WACHS Newborn Care Plan Newborn Care Pathway Newborn … · Skin Eyes Cord ID bands x 2 AM sign PM...

�� Hospital / Health Service

WACHS Newborn Care Pathway

Ward: �� Doctor: ��

Surname UMRN / MRN

Given Name DOB Gender

Address Post Code

Telephone

Newborn care needs assessment and planning – review each shift - when complete

Date / time

Age in hours 0 - 24 24 - 48 48 - 72 72 - 96 96 - 120 120 - 144

Weight (grams)

Routine care needs

Vitamin K IM

Vitamin K Oral

Hepatitis B

Remove cord clamp

Newborn Blood Spot Screen

Vitamin K 2nd oral

SaO2 test

BF/ day OR mls / kg / day

Output

PU x1

Mec x1

PU x 1-3

BO x 2

PU x 3-4

BO trans

PU x 3-4

BO trans

PU > 6

BO yellow

PU > 6

BO yellow

RM Check AM PM N AM PM N AM PM N AM PM N AM PM N AM PM N

Skin

Eyes

Cord

ID bands x 2

AM sign

PM sign

Nocte sign

Additional charts in use Codes for RM Check

WACHS wide standardised forms: Skin Colour N Normal P Pale Pl Plethoric

MR 176P Neonatal / Paediatric Intravenous Fluid Treatment M Mottled C Cyanotic J Jaundice

MR 144P Neonatal / Paediatric Fluid Balance Chart Skin Integrity I Intact D Dry R Rash

MR 170D National Inpatient Medication Chart (Paediatric) E Excoriated S Spots

MR 140D Newborn Observation and Response Chart Eyes C Clear D Discharge

See local MR forms for: R Red J Jaundice

Special Care Nursery Admission Sheet Cord C / D Clean & Dry C / M Clean & Moist

Neonatal Abstinence Scoring Chart R Red / Inflamed O Offensive

Other:

ID Bands x 2 C Correct & insitu R Replaced & correct

Print Name Designation Initial Print Name Designation Initial

WACHS VERSION DATED 11 MARCH 2015 on behalf of WACHS Coordinator of Midwifery

MR

75

N

EWB

OR

N C

AR

E PA

THW

AY

Maternal and infant bands match

______________ Hospital / Health Service

WACHSNewborn Care Pathway

Surname UMRN / MRN


Address Post Code

Telephone

Newborn Discharge Plan

Discharge Checklist Date / Time or Staff

Initials Comments

Advise mum - signs of unwell baby

Hearing screen completed (or follow up arranged)

Medication and instructions given(i.e. Oral Vit K, antibiotics, eye drops)

Follow-up appointments advised or booked (i.e. Paediatrician)

Weight gain achieved (or follow-up arranged)

Stork Child Health summary complete and in Purple Child Health Record book

Special Child Health Referral sent (if required)

Discharge check completed by a doctor

Stork discharge completed

SaO2 screening completed

Discharged by (print name): Sign: Date & Time:

Newborn Blood Spot Screening completed(or follow up arranged)

Confirm maternal and infant ID bands match

Confirm maternal and infant identity

SaO2 screen for critical congenital heart disease (CCHD) completed < 24 hours of age (or within 1 hour of discharge). Conduct on Right Hand (RH) and either foot. Document results below.

SaO2 ≥ 95% in RH and foot and ≤ 3% difference between RH and foot – Normal

SaO2 90 - 94% RH or foot or > 3% difference between RH and foot – Retest in 1 – 2 hours

Retest:

SaO2 < 90% in either RH and foot – immediate medical review

Date: Time:

Print Name:

Designation:

Signature:

RH Foot

RH Foot

RH Foot

RH Foot

WACHSNewborn Care Plan

Hospital / Health Service

SURNAME

GIVEN NAMES DOB

TELEPHONE

GENDER

ADDRESS POSTCODE

UMRN / MRN

Please use I.D. label or block print



SURNAME

GIVEN NAMES DOB

TELEPHONE

GENDER

ADDRESS POSTCODE

UMRN / MRN


DOCTOR:

WARD:

WMR7504/20 M

R 7

5N

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rn C

are

Plan

HC

WZZ

FMR

0075

WACHS VERSION DATED APRIL 2020

XC

3003

20

WMR75 HCWZZFMR0075.indd 8-1 6/4/20 9:45 am



Birth History

Surname UMRN / MRN


Address Post Code

Telephone

Obstetrician / GP Paediatrician Referring MO / GP / Hospital

Previous Medical History Maternal Blood Group: Previous Pregnancies

Antibodies Year

Date

VDRL / RPR

Hep B / C

HIV

OGST Pos Neg

Present Pregnancy Labour Details

LNMP EDC Spontaneous Induced Method:

