Newborn Common Scenarios/Special Situations
See YKHC Clinical Guideline for Neonatal Jaundice for 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
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.
Neonatal Drug Exposure
If the pregnant woman is known to use narcotic medication that could put the infant at risk of neonatal abstinence syndrome, all reasonable attempts to have the mother travel to Anchorage for her 'be-in-Bethel (BIB)' date are made. If the infant is delivered in Bethel, we now follow the Eat, Sleep, Console Approach to manager any symptoms that develop.
- Grisham et al. Eat, Sleep, Console Approach: A Family-Centered Model for the Treatment of Neonatal Abstinence Syndrome. Advances in Neonatal Care: April 2019 - Volume 19 - Issue 2 - p 138-144. doi: 10.1097/ANC.0000000000000581.
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 thermoregulation. 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.