PLACE LABEL HERE
NEWBORN ADMISSION
TERM (> 37 WEEKS)
STANDING ORDERS
Nurse initiated protocol based on medical staff approved criteria and policy # 7000-09
(birth of a newborn with an estimated gestational age of 37 weeks or greater).
Orders with a “” are indicator choices and are NOT implemented unless checked.
Diagnosis: Live born infant  Singleton  Twin  Triplet  ____________
Delivery:  Vaginal  Cesarean  Born outside of hospital
2. Newborn hearing screen prior to discharge
3. Point-of-care blood glucose if symptomatic
4. Metabolic screen at 24 hrs of age or greater
5. Notify Physician/APRN for positive DAT only if cord bilirubin is ≥ 4
6. Vital signs at 30 minutes of age, then q 30 minutes until temp stable for 2 hrs, then q 12 hrs and prn.
Physician/APRN if grunting, retracting, HR < 80, HR >180, T > 100.4°F (38°C) or T < 97oF (36o C) , or
SpO2 < 95%.
If RR > 60 and no other respiratory distress, then re-assess RR in 30 min & notify provider if RR > 60.
7. Ballard exam if:
 Infant of diabetic mother
 No prenatal care
 EGA > 42 weeks
 Birth weight < 2,500 gm
 Birth weight > 4,000 gm
8. For central cyanosis provide free-flow 100% O2 , place on pulse oximetry, and notify physician/APRN
9. CCHD screen
10. Initiate Newborn Jaundice Assessment (form # 18642)
11. Diet: term infant formula, if not breastfeeding. Hold feeding if respiratory rate ≥ 70 or any respiratory distress
1.
Admit as Inpatient.
MEDICATIONS:
12. AquaMephyton (phytonadione) 1 mg IM x 1 dose
13. Erythromycin ointment to each eye x 1 dose
14. Hepatitis B vaccine 0.5 ml IM x 1 dose per parent’s request (form # 18777)
15. Emollient ointment applied topically q 12 hrs prn for dry skin
16. Sucrose 24% oral solution 1-2 ml orally x 1 dose just prior to painful procedures
17. Tylenol (acetaminophen) 10 mg/kg po x 1 dose following surgical procedures
________ ________ _________________________
Date
Time
Nurse Signature
_____________________
Physician Signature
___________
PID Number
Copy to pharmacy
*1-1294*
FORM 1-1294 REV. 12/2015
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