEEKS) NEWBORN RESUSCITATION ALGORITHM ............................................................................................ 14 ADMISSION ROUTINE ................................................................................................................................................................ 15 VITAMIN K ............................................................................................................................................................................... 16 ADMISSIONS TO THE NEONATAL UNIT IN THE FIRST MONTH AFTER BIRTH (OR CORRECTED AGE) ............................................. 16 SMALL BABY PROTOCOL - GUIDELINES FOR THE < 28 WEEK NEONATE .................................................. 18 ANTENATAL CARE .................................................................................................................................................................... 18 CARE AT BIRTH ........................................................................................................................................................................ 20 CARE IN THE GOLDEN HOUR .................................................................................................................................................... 22 CARE IN WEEK ONE .................................................................................................................................................................. 24 RESPIRATORY SUPPORT............................................................................................................................................. 26 ANTENATAL STEROIDS ............................................................................................................................................................. 26 CPAP ....................................................................................................................................................................................... 26 HEATED HUMIDIFIED HIGH FLOW NASAL CANNULA OXYGEN ................................................................................................. 28 INDICATIONS FOR INTUBATION AND VENTILATION ................................................................................................................... 29 SLE VENTILATOR ..................................................................................................................................................................... 29 MODES OF VENTILATION .......................................................................................................................................................... 29 VENTILATOR SETTINGS ............................................................................................................................................................ 31 BLOOD GASES .......................................................................................................................................................................... 31 PRINCIPLES OF VENTILATION ................................................................................................................................................... 31 HIGH FREQUENCY VENTILATION .............................................................................................................................................. 32 PNEUMOTHORAX ...................................................................................................................................................................... 34 SEDATION FOR VENTILATED BABIES ........................................................................................................................................ 35 ARTIFICIAL SURFACTANT ......................................................................................................................................................... 35 IN/OUT SURFACTANT ............................................................................................................................................................... 36 OXYGEN SATURATION TARGETS – NICU INPATIENTS .............................................................................................................. 36 SLEEP STUDIES ......................................................................................................................................................................... 37 APNEA MONITORING ................................................................................................................................................................ 38 FLUIDS .............................................................................................................................................................................. 39 INTRAVENOUS FLUIDS .............................................................................................................................................................. 39 PRESCRIBING ADDITIVES .......................................................................................................................................................... 40 CALCULATING DEXTROSE CONCENTRATIONS .......................................................................................................................... 42 HYPONATRAEMIA ..................................................................................................................................................................... 42 HYPOKALAEMIA ....................................................................................................................................................................... 43 HYPERNATREMIA ...................................................................................................................................................................... 44 HYPERKALAEMIA ..................................................................................................................................................................... 44 NEONATAL NUTRITION GUIDELINES ..................................................................................................................... 46 DIETITIAN REFERRAL GUIDELINES ........................................................................................................................................... 47 FOOD SUPPLEMENTS AND VITAMINS .......................................................................................................................................