Gama Hospital

Al Khobar K.S.A

The Standards of Care in Nursery

GOAL:

To establish guidelines for nurses providing care for babies

OBJECTIVES:

1. To provide immediate newborn care

2. To stabilize infant’s temperature
3. To provide proper identification on Newborn
4. To provide prophylaxis in the treatment of infection to the eye
5. Explain the procedure for assessment of the newborn.
6. Describe common deviations from normal physiologic findings during
examination of the newborn.

I. Admission to the newborn nursery

Healthy newborns should remain in the delivery room with their mother as
long as possible to promote immediate initiation of breastfeeding and early
bonding. When possible, physical assessments, administration of medications,
routine laboratory tests and bathing should occur in the mother’s room.

a) Upon delivery, an assessment of gestational age is performed on all

infants using expanded Ballard score.
b) Weighing and Anthropometric measurement is done. On the basis of
these measurements, the infant is classified as appropriate for
gestational age (AGA), small for gestational age (SGA) or large for
gestational age (LGA).
 c) Infant’s temperature is stabilized with one of three possible modalities:
 Skin to skin contact with mother
 Open radiant warmer on servo control
 Incubator on servo control
d) Universal precautions should be used with all patient contact.
e) The first bath is given with warm tap water and non medicated soap
after axillary temperature of >36.3 degrees Celsius has been recorded.
f) Acceptable practices for umbilical cord care include exposure to air, or
application of topical antiseptics, such as triple dye or topical
antibiotics such as bacitracin. The use of topical antiseptics or
antibiotics appears to reduce bacterial colonization of the cord,
although no single method of cord care has proved to be superior in
preventing colonization and disease. Keeping the cord dry promotes
earlier detachment of the umbilical stump.

II. Routine Medications

a) All newborns should receive prohylaxis against gonococcal opthalmia

neonatorum within 1 to 2 hours of birth, regardless of the mode of
delivery. Prophylaxis is administered as a single ribbon of 0.5%
erythromycin ointment or 1% tetracycline ointment bilaterally in the
conjunctival sac.
b) A single intramuscular dose of 0.5 to 1 mg vitamin K oxide
(phytonadione) should be given to all newborns before 6 hours of age
to prevent vitamin K deficiency bleeding (VKDB). Oral vitamin K
preparations are not recommended because late VKDB (2-12 weeks of
age) is best prevented by the administration of parenteral vitamin K.
c) Administration of the first dose of preservative-free hepatitis B
vaccine is recommended for all infants during the newborn
hospitalization, even if the mother is hepatitis B surface antigen
(HBsAg) negative.

 Hepatitis B vaccine is administered by 12 hours of age when

the maternal HBSAg is positive or unknown. Infants of HBsAg
positive mothers also require hepatitis B Immune globulin
(HBIG)
 The vaccine is given after parenteral consent as a single
intramuscular injection of 0.5ml of either Recombivax HB or
Energix-B.
 Parents must be given a vaccine information statement at the
time the vaccine is administered.

III. Screening
 1. Pre natal screening test results should be reviewed and documented
on the infant’s chart at the time of delivery. Maternal pre natal
screening tests typically include the following:

 Blood type, Rh, antibody screen

 Hemoglobin or Hematocrit
 Rubella Antibody
 HBsAg
 Serologic test for syphilis
 Human Immunodeficiency Virus
 Group B Streptococcus (GBS) culture
 Gonorrhea and Chlamydia cultures
 Glucose Tolerance Test
 Multiple-marker screening
 Cystic Fibrosis Carrier testing

2. Cord Blood is saved up to 14 to 21 days, depending on blood bank

policy.

 A blood type and direct Coombs should be performed on

any infant born to a mother who is Rh Negative, has a
positive antibody screen, or who has had a previous infant
with Coombs-positive hemolytic anemia.
 A blood type and DAT should be obtained on any infant if
jaundice is noted within the first 24 hours of age or there is
unexplained hyperbilirubenemia.

3. Newborn metabolic screen

The American Academy of Pediatrics (AAP) recommends

universal newborn screening for specific disorders for
which there are demonstrated benefits of early detection
and efficacious treatment of the condition being tested.

IV. Routine Assessments

a) The infant’s physician should perform a complete physical

examination within 24 hours of birth.
b) Vital signs including respiratory rate, heart rate and axillary
temperature are recorded every 8 to 12 hours.
c) Each urine and stool output is recorded in the baby’s chart. The first
urination should occur by 30 hours of age. The first passage of
meconium is expected by 48 hours of age. Delayed urination or
stooling is cause for concern and must be investigated.
 d) Daily weights are recorded in the infant’s chart. Weight loss in excess
of 8 to 10% is cause for concern and must be investigated.

V. Feedings

The frequency, duration and volume of each feed will depend on whether
the infant is breastfeeding or bottle feeding.

a) The breast-fed infant should feed as soon as possible after delivery,

preferably in the delivery room, and feed 8 to 12 times per day
during newborn hospitalization.
b) Standard 20 cal/oz, iron containing infant formula is offered to
infants for whom breastfeeding is contraindicated or at the request
of a mother who desires to bottle feed.
 Infants are fed at least every 3 to 4 hours.
 During the first few days of life, the well newborn should
consume at least 0.5 to 1 oz/feed.
 The frequency and volume of each feed is recorded in the
baby’s medical record.

References:

 Manual of Neonatal Care Lippincott 7th edition

Standards of Care in Nursery

Ms. Wella Joy G. Panopio

NICU/Nursery Staff Nurse
January 2016