Sugars, sugars, sugars everybody!
when to check sugars for 12 hours
LGA (>90th percentile)
maternal history of GDM
when to place childline
drug use during pregnancy
3 things to consider for cord management
term
tone
crying/breathing
wet/dirty diapers on day 1 of life & day 4 of life
1 wet diaper, 1 dirty diaper on day 1 of life
6 or more wet diapers on day 4 of life
fluids (type and volume) for babies who are unable to feed PO
SGA (<10th percentile)
preterm (<37 weeks)
what goes on biliboard?
babies who need PCP appointments made
weight check and bilirubin checks
when to consider CPAP (2)
labored breathing
persistent cyanosis
how long for umbilical stump to fall off
1-3 weeks
when to consider morphine for neonatal opioid withdrawal syndrome (NOWS)
yes to any 1 of eat sleep console AND non-pharmacologic care has been optimized first and non NOWS causes are ruled out
when to collect first blood sugar after birth (if needed)
4 hours
baby is intubated and needs transfer... who to call?
internal = medcall
external (Geisinger) = transfer line
will speak with NICU provider and give sign out
PEEP/PIP for >/=32 weeks
PEEP/PIP for <32 weeks
PEEP 5, PIP 25-30
PEEP 5, PIP 20-25
feeding
if breastfeeding- 15 minutes per side
fluid requirements (amounts/calculations)
what weight to use when calculating?
60-80cc/kg/day and increase by 20-30cc/kg/day until reaching 160 cc/kg/day
use BW until surpasses BW
first sugar <25... now what?
skin to skin & refeed
administer glucose gel
recheck sugar in 1 hour after feed/gel
discharge timeline for SVD babies versus c-section babies
SVD (if multip)- 24 hours
SVD (if primip) - 24-48 hours
c-section- 48 hours
when to ventilate (2)
apnea or gasping
HR < 100
normal weight loss - when does it peak and when is birth weight regained?
5-10%
Peaks at days 2-4 of life
BW regained by days 10-14 of life
sepsis workup for newborn includes...
blood cultures
antibiotics
CXR
iSTAT
placenta pathology
sugar needs to be greater than what before needing glucose gel
35
c-section prep
talk to parents about peds role during c-section feeding/meds/PCP before section
give gloves to scrub nurse
check warmer
can pre-scrub in by level 1
what to do when HR < 60
intubate or laryngeal mask
chest compressions
coordinate 3:1 with ventilation
UVC or IO
epinephrine every 3-5 minutes
what is colic and how to soothe?
colic is crying 3 hours a day, 3 days a week for over 3 weeks
5 S's = swaddle, side/stomach position, shushing (white noise), swinging (gentle rocking), sucking (pacifier)
digestive relief- bicycle kicks and gentle tummy time
antibiotics for concern for sepsis (</= 7 days of life)
gentamicin - 4mg/kg/dose every 24 hours
ampicillin - 150mg/kg/day divided into every 8 hours