P2010/0382-001 4.

3-09WACS Title: Replaces: Description: Target Audience: Key Words: Policy Supported:

Care of the Well Newborn

Neonatal Management Care of the Well Newborn Care of the well newborn following birth Midwifery and Medical Staff, Queen Victoria Maternity Unit Newborn, identification, observation, assessment
P2010/0380-001 Neonatal Resuscitation P2010/0299-003 Breastfeeding Protocol P2010/0377-001 Examination of the Newborn P2010/0306-001 Extended Midwifery Service P2010/0381-001 Universal Newborn Hepatitis B Immunisation Newborn Screening

Purpose: To ensure that the immediate care provided by the midwife to the neonate at birth facilitates adaptation to extrauterine life and to identify early problems. Procedure: Immediately following birth Ensure gloves are worn when handling baby until it is bathed. Resuscitate baby if necessary (Refer to policy "Neonatal Resuscitation") Assess the Apgar score (Refer to policy "Neonatal Resuscitation") Dry and leave baby skin-to-skin with the mother to prevent hypothermia and to promote bonding. Cover mother and baby with warm wrap or blanket. ID bands are checked with the mother, support person or midwife and secured to the baby's wrist and ankle. If the mother chooses to breastfeed, encourage and support the first feed when the baby's instincts are greatest to promote successful breastfeeding. Vitamin K 1mg/0.1ml IMI. Only give with parental consent and in accordance with General Orders. Hepatitis B vaccine 0.5mcg/0.5ml. Only give with parental consent and in accordance with General Orders. (Refer to policy "Newborn Hepatitis B Vaccine"). Identification of the Newborn All babies must be recorded under their mothers surname, B/O mothers first name, babys date of birth. Identification labels should have the above information and include the babys medical record number and mothers medical record number eg. BLOGGS B/O Jane DOB 1.1.05 BUR 123456 MUR 234567 ID bands to be checked whenever the baby is transferred or whenever mother and baby are separated.
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Newborn Observations The first set of baseline observations are performed within half an hour of birth, then hourly for four hours. Observations include: PA temperature Heart rate Respiratory rate Colour Activity Document on the Neonatal Clinical Pathway and report any abnormalities to medical officer. Refer to the guidelines on the Neonatal Clinical Pathway regarding observations of the baby and when to report an abnormality. All babies should have a newborn examination (see policy 4.9) within the first 24 hours of life and prior to discharge. It is expected that at least one of these examinations will be completed by a medical officer. When appropriate (when the neonates temperature is normal and following the first breastfeed): Conduct an initial physical examination (refer to Examination of Neonate Policy 4.9) Bare weight Measure length Measure head circumference and dress in pre-warmed clothes. Documentation Examination and observations on the Neonatal Clinical Pathway Obstetric and Neonatal Summary Sheet Personal Health Record (Blue Book). Baby Progress Notes Perinatal Data Collection Form Babies born before midday are considered day 1 Babies born after midday are considered day 0. Transferring to the Postnatal Ward Mother and baby are transferred to Ward 4O unless the mother is too unwell or if the baby has been admitted to Ward 4N. Provide parents with introduction and orientation to the unit. Check identification bands. Safety and Security of the Newborn Newborns are not to be left unattended in the ward. It is acceptable for babies to be left supervised by relatives and significant other persons at the request of the mother. Alternatively the mother should liaise with her midwife to negotiate a suitable time for her to leave the unit while the midwife supervises the baby. Newborn and maternal ID bands should be checked following any period of separation. Daily Newborn Examination A daily examination should be performed on all postnatal babies to identify actual or potential problems Arrange a convenient time with the mother (prior to a feed) Wash hands
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Ensure area is warm Observe the naked baby to determine general shape, proportions, and gross abnormalities. Check identification of baby, ensuring 2 identification tags are present. Examine fontanelles, to ensure they are not bulging or sunken. Examine eyes for discharge, opacity or abnormal colour (jaundice). Examine skin for colour, rashes, pustules, wounds, dryness and general condition Examine umbilical cord for discharge, redness, flares or offensive odour. Assess the feeding pattern to ensure sufficient intake and supply if breastfeeding Assess the elimination pattern ie. wet and dirty nappies/changing stool Document findings on neonatal clinical pathway and any variance in the babys progress notes. Refer any abnormal findings to the medical officer.

Discharge All newborns should have a discharge examination (Examination of the Newborn WACSClinProc4.9) completed and documented in their Personal Health Record. A copy of the examination is pasted into the newborns medical record. Appointments should be made for babies who require specialist follow-up. Extended midwifery follow up is available to mothers and newborns who meet the criteria for home visits (Extended Midwifery Service WACSClinProc3.4). Outpatient Breastfeeding Clinic is available for mothers and newborns within the first 2 weeks postnatal. Written referral to the Child and Family Health Nurse should be completed for all mothers and newborns. Consider telephone or fax contact with CFHN service if additional support or assistance is required. Ensure discharge medications obtained, if required. Fax discharge or transfer to DEM between 1600 and 0700.
Attachment 1 References

Performance Indicators: Evaluation of compliance with guideline to be achieved through medical record audit annually by clinical Quality improvement Midwife WACS Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years via Policy and Procedure working group coordinated by the Clinical and Quality improvement midwife. November 2009 Midwives and medical staff WACS Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Stakeholders: Developed by:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services

Date: _________________________
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ATTACHMENT 1 REFERENCES Joanna Briggs Institute 2006 Newborn: Delivery room: Immediate care Online: http://www.jbiconnect.org/connect/ebhc/embed/practice-manuals.php Joanna Briggs Institute 2006 Newborn: Delivery room: Initial care http://www.jbiconnect.org/connect/ebhc/embed/practice-manuals.php Online:

Joanna Briggs Institute 2006 Newborn: Drug administration: Hepatitis B vaccine Online: http://www.jbiconnect.org/connect/ebhc/embed/practice-manuals.php Joanna Briggs Institute 2005 Newborn: Intramuscular Vitamin K Online: http://www.jbiconnect.org/connect/ebhc/embed/practice-manuals.php Joanna Briggs Institute 2005 Newborn: Postnatal Ward: Observations Online: http://www.jbiconnect.org/connect/ebhc/embed/practice-manuals.php King Edward Memorial Hospital 2006 Immediate care of the neonate clinical guideline Online: http://www.kemh.health.wa.gov.au/development/manuals/O&G_guidelines/sectionb/1 0/b10.1.1.pdf King Edward Memorial Hospital 1999 Routine care of the neonate in the ward clinical guideline Online: http://www.kemh.health.wa.gov.au/development/manuals/O&G_guidelines/sectionb/1 0/b10.1.1.pdf

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