MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST
Immediate Care of the Newborn
Requested/
Required by: Women’s and Children’s Directorate
Main author: Midwife (TC)
Other contributors: Consultant Paediatrician (RG)
CNST Maternity Co-Ordinator (AC)
Document lead: CNST Maternity Co-Ordinator (AC)
Contact Details: ext 33514
Supersedes: Immediate Care of the Newborn (Version 2.0: November 2009)
Approved by: Clinical Risk Management Group Date: 6th October 2011
Ratified by: Clinical Risk Management Group Date: 6th October 2011
Review date: October 2014
Disclaimer:Printed copies of this document may not be the most recent version.
The master copy is held on Q-Pulse Document Management System
This copy – REV3.0
Document History
Requirementfor document: / · CNST Maternity Standards 2011/12; Standard 5, Criterion 4
Cross References /
Associated Documents / Cross References
Maidstone & Tunbridge Wells NHS Trust Maternity. (2011).
Admission to the Neonatal Unit Trust Intranet, Datix Guidelines system: A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Maternity. (2011).
Antenatal Clinical Risk Assessment. Trust Intranet, Datix Guidelines system: A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Maternity. (2011).
Auscultation and Electronic Fetal Monitoring. Trust Intranet, Datix Guidelines system: A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Maternity. (2011).
Care of Women in Labour including Clinical Risk Assessment in Labour Trust Intranet, Datix Guidelines system:
A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Maternity. (2011). Diabetes in Pregnancy. Trust Intranet, Datix Guidelines system: A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Paediatrics. (2009). Feeding and nutritional supplementation on the neonatal unit. Trust Intranet, Datix Guidelines system: A Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Maternity. (2008). Guideline for Management of Haemolytic Group B Streptococcus during Pregnancy and Labour. Trust Intranet, Datix Guidelines system: A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Maternity. (2011).
Handover of Care (Onsite). Trust Intranet, Datix Guidelines system:
A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Maternity. (2011).
Neonatal Resuscitation. Trust Intranet, Datix Guidelines system:
A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Paediatrics. (2009). Neonatal Drug Withdrawal. Trust Intranet, Datix Guidelines system: A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Paediatrics. (2009).
Neonatal prophylactic vitamin K (Term babies). Trust Intranet, Datix Guidelines system: A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Maternity. (2011).
Newborn Feeding. Trust Intranet, Datix Guidelines system:
A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Maternity. (2009).
Newborn Security. Trust Intranet, Datix Guidelines system:
A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Maternity. (2011). Postnatal Information and Care Planning Guideline Trust Intranet, Datix Guidelines system: A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Paediatrics. (2008). Prevention and treatment of group B streptococcal (GBS) infection.
Trust Intranet, Datix Guidelines system: A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Maternity. (2011). Record Keeping and the Management of Maternity Records. Trust Intranet, Datix Guidelines system: A – Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust. (2011). Maternity Training Strategy & Training Needs Analysis Matrix. Trust Intranet, Datix Guideline System. A – Clinical Policies & Guidelines. Maternity.
Maidstone & Tunbridge Wells NHS Trust Paediatrics. (2008).
The identification and treatment of neonatal hypoglycaemia.
Trust Intranet, Datix Guidelines system: A Clinical Policies & Guidelines
Maidstone & Tunbridge Wells NHS Trust Paediatrics. (2008). The prevention of meconium aspiration syndrome. Trust Intranet, Datix Guidelines system: A Clinical Policies & Guidelines
Associated Documents:
Advisory Council on the Misuse of Drugs. (2003). Hidden Harm. Available at: www.drugs.homeoffice.gov.uk
Department of Health. (2004). Maternity Standard, National Service Framework for Children, Young People and Maternity Services. London: COI. Available at: www.dh.gov.uk
Enkin M, Marc j, Kierse C, Neilson J, Crowther C, Duley L, Hodnett E, Hofmeyr J. (2000). A guide to effective care in pregnancy and childbirth 3rd Edn. Oxford: Oxford University Press
Gregson S and Blacker J (2011) Kangaroo care in pre-term or low weight babies in a postnatal ward. British Journal of Midwifery: 19; 9, 568-577
Johanson R, Cox C, Grady K and Howell C. (2003). Managing obstetric emergencies and trauma. The MOET Course Manual. London: RCOG Press
National Institute for Health and Clinical Excellence. (2008). Diabetes in pregnancy: Management of diabetes and its complications from pre-conception to the postnatal period. London: NICE. Available at: www.nice.org.uk
National Institute for Health and Clinical Excellence. (2007). Intrapartum care: Care of healthy women and their babies during childbirth. London: NICE. Available at: www.nice.org.uk
National Institute for Health and Clinical Excellence. (2010). Pregnancy and Complex Social Factors: A model for service provision for pregnant women with complex social factors. London: NICE. Available at: www.nice.org.uk
Rossi EM, Philipson FH, Williams TG et al. Meconium aspiration syndrome: interpretation and neonatal attributes. (1989). Amer J Obstetric Gynaecology; 161: 1106-1110
Royal College of Obstetricians and Gynaecologists. (2003). Prevention of Early Onset Neonatal Group B Streptococcal Disease. London: RCOG. Available at: www.rcog.org.uk
Royal College of Anaesthetists, Royal College of Midwives, Royal College of Obstetricians and Gynaecologists, Royal College of Paediatrics and Child Health. (2007). Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour. London: RCOG Press. Available at: www.rcog.org.uk
Stables D and Rankin J. (2005). Physiology in Childbearing with Anatomy and Related Biosciences. London: Elsevier Limited
UNICEF UK. Baby Friendly Initiative UK. (1995). UNICEF
UNICEF UK. Baby Friendly Initiative in the Community. (1997). UNICEF
UNICEF UK. Baby Friendly Initiative, Towards National, Regional and Local Strategies for Breastfeeding. (May 1999).
