Guidelines for Neonatal Healthcare Providers 5th Edition

1 Pre-transport / Post-resuscitation Stabilization Care of Sick Infants Guidelines for Neonatal Healthcare Providers 5th Edition Learner Manual Kristine A. Karlsen This educational program provides general Guidelines for the assessment and stabilization of sick infants in the post-resuscitation / pre-transport stabilization period. These Guidelines are based upon evidence-based recommendations in Neonatal texts and published literature whenever possible. When necessary, common Neonatal stabilization care practices were evaluated and incorporated into this program. Changes in infant care may impact the recommendations contained in this program;. such changes should be assessed on a regular basis. While caring for sick infants, Healthcare Providers may encounter situations, conditions, and illnesses not described in this manual. It is strongly recommended that additional nursing and medical education materials and consultation with Neonatal experts are utilized as necessary.

2 Prior to implementing these program Guidelines , the content of this manual should be reviewed and approved for use by appropriate policy committees at your institution or facility. The contents of this manual may not be reproduced, Graphic Designer duplicated, photocopied, or transmitted in any form Kristin Bernhisel-Osborn, MFA. without the express written permission of the author. PowerPoint Designer Kristine A. Karlsen 2006. All rights reserved. Mary Puchalski, MS, RNC, APN/CNS. Kristine A. Karlsen MSN, RNC, NNP. Medical Illustrators Author/Founder John Gibb, MA. , Inc. Marilou Kundmueller RN, MA. Park City, Utah Copy Editor Address communications to: Heather Bennett The Program Box 980023. Park City, Utah 84098. USA. Phone 1-435-655-8171. Email: ISBN: 0-9758559-3-X. ISBN 13: 9780975855935. is endorsed by the March of Dimes Content Reviewers Tammy Allen, RN Kim Firestone, BS, RRT Nancy O'Neill, RN, MN, NNP Jeanne Simmerman, BSN, RNC.

3 Lead Instructor Neonatal Outreach Educator Neonatal Nurse Practitioner Lead Instructor Neonatal Intensive Care Unit Akron Children's Hospital Neonatal Intensive Care Unit Community Medical Center St. Luke's Regional Medical Center Akron, Ohio IWK Health Centre Missoula, Montana Boise, Idaho Halifax, Nova Scotia Jay P. Goldsmith, MD Michael Speer, MD. Canada Laura Aure, MS, RNC Chairman, Emeritus, Professor of Pediatrics NICU Clinical Educator Department of Pediatrics Webra Price-Douglas, PhD, CRNP, Division of Neonatology Primary Children's Medical Center Oschner Clinic Foundation IBCLC Texas Children's Hospital Salt Lake City, Utah Clinical Professor Transport Coordinator Baylor College of Medicine [Emotional Support Module] Tulane University Maryland Regional Neonatal Houston, Texas New Orleans, Louisiana Transport Program Marilyn M Benis, RNC, MS, NNP Howard Stein, MD. University of Maryland Medical Neonatal Nurse Practitioner Linda M.

4 Ikuta, RN, MN, CCNS, PHN Neonatologist and Pediatric Center & Johns Hopkins Hospital Neonatal Clinical Nurse Specialist Cardiologist Vermont Children's Hospital at Baltimore, Maryland Packard Children's Hospital Toledo Children's Hospital Fletcher Allen Health Care Stanford University Medical Center Mary Puchalski, MS, RNC, Toledo, Ohio Burlington, Vermont Palo Alto, California APN/CNS. Michael Trautman, MD. Carl L. Bose, MD Maternal / Child Clinical Robert Insoft, MD Medical Director of Transport Professor of Pediatrics Nurse Specialist Medical Director NICU and Riley Children's Hospital Neonatal /Perinatal Medicine Elmhurst Memorial Healthcare Pediatric Transport Services Associate Professor of Pediatrics University of North Carolina Elmhurst, Illinois Mass General Hospital for Children Indiana University Chapel Hill, North Carolina Boston, Massachusetts Patricia A. Reuter, MSN, RNC Indianapolis, Indiana Mark S.

5 Brown, MD MSPH Neonatal Outreach Coordinator Mark Kaneta, MD Karen S. Wood, MD. Neonatologist and Children's Mercy Hospital Neonatologist Assistant Professor of Pediatrics Lead Instructor Kansas City, Missouri Community Medical Center Medical Director Presbyterian / St. Lukes Medical Pediatric Transport, UNC AirCare Missoula, Montana Evelyn Rider, MD. Center Medical Director NICU Medical Director Denver, Colorado Tracy B. Karp, MS, RNC, NNP. Benefis Healthcare / Great Falls Nurse Practitioner Program Manager Robert D. Christensen, MD Clinic, LLP Division of Neonatal -Perinatal Nurse Practitioner Program Great Falls, Montana Medicine Medical Director Primary Children's Medical Center Chapel Hill, North Carolina McKay Dee Medical Center Salt Lake City, Utah Jan Romito, RNC, MSN, NNP. Ogden, Utah Pediatrix Medical Group of Texas [Lab work module] Phyllis Lawlor-Klean, MS, RNC, Driscoll Children's Hospital APN/CNS Surgery consultants Corpus Christi, Texas Susan Cullen, RN, MSN NICU Clinical Nurse Specialist Earl C.

