Subject:  Management of the Neonate at Delivery

POLICY:          Infants will be carefully monitored to assure a healthy transition to extrauterine life.  The infant that presents with signs and or symptoms that are outside the range of normal will be addressed and will be appropriately assessed for continuing care, assessment and or transfer to an advanced neonatal care unit.

DESCRIPTION: The newborn will be assessed for temperature, pulse, respirations, feeding, color, activity and the presence of void and/or stool.  All assessments and procedures will be noted on the flow sheet (attached).  Variations outside of the normal limits will have complete written notes on the care given and actions taken. 

GUIDELINES: 1. Temperature

·        A neonate’s temperature should be maintained between 98.0 F (36.67 C) and 99.9 F (37.7 C)

·        Temperature variances can occur with maternal temperature variances, glucose level variances and infection.

·        Extended periods of cold stress can lead to harmful side effects which include hypoglycaemia, respiratory distress, hypoxia, metabolic acidosis, necrotizing enterocolitis and failure to gain weight.

·        The room temperature will be maintained at greater than 70o F.

·        The following may precipitate heat loss and will be avoided: cool weighing scales, cool stethoscope, cool linens, cold hands, cold mattress, draughts from open windows, over handling (passing from person to person), wet skin, wet diaper, wet bed.

·        The signs and associated problems of cold stress are: decreased temperature, mottled and/or pale, metabolic acidosis, tachycardia, hypoglycemia, bradycardia.

·        To intervene in this situation: Identify and eliminate any environmental causes, eg wet bed, over exposure, handling, place skin to skin on mother’s or partner’s skin with blanket covering, Take the neonate's temperature every 30-60 minutes until warmed to an acceptable temperature.

·        The signs and associated problems of heat stress are: central temperature above 37.3°C and rising, increased peripheral temperature and decrease in core-toe gap, ie < 1°C, tachycardia, tachypnea, restlessness, dehydration, stress.

·        To intervene in this situation: Check environmental temperature and reduce by 0.5°C at 30-60 minute intervals, Remove excess layers and clothing.

·        The neonate should be observed and the following aimed for:  capillary refill time < 2 seconds, pink color, skin warm to touch, no increase in heart rate above normal, palpable peripheral pulses.

2. Pulse

·        A neonate’s pulse should be between 120 and 160 BPM.

·        Tachycardia may result from temperature elevation, infection, respiratory distress, volume depletion, cardiorespiratory disease, drug withdrawal and hyperthyroidism. Bradycardia often results from apnea and is often seen with hypoxia.

·        Heart rate issues are to be discussed with the physician.

3. Respirations

·         Normal newborn respirations should be between 40 and 60 breaths a minute.

·        It is normal for newborns to have episodic breathing (no breaths for less than 15 seconds).

·        Variations should be assessed and the protocol for respiratory distress in the newborn followed.

4. Feeding

·        A latch score is located on the maternal postpartum care record and is to be completed and causes examined if the score is less than ten.

·        It is normal for the newborn to latch and feed within the first two hours after birth.  If the newborn has not fed well in the first 4 hours the infant will be assessed for other complicating factors.

·        An infant may have difficulty breastfeeding in the following situations:

·        The provider must rule out infection, tachynyea, hypoglycemia or other critical health issues. Check all vital signs are within normal ranges, check for normal newborn response and behavior, O2 saturation levels and blood glucose levels.

·        When critical health issues have been ruled out an IBCLC (lactation specialist) is to be called to The Birth Center for evaluation of the breastfeeding relationship.