neonatal intensive care unit protocols

5) Attempt to flush line with normal saline using a 10 mL syringe. Advances in Intensive Care *NMR=neonatal mortality rate: # deaths to infants <28 days/1,000 live births 4.62 4.54 4.67 4.63 4.52 4.54 4.46 4.42 4.29 4.18 O2 % on RIGHT Hand Neonatal Intensive Care Unit (NICU) Protocol Pulse oximetry screening for Critical Congenital Heart Disease (CCHD) Perform on all infants once stable on Room Air for 24 hours In addition, we hope to gain the additional benefit of decreasing the severity of PDA effects by adopting some of the most successful prophylactic Indocin protocols. /Height 155 > 7 days of nasal CPAP or nasal cannula oxygen, c. any infant going home on medications for “chronic lung disease”, d. any infant with confirmed or highly suspicious sepsis (i.e., NEC), f. any infant born with congenital viral infections, g. any infant who is both SGA and < 37 weeks EGA, h. any infant requiring > 2 transfusions for anemia (hemolytic or non-hemolytic). Guidelines for the Use of Alteplase (Cathflo Activase®) for the, Declotting of Central Lines or to Clear Persistent Central Line. Neonatal intensive care unit protocols pdf 2018 - 2019 RESIDENT REFERENCE NICU STUDIES, PROTOCOLS, AND PROCEDURESThe purpose of this document is to serve as a guide for residents of clinical protocols and procedures in the NICU. /Subtype /Image Neurology. Infants scheduled for hospital discharge should have their CUS performed as an inpatient prior to discharge assuming adequate time from the previous CUS has elapsed (recommended minimum is 3 weeks). Will need to follow serum Na+ levels and may need to consider intravenous or enteral sodium replacement with long-term reservoir tap. PDA ligation in our practice is less than 50% of that seen in the VON database. ~��-����J�Eu�*=�Q6�(�2�]ҜSz�����K��u7�z�L#f+��y�W$ �F����a���X6�ٸ�7~ˏ 4��F�k�o��M��W���(ů_?�)w�_�>�U�z�j���J�^�6��k2�R[�rX�T �%u�4r�����m��8���6^��1�����*�}���\����ź㏽�x��_E��E�������O�jN�����X�����{KCR �o4g�Z�}���WZ����p@��~��T�T�%}��P6^q��]���g�,��#�Yq|y�"4";4"'4"�g���X������k��h�����l_�l�n�T ��5�����]Qۼ7�9�`o���S_I}9㑈�+"��""cyĩЈ,��e�yl������)�d��Ta���^���{�z�ℤ �=bU��驾Ҹ��vKZߛ�X�=�JR��2Y~|y��#�K���]S�پ���à�f��*m��6�?0:b��LV�T �w�,J�������]'Z�N�v��GR�'u���a��O.�'uIX���W�R��;�?�6��%�v�]�g��������9��� �,(aC�Wn���>:ud*ST�Yj�3��ԟ��� %PDF-1.4 The Guidelines are applicable to Level 2 and Level 3 neonatal care. You must avoid giving any volume that may enter the patient. Suggested criteria for 31-37 week gestational age premature infants who may benefit from ROP screening: a. /CA 1.0 Finally, once catheter is patent (you have successfully withdrawn 0.5-1 mL of blood), discard withdrawn blood sample (DO NOT INFUSE DRUG INTO PATIENT) and Thus, our protocol will try to take advantage of, 1. >> Patients with known persistent catheter-related bacteremia unless approved by Pediatric ID. after birth in a health care facility. >> << • Infections occurring on the day of birth/admission or the day after are not health care-associated infections. � �l%��Ž��� �W��H* �=BR d�J:::�� �$ @H* �,�T Y � �@R d�� �I �� • Infections occurring on the day of birth/admission or the day after are not health care-associated infections. Routine cranial ultrasounds should be scheduled for Monday, Wednesday, or Friday. 6. with bedside nurse and plan to do the puncture when the patient is not under stress. Level 2 and Level 3 neonatal care refer to neonates requiring special and intensive care respectively. Prep skin with betadine swabs and let sit for 3-5 minutes. Clinical or X-ray evidence of NEC or perforation, 5. /AIS false 93: 543-550, 1994 and the Cochrane Collaborative Database (, Consider the risk / benefit ration of initiating or continuing Indocin therapy in ALL PATIENTS. Other retrospective studies have raised cautionary flags about this regimen as there has been no improvement in long-term neurodevelopmental outcomes in. /Producer (�� Q t 4 . 3 0 obj is required for all parents and health care personnel entering the NICU. The definitions for Level 1, Send CSF sample in three separate tubes for glucose, protein, cell counts and culture at least every other day, and as directed by the Neonatologist. Neonatal Intensive Care Units (NICU). 