Newborn Nursery Rotation

Quick Links:

• Kaiser Sepsis Calculator - We typically use the CDC incidence for the "Incidence of Early-Onset Sepsis" Portion

• BiliTool - updated with 2022 Bili Guidelines

• PediTool - growth charts and other tools for pediatrics, updated with 2022 Bili Guidelines

• NEWT - Newborn Weight Loss Tool to objectively calculate weight loss as compared to a sample of 160,000 >36GA newborns

• Mayo Clinic Peds Lab Values - Also refer to Harriet Lane

• VisualDx - Great for Dermatology and other visual findings

• Up To date - all the things

• Newborn Nursery Templates - To help with Rounding

• Dr. Simangan's Epic Epic Nursery tips - EPIC and General Nursery Tips (likely outdated)

• Gomella Neonatology -a Neonatal Handbooks (has a great section for "On Call Problems")

• AAP Textbook of Pediatric Care - Part 4 - Sections include: Routine Care Issues, Assessment & PE of the Newborn, Neonatal Medical Conditions.

• Draeger Bilimeter Manual

  • Article Cited from Pediatrics (includes TCB nomograms) - Infants who require closer evaluation and observation initially are those whose bilirubin levels are ≥95th percentile, ie, increasing more rapidly than 0.22 mg/dL per hour in the first 24 hours, 0.15 mg/dL per hour between 24 and 48 hours, and 0.06 mg/dL per hour after 48 hours.

• UNLV Medicine Patient Forms - Forms for future patients of UNLV Pediatrics

Excerpt from the Updated 2022 Bili Guidelines

• KAS 6: TSB should be measured if the TcB exceeds or is within 3 mg/dL of the phototherapy treatment threshold or if the TcB is ≥15 mg/dL. (Aggregate Evidence Quality Grade C, Recommendation)

• KAS 7: If more than 1 TcB or TSB measure is available, the rate of increase may be used to identify infants at higher risk of subsequent hyperbilirubinemia.^70–72 A rapid rate of increase (≥0.3 mg/dL per hour in the first 24 hours or ≥0.2 mg/dL per hour thereafter) is exceptional⁷³ and suggests hemolysis. In this case, perform a DAT if not previously done. (Aggregate Evidence Quality Grade D, Option)

Quick Definitions:

• Term Terms

  • Extremely preterm (<28 weeks)

  • Very preterm (28–<32 weeks)

  • Moderate or late preterm (32–<37 completed weeks of gestation)

  • Early term: 37 0/7 weeks through 38 6/7 weeks

  • Full term: 39 0/7 weeks through 40 6/7 weeks

  • Late term: 41 0/7 weeks through 41 6/7 weeks

  • Post term: 42 0/7 weeks and beyond

• Weight

  • Low Birth Weight (Any baby less than 2500g, regardless of gestational age)

    • Very Low Birth Weight <1500g

    • Extremely Low Birth Weight <1000g

  • Appropriate for gestational age (AGA): the baby's weight is appropriate for the gestational age (weight between 10th and 90th percentile)

  • Small for gestational age (SGA): a baby's weight is less than expected for the gestational age (weight less than 10th percentile)

  • Large for gestational age (LGA): a baby's weight is more than expected for the gestational age (weight more than the 90th percentile)

  • TIP: The CDC recommends that health care providers:

    • Use the WHO growth charts to monitor growth for infants and children ages 0 to 2 years of age in the U.S.

    • Use the CDC growth charts to monitor growth for children age 2 years and older in the U.S.

  • TIP: We require a Car Seat Challenge for any baby born below 2500g and/or under 37 wk GA

• Head Size

  • TIP: always re-measure any concerning head circumference (and have the nurse input your value to the chart) (measuring tape available by the NICU Clerk), and plot your result in PediTool

  • Microcephaly (definition is not quite universal) accepted limits include:

    • OFC more than 2 SD below the mean (<3rd percentile)

    • Borderline microcephaly: Occipitofrontal circumference (OFC) between 2 and 3 standard deviations (SD) below the mean for age, sex, and gestation

    • Moderate microcephaly: OFC between 3 and 5 SD below the mean for age, sex, and gestation

    • Severe microcephaly: OFC ≥5 SD below the mean for age, sex, and gestation

    • Macrocephaly: >97th percentile for age

• Labor

  • TIP: On EPIC's Grease Board there is a tab for the Cervical Exam displayed as three numbers like this #/##/#, which represent Dilation/Effacement/Fetal Station

  • Effacement: As the fetal head drops down into the pelvis, it pushes against the cervix which causes it to relax and thin out. Effacement is described as a percentage from 0% to 100%

  • Dilation: After the cervix begins to efface, it will also start to open. Cervical dilatation is described in centimeters from 0 to 10. At 0, the cervix is closed. At 10, it's completely dilated.

  • Fetal Station: The fetal station is a measurement of how far the baby has descended in the pelvis, measured by the relationship of the fetal head to the ischial spines

    • -5 station is a floating baby

    • -3 station is when the head is above the pelvis

    • 0 station is when the head is at the bottom of the pelvis, also known as being fully engaged

    • +3 station is within the birth canal

    • +5 station is crowning

• Chorioamnionitis: (intraamniotic infection)

  • Maternal Intrapartum temperature is 38.0-38.9 C AND one of the following:

    • Maternal Leukocytosis

    • Purulent Cervical Drainage

    • Fetal Tachycardia

  • An isolated maternal temp of 38-38.9 without apparent cause is not considered to be an intraamniotic infection.

• I:T Ratio

  • (promyelocytes, myelocytes, metamyelocytes and bands) / (promyelocytes, myelocytes, metamyelocytes and bands + neutrophils)

  • concerning if > 0.20