PLACE LABEL HERE

NEWBORN ADMISSION

TERM ( 37 weeks)

STANDING ORDERS

Standing order based on medical staff approved criteria and policy # 7000-09

(birth of a newborn with an estimated gestational age of 37 weeks or greater).

1.Admit as Inpatient.Diagnosis: Live born infant  Singleton  Twin  Triplet  ______

Delivery:  Vaginal  Cesarean  Born outside of hospital

2.Point-of-care blood glucose if symptomatic.

3.Vital signs at 30 min of age, then q 30 min 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), RR60, or T < 97oF (36oC), or

SpO2 < 95%.

4.Ballard exam if: Infant of diabetic mother, no prenatal care, EGA > 42 weeks, birth weight < 2,500 gm OR > 4,000 gm

5.For central cyanosis provide free-flow 100% O2,place on pulse oximetry, and notify physician/APRN

6.Evaluate baby for risk criteria for sepsis per hospital policy (#7006-08) and if criteria are met, notify physician/APRN to initiate Neonatal Sepsis Evaluation Orders (#32740)

7.Notify Physician/APRN to initiate Newborn Jaundice Protocol Orders (#42889) for:

  • An infant that appears jaundiced at <12 hrs of life
  • An infant that appears jaundiced between 12 and 24 hrs
  • Cord bilirubin is ≥ 4 mg/dL
  • Maternal blood type O and baby is A, B, or AB
  • Maternal history of anti C or anti E antibodies
  • Rh negative mother and Rh positive infant AND did not receive Rhogam
  • Rh negative mother and Rh positive infant AND it is unknown if mother received Rhogam
  • Family history of hemolysis (G6PD deficiency, spherocytosis)

8.Diet:

  • Breastfeed on demand
  • If maternal preference is to formula feed, provide term formula
  • Notify physician/APRN if a medical indication for supplementation is present to initiate Supplementing a Breastfeeding Infant Orders (#39670)
  • Hold feeding if respiratory rate> 60 or any respiratory distress

9.Transcutaneous bilirubin (TcB) measurement at 24 hrs of life, if result is 8 mg/dL, obtaina serum T&D bilirubin. If serum total bilirubin is 8 mg/dL call the providerto initiate Newborn Jaundice Protocol Orders (#42889).

10.State newborn screen after 24 hrs of life

11.CCHD screen after 24 hrs of life

12.Newborn hearing screen prior to discharge

13.Obtain an additional TcB within 4 hrs of discharge (unless baby has been on phototherapy)

MEDICATIONS:

14.AquaMephyton (phytonadione) 1 mg IM x 1 dose

15.Erythromycin ointment to each eye x 1 dose

16.Hepatitis B vaccine 0.5 ml IM x 1 dose per parent’s request (#18777)

17.Emollient ointment applied topically q 12 hrs prn for dry skin

18.Sucrose 24% oral solution 1-2 ml orally x 1 dose just prior to painful procedures

19.Tylenol (acetaminophen) 10 mg/kg po x 1 dose following surgical procedures

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Date TimeNurse SignaturePhysician Signature PID Number

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