Drugs Membranes Ruptured: Date: Time:

GBS Neg Pos Unknown Date: Suspected Fetal Compromise: Yes No

Celestone Date: Time: Mec Stained Liquor CTG Abnormal

IV A/B in labour Date: Time: Pyrexia in Labour Highest Temp:

USS Abn Findings: Date: Time: Temp:

Stage 1: hrs Stage 2: hrs

Length of labour: hrs

Presentation Birth Mode Analgesia / anaesthesia Placenta

Vertex Spontaneous Epidural Healthy Calcified

Breech Forceps GA Infarcted Offensive

Other Vac. Ext. Spinal Evidence of abruption

Specify: ELUSCS Opioids IMI IVI Cord vessels: 3 or 2

NELUSCS Other: Other:

Infant birth details Resuscitation required: Yes No

Date of Birth (DOB) 2 At: hrs Suction Drugs:

Gender Male Female Oxygen Dose:

Birth weight grams From: To: min

Length cm Intubation From: To: min

Head Circumference cm ECC From: To: min

Gestation weeks Other Specify:

Condition at birth Cord blood analysis: Yes No

APGAR Score 1 min 5 min 10 min Time cord clamped: Time sample collected:

Colour Time sample processed: Reason no sample:

Respiration Arterial Venous

Reflex Irritability pH

Muscle Tone PCO2

Heart Rate PO2

Total HCO3

First breath @ mins BE / BD

Resps established mins Lactate

SIGNATURE ID Bands x 2 confirmed with mother / applied

Print Name:

Sign: __________________________ Date: ________________Designation:

min

min

min

Bag & Mask / Neopuff



SURNAME

GIVEN NAMES DOB

TELEPHONE

GENDER

ADDRESS POSTCODE

UMRN / MRN




SURNAME

GIVEN NAMES DOB

TELEPHONE

GENDER

ADDRESS POSTCODE

UMRN / MRN


Birth History

TREATMENT THRESHOLD FOR JAUNDICE AT 35 WEEKS OR MORE GESTATION(plot each SBR result below)

Bili

rubi

n (µ

mol

/L)

450

400

350

300

250

200

150

100

50

0

Postnatal Age (hours)

Wei

ght )

kg)

NEONATAL WEIGHT CHART5

4.84.64.44.24

3.83.63.43.23

2.82.62.42.22

Birth 24–48 48–72 72–96 96–120 120–144

Hours

0 12 24 36 48 60 72 84 96 108 120 132 144 156 168

Infants at lower risk (> 38 wks and well) Infants at medium risk (> 38 wks and risk factors 35–37 6/7 wks and well) Infants at higher risk (35–37 6/7 wks and risk factors)

• It is an option to provide conventional phototherapy in hospital or at home at TSB levels 35–50 µmol/L below those shown, but home phototherapy should not be used in any infant with risk factors.

• Use total bilirubin. Do not subtract direct reacting or conjugated bilirubin.• Risk factors = isoimmune hemolytic disease, G6PD deficiency, asphyxia,

respiratory distress, significant lethargy, temperature instability, sepsis, acidosis.• For well infants 35–37 6/7 wks can adjust TSB threshold around the medium

risk line; lower levels for infants closer to 35 ks gestations and higher levels for infants closer to 37 6/7 wks.




Birth History

Surname UMRN / MRN


Address Post Code

Telephone

General Appearance Tick Normal At birth comments Tick

Normal Before discharge comments

HeadHair colour / coverage

Skin Eyes

Mouth

NoseEars

Respiratory Cardiovascular

AbdomenUmbilicus

Genitalia

AnusMusculoskeletal

HipsNeurological reflexes

Distinguishing features:Please list for identity purposes

Assessed at birth Assessed before dischargeName: Name:Designation: Designation:

Signature: �� Signature: ��

Date: Time: Date: Time:

Treatment Plan / Investigations

Requires admission to SCN: Yes No Provisional Diagnosis:

SIGNATURE

Print Name:

Sign: �� Date: ��Designation:



Surname UMRN / MRN


Address Post Code

Telephone

Newborn feeding chart

Feeding Code Bowel & Urine Codes1 Offered but doesn’t attach. Not interested M Meconium ┼ Slightly damp