4. The Newborn Intensive Care Unit (NICU) has 46 cots, comprising 16 Level 3 (intensive care) spaces and 30 Level 2 spaces. An ECHO, Reference: Ment, et al. HAI in newborns is an infection of the newborn that occurs after birth in a health care facility. Level 2 and Level 3 neonatal care refer to neonates requiring special and intensive care respectively. > 3 days on the ventilator with a significant oxygen requirement, b. Patients with known hypersensitivity to Alteplase or any component of the formulation, Patients with known increased risk of bleeding. Cochrane Collaborative meta-analysis of well designed clinical trials using prophylactic Indomethacin therapy to prevent severe IVH demonstrates that prophylactically administered Indomethacin begun before 12 hours of age in preterm infants, (generally < 1500 gms birthweight) decreases the incidence of severe IVH in this population. Our practice has had a lower incidence of severe IVH versus the Vermont-Oxford database for several years using prophylactic Indocin therapy in infants < 28 weeks gestational age (~ 10% versus 15%). 1 2 . 8) Place label or sign on catheter to alert others to the presence of an Alteplase-filled catheter. /Type /ExtGState 6 0 obj If the initial CUS demonstrates a Grade I, II, III, or IV hemorrhage, follow up CUS exams may be every 1-2 weeks until the lesion is stable or intervention is required. Level 1 neonatal care which is defined as normal general neonatal care, is excluded from these guidelines. /Filter /FlateDecode bacteremia. endobj Neonatal patients in ED, PICU and Paediatric Wards at JHCH, and at home on Home Midwifery Service (HMS) Referral to Allied Health in NICU Short Term Escalation Plans (STEPs) for Neonatal Patient Flow Transfer Of Care from Neonatal Intensive Care (NICU) Section 03 - General Care Level 1 neonatal care which is defined as normal general neonatal care, is excluded from these guidelines. flush catheter with 0.3 mL of saline followed with an equal amount of heparin solution. Check patient’s activity, need for suctioning, feeds, etc. endobj DO NOT INFUSE DRUG INTO Remove the needle and apply pressure with a sterile 2X2 gauze for 1 min. /Type /XObject 9) After 30-60 minutes of dwell time, assess catheter function by attempting to aspirate blood (0.5–1 mL for infants < 10 kg). 7. They may not reflect our current practice, they may be in the process of being updated and they may contain errors or practices that are not consistent with practices elsewhere. 1. Many physical and emotional changes occur for mother and baby. 3. << Ment, LR, et. Attach a 25 gauge Butterfly needle to a 5 cc or 10 cc syringe. The Newborn Intensive Care Unit (NICU) has 46 cots, comprising 16 Level 3 (intensive care) spaces and 30 Level 2 spaces. endobj If resistance is encountered, do not Alteplase should also be used with caution in, Patients with known active internal bleeding, Patients who have had surgery within the preceeding 48 hours, Alteplase medication (1 mg/mL) in 10 mL syringe drawn up and reconstituted by Pharmacy, Sign or label indication “Do Not Use Catheter – contains Alteplase”. • Timeframes between 72 hours and 7 days are often used. /ColorSpace /DeviceRGB 7) • Timeframes between 72 hours and 7 days are often used. after birth in a health care facility. Blood Transfusion Protocol and Guidelines, Protocol for Genetic Postmortem Evaluation (Greenwood Genetics Center), Steroid Therapy for Vocal Cord Edema and Bronchopulmonary Dysplasia in the NICU, Rickets of Prematurity (Alkaline Phosphatase) Monitoring Protocol, Prophylactic Indomethacin to Prevent IVH in Infants < 28 weeks gestational age, Immunization Recommendations for the NICU. Handwashing 7) Install Alteplase into catheter (NOT INTO THE PATIENT). stream The birth of a baby is a wonderful yet very complex process. Insert the needle into the reservoir. American Academy of Pediatric Recommendations for Management of Infants Born to Mothers with Suspected or Presumed Group B Streptococcal Infections. Typically, these exams are reserved for infants with severe pneumothorax, shock, asphyxia, meningitis, seizures, etc. Level 2 spaces are divided into 20 High-Dependency Level 2 spaces and 10 Low-Dependency (Parent-Infant Nursery, or PIN) spaces. 18. /BitsPerComponent 8 10) If unable to aspirate, allow drug to dwell for another 30-60 minutes of time, then reassess catheter patency. Consider targeted decolonization for S. aureus-colonized neonatal intensive care unit patients in addition to the implementation of, and adherence to, appropriate infection prevention and control measures in an outbreak setting, or when there is ongoing healthcare-associated transmission, or an increase in the incidence of infection. HAI in newborns is an infection of the newborn that occurs after birth in a health care facility.