6 Downey, Jr., MD. Neonatal Nurse Educator Christ Hospital Medical Center Terri Russell, MS, RNC, APN/NNP. Associate Professor of Surgery Lead Instructor Oak Lawn, Illinois Coordinator NNP Program Pediatric Surgery Eastern Maine Medical Center Rush University Diane Lorant, MD Primary Children's Medical Center Bangor, Maine Neonatal Nurse Practitioner Associate Professor of Pediatrics Salt Lake City, Utah University of Chicago Hospitals Theresa S. Davis, APRN-BC, MSN, Indiana University Chicago, Illinois Donald Plumley, MD. PNP Riley Childrens Hospital Pediatric Surgery Neonatal Outreach Coordinator Indianapolis, Indiana Patricia A. Scott, MSN, RNC, NNP. Director Pediatric Trauma The Medical Center of Central Coordinator, Neonatal Nurse CAPT Martin J. McCaffrey, MD Arnold Palmer Children's Hospital Georgia Practitioners Neonatal Specialty Advisor to Children's Surgical Associates Macon, Georgia Mid-Tennessee Neonatology Associates the Navy Surgeon General Orlando, Florida Coordinator, Neonatal Transport Marion E.

7 DeLand, BScN, RNC Department of Pediatrics Services Neonatal Nurse Educator Naval Medical Center San Diego Centennial Medical Center San Diego, California Women's College Campus of The Women's Hospital Neurosurgery consultant Sunnybrook & Women's College Mary Jane McGregor, RN, BSN Nashville, Tennessee Health Sciences Centre Marion L. Walker, MD. Clinical Educator Neonatal ICU. Ray Sibberson, MS, RRT, FAARC Chairman, Division of Pediatric Toronto, Ontario, Canada LDS Hospital Professor, Respiratory Care Program Neurosurgery Salt Lake City, Utah Roger Faix, MD Director of Clinical Education University of Utah School of Medicine Professor of Pediatrics Charles Mercier, MD The University of Akron Primary Children's Medical Center University of Utah School of Medicine Vermont Regional Perinatal Program Akron, Ohio Salt Lake City, Utah Attending Neonatologist Department of Pediatrics Primary Children's Medical Center University of Vermont LDS Hospital Burlington, Vermont iii S a l t L a k e C i t y, U t a h SUGAR & SAFE CARE.

8 Table of Contents Neonatal Lab Values ..inside front cover TEMPERATURE. INTRODUCTION ..1. Program Philosophy ..1. Program Goals ..1. Newborn Transport ..1. The Mnemonic ..2. The ABCs ..3. Module One SUGAR and SAFE CARE ..5. AIRWAY. Sugar and Safe Care Module Objectives ..6. Safe Patient Care ..7. Sugar General Guidelines ..8. Preparation for Extrauterine Life and Factors that Affect Glucose Stability After Birth ..9. Three Main Factors that Impact Blood Glucose After Birth ..9. Inadequate Glycogen Stores: High Risk Groups ..10. BLOOD PRESSURE. Hyperinsulinemia: High Risk Groups ..12. Increased Utilization of Glucose: High Risk Groups ..13. REVIEW: Infants at increased risk for hypoglycemia ..14. Glucose Monitoring ..15. Bedside Monitoring of Blood Glucose ..15. Signs of Hypoglycemia ..16. Recommended Target Blood Sugar for Sick Infants Who Require Neonatal Intensive Care ..16. Initial IV Fluid and Rate.

9 17. LAB WORK. Indications for Umbilical Catheterization and Safe Use of Umbilical Catheters ..22. Heparin Safety ..26. Sugar Module Key Points ..28. General Approach for the Initial Fluid and Glucose Management of Sick Infants ..28. APPENDIX HYPERLINK: Malrotation and Midgut Volvulus ..29. EMOTIONAL SUPPORT QUALITY IMPROVEMENT. APPENDIX Classification of Newborns (Both Sexes) by Intrauterine Growth and Gestational Age ..30. APPENDIX HYPERLINK: IV Insertion ..31. APPENDIX Securing a Peripheral IV Using Clear Surgical Dressing and 1 2-Inch Clear Tape ..32. APPENDIX Calculating Umbilical Catheter Depth Using a Mathematical Formula ..34. APPENDIX Determining Umbilical Catheter Tip Location Using a Graph ..35. APPENDIX Example: How To Use the Shoulder-To-Umbilical-Length Measurement Graph to Calculate Umbilical Artery Catheter Insertion Depth ..36. APPENDIX HYPERLINK: Umbilical Line Malpositions.

10 37. APPENDIX Recommended Actions to Correct the Location of a Malpositioned UAC ..39. APPENDIX HYPERLINK: Umbilical Catheterization Procedure ..40. Appendix Securing an Umbilical Catheter ..42. v Module Two TEMPERATURE ..43. Temperature Module Objectives ..44. Introduction ..44. Key Concepts ..44. REVIEW: Infants at Highest Risk for Hypothermia ..45. What is a Normal Core Temperature for Infants and What is Considered Hypothermic? ..46. Normal Response to Cold Stress in Term Infants ..46. Mechanisms of Heat Loss ..49. Conductive Heat Loss ..50. Convective Heat Loss ..51. Evaporative Heat Loss ..52. Radiant Heat Loss ..53. Radiant Heat Gain ..54. Physiologic Response to Hypothermia: Term and Preterm Infants ..55. Norepinephrine and Peripheral Vasoconstriction ..56. Norepinephrine and Pulmonary Vasoconstriction ..57. Detrimetal Effects of Hypothermia ..58. Rewarming the Hypothermic Infant ..59. Incubator Method of Rewarming.