Welcome to the Newborn Nursery

1. Welcome to the Newborn
Nursery
Erin Burnette, NP-C
Emily Freeman, CPNP
Jamie Haushalter, CPNP

2. Objectives
• Recognize the important factors in the maternal history and labor/delivery
process which may affect the newborn. These factors include: pertinent social
issues, chronic medical conditions in the mother, genetic risk factors,
maternal/infant Rh/ABO status, maternal drug use, maternal infection, type of
delivery, APGAR scores, etc.
• Develop novice competence in the examination of the newborn infant. This
includes recognition of normal and abnormal physical characteristics and
estimation of gestational age.
• Develop practical knowledge of the following topics and demonstrate competence
in using such knowledge to counsel families about routine newborn care:
– Prevention of cross infection it the nursery
– Breast and bottle feeding
– Parental counseling in routines of newborn care.
– Recognition of psychosocial factors that may affect maternal/infant interaction
– Circumcision
– Newborn screening
• Verbalize appropriate utilization of protocols for the newborn infant
(hypoglycemia, hyperbilirubenemia, DDH, toxicology).

3. Newborn Orientation Guide
• Schedule, pre-rounding, gathering of
information
• Gestational age growth curve/percent-
change.com
• Bili curve/Bilitool.com
• GBS protocol
• Hypoglycemia protocol
• Drug screening protocol

4. Basics
• Standard of care is “rooming in”
• Try to minimize disruptions to maternal-
infant bonding.
• Encourage and promote breastfeeding
• Quiet time
• 2-4 pm

5. “Happy Crisis”
• Happy Crisis of new parents
• You as the Physician
• Perception is Reality
–Importance of how you say, as well as
what you say
• Your Comfort Zone
• You are not the only source. We want you
to ask questions 
"Happy Crisis" by W. Brown

6. FIRST ENCOUNTER
“You never get a second chance to make a first
impression.” H&S Commercial
• Newborn Exam through the eyes of a parent
• Do your homework:
• Know your patient and parent
• Call infant by his/her name
• Clearly Identify Self
• Know the Players in the Room
"Happy Crisis" by W. Brown

7. PRESENTATION
Keep it Simple [KISS Principle]
• Questions/Concerns without answers
–Yours and theirs
–Have a positive definitive plan
–Follow thru at expected time re: hyper-
concerns of the new parents.
• Don’t share your concerns unless there is
a definitive plan
"Happy Crisis by W. Brown

8. Neonatal Jaundice
• Almost all newborns will develop jaundice in the first few days of life
• All babies are screened using a transcutaneous bilirubin (TCB)
monitor at 18-22 hours of life
– If the initial TCB at this time is ≥ 7 nursing will order a neonatal
(serum) bilirubin level (AKA “neobili”) with NBS.
– Trust your clinical judgment.
• TCB prior to discharge.

9. Hyperbilirubinemia

10. Risk for hyperbili
www.bilitool.org

11. SpO2 screening for Critical Congenital
Heart Disease
• All infants need to be screened for Critical
Congenital Heart Disease (CCHD) prior to
discharge.
• Infant’s >18 hours of life need to have a SpO2
level checked in their right hand and either
foot.
• Infant passes if >95% and less than 3%
difference between hand and foot.

12. Algorithm
Pulse Ox on Right Hand (RH) and One Foot After 18 Hours of Age

13. Hypoglycemia Protocol
• Late Preterm: 34-36 6/7 weeks; SGA: <2500g; LGA:
>4000g; IDM: medication OR diet controlled.
• LIP may ask for protocol to be initiated if infant is LGA
or SGA once plotted on growth chart, or if other risk
factors are present.
• Goal is 3 consecutive blood glucose levels ≥41 from
birth-4hrs or ≥46 after 4hrs of life.
• May need to offer hand expressed colostrum, donor
breast milk or formula as medically indicated for
treatment of hypoglycemia.
• Please see algorithm for s/sx of hypoglycemia or other
reasons to consider initiation of the protocol.

15. Late Preterm Infant
• Infants between 34-36 6/7 weeks gestation
will follow the late preterm infant pathway
(review on curriculum website)
• Close monitoring of feedings, jaundice,
weight, and temperature during hospital stay.
• No discharge prior to 48 hours.
• Special crib card, baby tracker, parent booklet
• Parent education

16. Neonatal Abstinence Syndrome
• Toxicology screens should be performed on at-risk infants
(maternal hx of drug use, late/insufficient prenatal care,
unexplained IUGR, etc. please refer to Guidelines for Infant
Drug Screening)
• Urine and meconium toxicology screens should be ordered
and obtained early, most accurate if they are from the first
void or stool.
• Infants exposed to opiates in utero are at risk of
withdrawal.
• Opiate weaning scoring should be obtained every 4 hours
• Non pharmacological measures (swaddling, sucking, quiet
environment, etc. should be implemented early)
• Morphine needed for 3 scores >8 or 2 scores >12

17. Breastfeeding
• Breastmilk is best for most infants
• True contraindications: HIV positive mother,
cocaine use
• Lactation consultants meet with every mother
• Mothers should feed when infant demonstrates
hunger cues and/or every 2-3 hours. 8-10
feedings per day.
• Colostrum initially, milk comes in after delivery
(timing depends on type of delivery/#of
pregnancies)

18. Daily Tasks
• Pre-rounding:
– Filling out a new patient card
– Obtaining daily information for interim babies
– Discharge information
• Morning report/grand rounds
• Walk Rounding with Resident/attending
• Noon conference/lunch
• Afternoon:
– Education with attending 1300/1500
– Admitting of new babies
– Follow up of any outstanding issues

19. NBN Cards
• Gather information on admission from:
– Moms chart: webcis for labs, H&P, ultrasound
reports, etc; echart (L&D summary and
Intrapartum singleton notes)
– Babys chart: webcis for labs, echart for
measurements, vital signs
• On interim days, review/update:
– Infant weight, voids/stools, bili checks, lactation
notes, immunizations, hearing test, newborn
screen

20. The Board
• You will find:
– Babies name, room #, c/s, birth time
– Service (UNC, FP, PHS, etc)
– Completion of Hep B, hearing test, NBS, circ….
– Other information such as SW consult, formula
feeding, etc.

21. Don’t
hesitate to
ask
questions!