UNICEF UK Baby Friendly Initiative. (2007). Guidance on the development of policies and guidelines for the prevention and management of: Hypoglycaemia of the Newborn. UNICEF. Available at: www.babyfriendly.org.uk
Vain N, Szyld E, Prudent L, Wiswell T, Aguilar A and Vivas N. (2004) Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial. The Lancet 364: 597-602
WHO/CHD. (Revised 1998) Evidence for the Ten Steps to Successful Breastfeeding. Geneva: WHO
Wiswell TE, Gannon CM, Jacob J et al. (2000). Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter international collaborative trial. Pediatrics; 105, 1-7
Wiswell TE, Tuggle JM, Turner BS. (1990). Meconium aspiration syndrome; have we made a difference. Pediatrics 85: 715-721
Version Control
Issue: / Description of changes: / Date:
1.0 / Care of the Newborn immediately after birth (including management of Hypoglycaemia/Hypothermia) / November 2005
2.0 / Updated version of document above; now includes Meconium present at delivery, GBS and baby born to a mother known to have misused substances in pregnancy / November 2009
3.0 / Guideline revised and updated to reflect service reconfiguration changes / October 2011
Policy Statement for
Immediate Care of the Newborn
Immediate Care of the Newborn
Contents
1.0 / Introduction and Scope of Procedural Document2.0 / Definitions
3.0 / Duties & Record Keeping Requirements
4.0 / Training / Competency Requirements
5.0 / Procedure for Immediate Care of the Newborn
5.1 / Background
5.1.1 / Routine care of the Newborn, following delivery
5.2 / Assessment of Babies at risk of Hypothermia and/or Hypoglycaemia
5.2.1 / Prevention, Detection and Management of Hypothermia
5.2.2 / Prevention, Detection and Management of Hypoglycaemia (includes babies at low risk and identified risk of developing hypoglycaemia)
5.3 / Management of Baby with Meconium present at delivery
5.3.1 / Background
5.3.2 / Management of Vigorous Baby
5.3.3 / Resuscitation of A Depressed Baby
5.4 / Prevention and Treatment of group B streptococcal (GBS) infection in the newborn
5.5
5.6 / Management of Babies born to Women known to have misused substances in pregnancy (alcohol and/or drugs)
Documentation of newborn care given
6.0 / Monitoring and Audit
App. 1 / Process Requirements
App. 2 / Consultation
App. 3 / Equality Impact Assessment
App. 4 / Paediatric Guideline: The identification and treatment of neonatal hypoglycaemia
App. 5 / Paediatric Guideline: Prevention and treatment of group B streptococcal (GBS) infection
App. 6 / Paediatric Guideline: Neonatal Drug Withdrawal
App. 7 / Neonatal Observations chart including Meconium, PROM and GBS
(Early warning score observation chart under development – anticipated in use November 2011)
App. 8 / Paediatric Guideline: Feeding and nutritional supplementation on the neonatal unit
App. 9 / Paediatric Guideline: The prevention of meconium aspiration syndrome
App. 10 / Audit tool
1.0 Introduction and Scope of Procedural Document
This guideline applies to all staff caring for women and their babies following birth.
It will ensure that the immediate care of the newborn is appropriate to the individual baby’s needs and that all professionals involved in providing care are aware of procedures to be followed in routine care and a range of special circumstances.
