1. Admit Inpatient to Central Nursery.
2. Obtain vital signs per standards.
3. CBG screen (using Lifescan One-Touch meter in neonatal mode)
• For infants less than 2500 GM or more than 4500 GM obtain CBG at 2 hours of age and ac at 4-6 hours of age.
• For infants of IDDM or GDM, obtain CBG at 1 hr, 2 hrs and ac at 4-6 hrs of age
• per MD orders or nurses’ discretion for vital sign instability.
• If CBG < 25 obtain stat serum glucose and notify MD and Neonatologist of serum result
• Place infants with low glucose ≥ 25 skin to skin with mother to feed
• If CBG is ≥ 25 but < 45, breastfeed for 15’ or longer if unable to breastfeed, feed 15-30 ml colostrum or 15-30 ml formula
• Obtain serum glucose 1 hour after feeding. If serum glucose < 40 but ≥ 25 re-feed as above a second time and
recheck serum glucose in 1 hour. If serum glucose < 40 notify MD.
• For infants with low CBG requiring intervention continue to feed q 3 hours and check q ac CBG until CBG > 45 x 2
or serum glucose > 40.
Notify MD for all CBG less than 45
*Hold bath until CBG is ≥ 45. May take baby to Mom’s room prior to bath for feeding.
4.
Breast - To breast ASAP and then on demand, no supplement
When mom unable/unwilling to feed, nipple feed breast milk (if available) or formula.
Do not cup feed.
Bottle - 20 calorie formula with iron q 3-4 hours or on demand:
Enfamil
Similac
Rotating
Mom’s choice if requested or per WIC Nutrition Program
For infants less than 6 lbs or less than 36 weeks gestation.
Enfacare
Neosure
Rotating
• For babies with respirations greater than 59, follow the clinical guidelines.
5. Erythromycin in both eyes within 1 hr after birth
6. Vitamin K 1 mg IM within 6 hrs of birth.
7. Triple Dye to umbilical cord at first bath and then alcohol every day.
8. Type and Rh on cord blood if Mom’s type: Mom’s Blood Type ____________
a. Rh negative and if baby is Rh positive, obtain Direct Coombs.
b. Type O and if baby is A, B, or AB, obtain Direct Coombs.
9. Draw Newborn Screen test before discharge; send to State Lab.
10. NB Hearing Screen in each ear. If infant does not pass two events, refer for diagnostic testing. Report results in
accordance with State requirement.
11. Central Nursery Standing Medical Orders including these orders as infant meets criteria.
a. Hepatitis B vaccination based on the mother’s HBsAG status:
NEGATIVE: With parent’s consent, give Hepatitis B vaccine
POSITIVE: Transcribe orders on separate MD order sheet.
PENDING: Obtain HBsAG results within 12 hrs: proceed as above.
b. Send Drug screen according to policy. Send both urine and meconium
c. Order social work consult on babies who have drug screens sent.
d. HIV Medication (Zidovudine Syrup):Initiate specific HIV order sheet.
e. Use standing orders for assessing jaundice.
Notify MD when serum bilirubin has been obtained and results are available.
Notify MD of serum bilirubin results at AM rounds.
12. For baby boys, Acetaminophen 40 mg PO at time of circumcision. May repeat times 1 after 4 hours.
13. MD will be notified of birth as soon as RN is aware of delivery and before the baby is 2 hrs old, between the hours of
0800 & 2000 . If infant is having a problem, the RN will notify the MD immediately.
14. For infants born overnight notify the MD: MD will call nursery in am
Between 6:00-6:30 AM
Verbal/telephone orders read back and verified.
________________________ __________________________________
_____________________________________
Nursing Secretary
RN
MD Signature
Date
24 Hour Chart Check ___________
Signature indicates both newborn Orders
and Central Nursery Standing Orders
MR12609-50-(3/2008)
White – CHART
Yellow – PHARMACY