HIGH RISK BABY PROTOCOL
SCREENING AND EARLY IDENTIFICATION
High risk babies are any baby born with complications. These include low birth weight, HIV exposure, low APGARS, jitters, seizures, congenital abnormalities, twins, jaundice, meconium aspirate amongst others. These children are significantly more at risk of developing a disability and thus require an intensive screening programme to ensure early identification and intervention. This is our ‘High Risk Baby Clinic’. In short, the baby is referred to us after birth, and then we screen the baby at 0, 3, 6, 9 and 12 months for developmental milestones, providing education and intervention as indicated along the way. The programme entails a lot of administrative duties and has thus been laid out in a protocol. Usually we experience the highest rate of defaulters (drop outs) in the first half of the year- partially (possibly) due to our high staff turn over of community service therapists. We urge you to read this carefully and ask for help if you do not understand it.
-HRB are identified in nursery according to set criteria (see referral form)
-Build relationship with ward doctor and mother as early as possible: this is your key to early referral and compliance with follow up dates
-CRF directions must be taken early on in the ward: staple them to the referral and file it in the HRBC folder
IN NURSERY, DISCUSS THE FOLLOWING:
-what is a HRB and why f/u is important
-explain the programme to the mom, and how often she needs to follow up
-explain milestones at various ages and how to assess
-speech therapy to intervene early with sucking and stimulation (NGT, syringe feeding, sucking)
-integrate with PNC and KMC (assistants)
-positioning and early identification (as well as doctor feedback!) is essential
-access to educational material: posters and pamphlets- use them in talks
-Check whether ALL moms understand the Road to Health card- immunizations, weight plotting and interpretation
DISCHARGE:
-mom comes up to therapy WITH BABY and referral note
-log baby onto register and GIVE NUMBER
-check mom’s understanding and buy-in to the programme
-check reflexes according to guidelines, note in Road to Health card and on the referral note itself
-check whether the baby is HIV exposed, and what the mothers choice is regarding breast or formula feeding: IF YOU ARE NOT CONFIDENT IN THIS DISCUSSION, REFER TO DIETICIAN.
-Check whether CRF directions have been taken
-Work out the baby’s developmental age (not their chronological age) and choose a 3 month follow up date based on this age: explain developmental age to the mother
-Stick star on front, or write ‘HRB’ in permanent marker on front of Road to Health Card for nurses quick identification at immunization and weighing stations
-File the referral form behind the month that they are supposed to follow up and write WHERE (which clinic) they are supposed to follow up.
THE KEY TO THIS PROGRAMME WORKING IS THAT THE BABY’S HRB REGISTER NUMBER APPEARS ON THE ROAD TO HEALTH CARD.
AT CLINIC:
-at the beginning of each month, Fionna will give each clinic a list of baby’s that are supposed to follow up. It is your responsibility to take this list to the clinic nurses as well as the nompilos/weighing nurses and re-explain the programme, as well as updating the amaWanted list at the weighing station.
-If you see a HRB, check whether they are on time, whether they are up to date with milestones, check weight (regular weighing? Recorded accurately? If not- re-educate mom. If underweight, give education and refer to dietician. Feedback problem to nurses).
-Record milestones, follow up date and HRBC number in clinic book
-When you return to Therapy, copy these details into the HRB file onto the child’s referral letter.
-Re-file under next follow up month.
-Do not discharge until 12 months old. Only discharge if very well. Give mom education on further stim and milestones 1-5 years, and advice to return EARLY if concepts not well formed. Link this to school performance and EARLY INTERVENTION = BETTER OUTCOME.
-If you find a HRB with CP or similar, set aside time for formal counselling (you do not need to refer to a paediatrician if you are certain it is a CP), start educating mom early, and get her into a support group early.
PROGRAMME REVIEW:
-this is done twice yearly
-it includes defaulter rates and disability rates
-it must be discussed with ward doctors and clinic nurses, as well as therapists and assistants
-problems with programme implementation and documentation must be discussed then
Compiled By: Fionna Kossmann
Jan 2010
Review date: Jan 2011