Newborn discharge criteria from nbsu units

1. Welcome & Introduction

2. Pre-test
Polls will launch on your screen.
If you do not see the poll on your screen, click
on the button in the bottom of your screen to
launch the poll. On mobile devices, this can be
found in the menu.

3. Dr. A. Deepak Kumar.
Associate professor
Eluru medical college.
Andhra Pradesh
#Naipunyam-13
Session 7: NBSU Discharge Criteria

6. 1) Look for Signs of Respiratory Distress
2) Assess Circulation
3) Differetiate convulsions / jittereness
4) Look for subtle convulsions

7. Check blood sugar
Check SPO2

8. Management of emergency signs
 Hypothermia
 Not breathing(Apnea)
 Shock
 Convulsions

9. 1) Temperature maintenance
2) Position and clearing airway
3) Oxygen administration
4) Prevent /treat Hypoglycemia
5) Refer all with emergency signs after
6) Stabilization
7) IV Fluids if not able to feed
8) Pre referral dose of antibiotics
Common actions for any new born with emergency signs

10. 1.Hypoglycemia
2.Hypocalcemia
3.Seizures, ect.
In department management of

12. 1) Problem?
2) Complete history of mother / delivery
3) Examining in the baby
4) Assessing feeding
5) Putting the DD
6) Management
7) Discharge
Admitting a baby

13. 1.Disinfection of surroundings
2.Equipment
Other things to be looked up on

14. Management of jaundice and Management of sepsis

17. Antibiotic Protocol

18. 1. Cry
2. Activity , reflexes
3. Weight gain
4. Adequacy of breast feeds
5. Temperature maintenance
6. Jaundice
7. Passing Meconium/urine
8. Vomiting
9. Danger signs
Postnatal Care of Newborn

25. Criteria for discharge from NBSU
1) Baby is maintaining normal body temperature (in room temperature/when cared
for by the mother)
2) Baby not requiring IV fluids/medications.
3) Baby is accepting breastfeed/assisted feeds well and gaining weight for 3
consecutive days
4) IV antibiotic therapy has been completed.
5) Baby admitted for neonatal jaundice and has completed treatment with
phototherapy
6) Mother has been counseled for danger signs: assisted feeding (as required), KMC
(as required) and follow up plan.

26. Preparation for Discharge
1) Prepare discharge summary. Birth weight, discharge weight, length and head
circumference should be mentioned in the discharge summary. A standard
format has been provided in the annexure.
2) Inform ASHAs/ANM about the discharge and home-based follow up
3) Baby should have received the following vaccines- BCG, zero dose OPV (can
be given till 14th day of life), and birth dose of hepatitis B (within 24 hours of
birth). There is no lower weight limit for vaccinating a newborn.
4) Advice screening for preterm babies to be done at a higher center for:
1. ROP for all babies < 2000 gms gms; at 4 weeks;
2. BERA (Brainstem evoked response audiometry) at 40 weeks
corrected age

27. A. 5. While communicating the discharge instructions to mother:
A) Use words that she understands
B) Use teaching aids that are familiar to her
C) Give feedback when she practices. Praise what was done well and make corrections, if
necessary
D) Allow more practice, if needed
E) Encourage the parent/mother to ask questions and answer all the questions.
6.Advise mother to give home care: Breastfeed infant exclusively, keep infant warm, keep
cord clean and dry, importance and correct method of hand washing & danger signs.

28. Nutritional supplements for LBW babies
1.Supplements are required for low birth weight babies and should be started, once the
baby is accepting full oral feeds.
2. Vitamin D: All LBW infants, who are exclusively breastfed should receive 400 IU daily of
vitamin D. The supplementation should continue until one year of age. Most available
vitamin D drops contain 400 IU/ml.
3. Multivitamin drops with zinc: All LBW infants, who are exclusively breastfed should
receive 1 ml/day from 2 weeks of age, till 40 weeks post menstrual age.
4. Calcium and phosphorous: All very low birth weight babies (birth weight< 1500 gms)
should receive elemental calcium and phosphorous at 120-160 mg/Kg/day and 60-80
mg/Kg/day, respectively. This may be continued till 40 weeks post menstrual age. For
optimal supplementation, the preparations having the calcium and phosphorous in 2:1
ratio should be used.
5. Iron: Elemental iron supplementation at 2 mg/Kg/day started at 2 weeks in

29. Advice at Discharge
1.Maintenance of body temperature – as explained earlier
2. Breast feed every two to three hours on a semi-demand schedule both during
day and night. During each feed, one breast should be completely emptied before
the baby is put to the other breast. Exclusive breastfeeding should be advised and
the mother should be counselled that there is no need for additional water or other
fluids except under medical supervision.
3. Skin care/bathing Always take special precautions during bathing to prevent
draught and chilling. Daily baths may be avoided during the winter months and the
baby can be sponged in a warm room to avoid exposure and to keep the baby
clean.

30. 4. Care of the umbilical stump: Do not apply any medication on the cord, leave it
open without any dressing. The cord usually falls after 4 to 10 days.
5. Care of the eyes: Some neonates may develop persistent epiphora (watering)
due to blockage of nasolacrimal duct by epithelial debris. The mother should be
advised to massage the nasolacrimal duct area (by massaging the either side of
the nose adjacent to the medial canthus) 5 to 8 times daily, each time before she
feeds the baby. Routine application of antiseptic ointment/drops for prevention of
ophthalmia neonatorum is not recommended
Immunization: It is recommended to give BCG vaccine, zero dose of oral polio
vaccine and Hepatitis B vaccine as per schedule and document it in the MCP Card.
The mother should be informed about the date of the next visit and the same
should be shown in the MCP card.

31. Checklist before discharge from postnatal ward
Ideally, all normal newborns should be discharged after 48 hours, along with
the mother once the following criteria are fulfilled:
 • Newborn is free from any illness, including significant jaundice
 • The newborn has been immunized
 • Adequacy of breastfeeding has been assessed in all newborns, indicated
by:
a. Passage of urine at 6 to 8 times over 24 hours
b. Onset of transitional stools
c. Baby sleeping well for 2-3 hours after feeding.
d. Normal weight loss pattern

32. Follow up
a) Preferably, each baby should be followed up in the clinic for assessment of growth
and development,
b) early diagnosis and management of illnesses and health education of parents.
c) Routine use of MCP card should be done to promote monitoring and awareness of
parents.
d) Immunization visits can be used for the assessment of newborns by providers.

33. Questions?

34. Post Test
Polls will launch on your screen.
If you do not see the poll on your screen, click
on the button in the bottom of your screen
to
launch the poll. On mobile devices, this can be
found in the menu.

35. RISE Project Overview
Reaching Impact, Saturation, and Epidemic Control (RISE) is a 5-year global project funded by the U.S. President’s
Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Agency for International Development (USAID) which works
with countries to achieve a shared vision of attaining and maintaining epidemic control, with stronger local
partners capable of managing and achieving results through sustainable, self-reliant, and resilient health systems
by 2024.
Contact information:
At RISE: Kelly Curran, RISE Project Director (kelly.curran@Jhpiego.org)
At USAID: Elizabeth Berard, USAID Agreement Officer’s Representative (eberard@usaid.gov)
This presentation was made possible through the United States Agency for International Development funded RISE program under the terms of the cooperative
agreement 7200AA19CA00003. The contents are the responsibility of the RISE program and do not necessarily reflect the views of USAID or the United States
Government.