Newborns

Newborn Admissions

Examine patient after delivery Complete Admission H&P. Please consider using, and saving as your own, the shared Newborn Admission template for boy and girl by McClure and Hampton or Pelkan’s pre-completed shared newborn note. They are pre-completed for normal newborns so you will need to change the exam for any abnormalities. They contain a good outline of what the admission note should include and you can modify it to your liking. These include maternal prenatal information that is helpful for the baby that needs to be seen in follow up. Complete newborn orders Complete medication reconciliation Place an E&M charge order

Scenarios/ Special Situations

Bili Lights:

See YKHC Clinical Guidelines or details on which babies require phototherapy and how to do it on OB unit.

Bethel newborn bilirubin follow-up: For babies born on the unit, the nurses will often agree to obtain a follow up bili on a baby on the following day. The patient will have to come directly to the OB unit and a hospitalist physician will need to be responsible for ordering the bili, reviewing the results and determining follow up. This will keep the patient from having to go to the clinic or ER (around sick people) for follow up labs

Circumcision:

Upon maternal admission, the desire for this elective procedure (if male or unknown gender) for their newborn is asked. Most mothers decline. This procedure is done most commonly prior to discharge, but also can be done outpatient for up to 4 weeks. A detailed consent form must be signed by the mother. Generally, only privileged active medical staff are able to do circumcisions due to the paucity of procedures.

Preterm and Sick Infants:

Call the pediatric hospitalist for any anticipated (or unanticipated) preterm deliveries, high-risk delivery or sick infant. Make sure nursing staff are preparing for a sick infant and RT and pharmacy are requested. Get more physician help if possible. Peds may need help activating, getting consents and paper work completed and extra hands in resuscitation.

Hospitalists should be familiar with the neonatal resuscitation cart and emergency resuscitation equipment, supplies and protocols (see links below) as the pediatrician may need assistance with the baby. Family Medicine Hospitalists may be responsible for the initial resuscitation and stabilization of a very sick newborn if the pediatrician is on a medevac or not able to leave another emergency.

Remember the ER and NW have nurses and staff that can help as well.

Many, apparently well seeming, infants delivered less than 36 weeks end up needing to be transferred because of difficulty with feeding and thermoregulations. Closely monitor these infants and have a low threshold to send these babies to Anchorage. Babies that deliver 36-37 weeks often do well, but these also need to be monitored and transferred if they are requiring more than routine care.

Neonatal Resuscitation Summary Chart Links to pdf.

YKHC Premie Warm Welcome Protocol

Newborn Rounding

Babies must be rounded on daily

Complete progress note on the baby daily. If night float delivered the baby, they will round and follow the patient until discharge, if they are still on shift.
Check 24 hour pulse ox result and make sure NB hearing screen is completed
Check lab tests ordered or done by nursing. All infants will get a fractionated bilirubin done before discharge. Some infants will have glucose monitored for jitteriness, LGA, SGA status etc. Some infants will have a Coombs ordered for ABO incompatibility.
Document weight with %loss, vitals, feeding and how the baby is doing
Complete and E&M charge

Newborn Discharge Process

Complete a Newborn Discharge Summary on all newborns

Dee Dee Paster has a good-shared newborn discharge note that you can use and adapt as your own. It has a place to cut and paste all the mom’s prenatal labs from the mom/baby’s admission note and she has put a line at the bottom for birth weight/discharge weight and % weight loss, and what the bili was. That way it’s easy to find for future reference.

Provide patient education such as Newborn Booklet-PEDS 9.8.13 Custom, Late Preterm Newborn PEDS 7.9.13 Custom, Circumcision, Jaundice information etc
Be sure the patient will get a 3-5 day of life follow up appt, 2 week and two month follow up appts or other f/u as needed
Complete the Medication Reconciliation
Complete and E&M charge
Update Diagnoses and Problem List if indicated