Any information is given to and discussed with women by a relevant professional at the appropriate time, as clinically indicated. This should be clearly documented in the appropriate place in the medical records, to enable continuity of care and good communication.
The Maternity Service provided to women by Maidstone & Tunbridge Wells NHS Trust was reconfigured in September 2011. Inpatient services for high risk women were transferred to the Tunbridge Wells Hospital at Pembury (TWH) with the Neonatal Unit also based at TWH.
Women are offered the following:
· Low risk women may choose to give birth at TWH, at home or the new midwife-led Birth Centre at Maidstone
· A range of outpatient maternity services including Antenatal Clinics, Obstetric Ultrasound and a Maternity Day Unit, continue to be offered at both TWH and Maidstone Hospital. These will be accessed, as appropriate, by both high and low risk pregnant women in each geographical area.
Clinical Risk Assessment (antenatal and intrapartum) is integral to planning the most appropriate place of birth for mother and her newborn.
Refer to MTW Guidelines: (referenced at pages 2 and 3)
● Antenatal Clinical Risk Assessment
● Care of Women in Labour including Clinical Risk Assessment in Labour
2.0 Definitions
Hypothermia: Temperature below 36.5 deg Celsius
Hypoglycaemia: Capillary Blood Glucose (CBG) below 2.6 mmol/l
Low Risk – women who are identified by risk assessment as suitable for midwifery led care during their pregnancy. Low Risk women may choose to give birth at home, at the Maidstone Birth Centre, or at TWH.
High Risk – women who are identified by risk assessment as having a condition or problem that require them to have additional care during their pregnancy. It is recommended that High Risk women receive care that is led by an Obstetric Consultant and give birth at TWH.
MTW – Maidstone & Tunbridge Wells NHS Trust
TWH – Tunbridge Wells Hospital at Pembury
3.0 Duties and Record Keeping requirements
It is the registered professional’s responsibility to deliver care that it based on current evidence, always acting in the mother’s and baby’s best interests.
All health care staff involved in maternal and neonatal health will adhere to this policy for continuity of care.
Any deviation from this guideline must be justified and recorded in the mother’s and/or baby’s notes.
Complete, accurate and timely documentation of care is integral to good practice. The mother’s health record and that of her baby should inform any clinician who has a responsibility for their care of all the relevant information, which might influence the proposed management. These records should also provide a contemporaneous and complete record of the mother’s or baby’s treatment and related features. In addition to ensuring good care maintaining these record keeping standards allows a clear picture of events to be obtained, which is imperative for managing claims and complaints.
Refer to MTW Guidelines: (referenced on page 3)
· Record Keeping and the Management of Maternity Records
· Handover of Care (onsite)
4.0 Training / Competency Requirements
Registered Midwives and Medical staff caring for obstetric/paediatric clients have a professional responsibility to maintain their competence. All professionals have a duty to keep their knowledge base up-to-date and this should be reflected in their annual appraisal.
Aspects included in this guideline will be updated in the care group annual mandatory multidisciplinary updates.
Refer to MTW Guideline: (referenced on page 3)
● Maternity Training Strategy & Training Needs Analysis Matrix
5.0 Procedure for Immediate Care of the Newborn
5.1 Background:
Childbirth is a unique and special experience. All those providing care to families at this time will endeavour, where mother and baby are healthy, to create a calm and unhurried environment in which parents may begin to establish a bond with their newborn as s/he adapts to extrauterine life. Biological nurturing, with all the benefits of skin-to-skin contact and the initiation of feeding will be encouraged. Should either mother or baby be unwell, or require medical intervention, every effort will be made to provide care in such a way that will promote the family’s bond as circumstances allow.
5.1.1 Routine Care of the Newborn, following delivery
· All staff handling babies are advised to wear gloves, at all times, for protection against potentially contaminated fluids
· If parents wish delayed cord-clamping refer to MTW guideline Care of Women in Labour.
· Following delivery, the baby should be dried and if there are any concerns, weighed. The baby should be returned to the mother’s abdomen adopting a biological nurturing position for a period of uninterrupted skin-to-skin contact. If not weighed following birth, then the baby can be weighed following the first hour of skin-to-skin contact and completion of the first feed. Ensure baby is covered with a dry wrap, especially the head
· In order to prevent and detect hypothermia in the newborn, the baby’s temperature should be recorded and documented within 30 minutes of birth.
· Whilst baby is on mother’s abdomen, the midwife should examine the baby, take the temperature, measure the head circumference, check the cord clamp and complete the documentation. Baby labels (Mother’s surname, hospital number, baby’s date of birth, time of birth, hospital number and ward destination, and if plain labels are used then state baby girl or boy) should be checked with parents and applied to the baby’s ankles.