2 Interested but doesn’t attach B Brown ┼ ┼ Wet

3 Attaches on and off G Green ┼ ┼ ┼ Saturated

4 Attaches but has uncoordinated suck Y Yellow

5 Good rhythmical sucking- short feed as determined by mother TCB transcutaneous bilirubin SaO2 O2 saturation

6 Good rhythmic sucking- long feed as determined by mother TSB total serum bilirubin PGL plasma glucoseDate / Age

TimeOffer /

Feed TypeCode mls Vomit Bowel

Colour Urine Comments Other i.e TCB

BFvariance # Signature

C



SURNAME

GIVEN NAMES DOB

TELEPHONE

GENDER

ADDRESS POSTCODE

UMRN / MRN




SURNAME

GIVEN NAMES DOB

TELEPHONE

GENDER

ADDRESS POSTCODE

UMRN / MRN


Birth History




Post Birth Care

Surname UMRN / MRN


Address Post Code

Telephone

Routine post birth observations for all newborns (well newborns not at risk, record observations below)

Date & Time

Temp(36.5 – 37.4)

ApexHeart Rate(110 – 160)

Respiratory Rate

(30 – 60)

Respiratorypattern / sounds

SaO2 Tone CommentColour

Record all observations for newborns identified at risk as below (including birth obs) on the NORC MR 140D.

Skin to skin at birth and until first feed (offer to all mothers)

Time Commenced: Reason for delay / interruption:

Time of first feed: Time of delay / interruption:

Neonatal feeding chart

Feeding Code Bowel & Urine Codes1 Offered but doesn’t attach. Not interested M Meconium Slightly damp






TimeOffer /

Feed TypeCodemls Vomit Bowel

Colour Urine Comments Otheri.e TCB

BF variance # Signature

C

For first hour perform 15/60 respiratory rate and sounds, colour and tone. Within first hour once: heart rate and temperature. If normal repeat all observations hourly twice or until 3 consecutive sets are normal. Noting SaO2 continuous monitoring for 2 hours.

WMR75_link_03-15.pdf 1 22/03/16 3:06 PM

Post birth observations outside the normal range: discuss with doctor / Paediatrician

Meconium liquor: 2-3 hourly before feeds for 12 hours

Neonate of diabetic / Gestational diabetes mellitus (GDM) mother > 37 weeks: 3 hourly for 24 hours and until 2 x PGL > 2.6

Operative Vaginal Birth: Level 1, 2 or 3 surveillances as per WACHS policy

Vigorous at birth with abnormal cord blood values: with feeds for 24 hours

2000 - 2500gms or 35 – 37 weeks: 3-4 hourly for 24 hours and then temp with feeds until 48 hrs

At risk of sepsis: refer to sepsis calculator, document EOS score and indicate management category in EOS section below.

APGAR <7 @ 5 or non-vigorous with abnormal cord blood values and/or any resus at birth -

to be admitted to Special Care Nursery (SCN) and discuss observation frequency with doctor / Paediatrician

Neonate <35 weeks consult with Paediatrician / Medical Officer



Surname UMRN / MRN


Address Post Code

Telephone

Newborn feeding chart

Feeding Code Bowel & Urine Codes1 Offered but doesn’t attach. Not interested M Meconium ┼ Slightly damp






TimeOffer /

Feed TypeCode mls Vomit Bowel

Colour Urine Comments Otheri.e TCB

BFvariance # Signature

C

EARLY ONSET SEPSIS SCORE (EOS) (ALL NEWBORNS ≥ 35 WEEKS)

Date / Time: ��

EOS Score: ��

Refer to the KEMH Policy / Guidelinesfor guidance on sepsis scoring and management plan

MANAGEMENT CATEGORY (tick applicable)

SCORE GREEN YELLOW RED

WELL

EQUIVOCAL

CLINICAL ILLNESS

Skin to skin at birth and until first feed (offer to all mothers)

Time Commenced: Reason for delay / interruption:

Time of first feed: Time of delay / interruption:



SURNAME

GIVEN NAMES DOB

TELEPHONE

GENDER

ADDRESS POSTCODE

UMRN / MRN




SURNAME

GIVEN NAMES DOB

TELEPHONE

GENDER

ADDRESS POSTCODE

UMRN / MRN


Post Birth Care


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WACHS Newborn Care Plan Newborn Care Pathway Newborn … · Skin Eyes Cord ID bands x 2 AM sign PM...

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