PPN 301 Week 7: Newborn Assessment and Care

Physiological adjustments (MAIN ONES ) (physiological adaptation of the newborn

• Establishing and maintaining respirations

• Adjusting to circulatory changes

• Regulating temperature

Chemical factors (establishing and maintaining respirations- physiological adaptation of the newborn)

• Activation of chemoreceptors in the carotid arteries and aorta due fetal hypoxia

• Contraction temporary decrease uterine blood flow and transplacental gas exchange-transient fetal hypoxia

• ↓Po2 and ↑Pco2, ↓blood pH

• Stimulation of the respiratory centre

Thermal factors- temp around the baby (establishing and maintaining respirations- physiological adaptation of the newborn)

• ↓extrauterine environment (outside the uterus )

• stimulates receptors in the skin, resulting in stimulation of the respiratory centre in the medulla. 

Note: Cold stress may be important for initializing breathing, but prolonged exposure should be avoided

Mechanical factors (establishing and maintaining respirations- physiological adaptation of the newborn)

• Changes in intrathoracic pressure from compression of the chest during vaginal birth.

• Relieve of the pressure result in a negative intrathoracic pressure, which helps draw air into the lungs. 

• Crying of baby 

  • increases the distribution of air in the lungs, promotes expansion of the alveoli. 

  • creates positive pressure which helps to keep the alveoli open.

Sensory factors-5 senses (establishing and maintaining respirations- physiological adaptation of the newborn)

• handling or drying the newborn, lights, sounds, and smells of the new environment can also be involved in stimulation of the respiratory centre. 

• Pain associated with birth can also be a factor

Circulatory adjustment (physiological adaptation of the newborn)

changes after birth  

• Expansion of the lungs increases the baby's blood pressure 

• Resulting in a major decrease in the pulmonary pressures and the  changes in pressure result in

• ↓shunting of blood to the ductus arteriosus and closure of the ductus arteriosus

• ↑ pressure in the left atrium of the heart and lower pressure in the right atrium causing the foramen ovale to close. 

• Failure may result in patent foramen ovale (hole in heart) and surgical repair is required

• R=Deoxygenated

• L= Oxygenated

Thermoregulation (physiological adaptation of the newborn)

• Heat regulation is most critical to the newborn’s survival.

• Anatomical and physiological characteristics of newborns place them at risk for heat loss-hypothermia

  • Larger body surface to body weight

  • Less adipose tissue & fat in newborn

  • Underdeveloped sweating and shivering mechanisms

  • Blood vessels closer to skin surface – contribute to heat loss

• Environmental factors -temperature and humidity of the air, flow and velocity of the air, and the temperature of surfaces in contact with and around the newborn. 

• Goal of care is to maintain a neutral thermal environment in which heat balance is maintained. 

  • To allow the newborn to maintain a normal body temperature to minimize oxygen and glucose consumption. 

Newborn heat loss

• Evaporation

• Conduction

• Radiation

• Convection

Evaporation (Newborn heat loss)

 Loss of heat when water evaporates from the skin and respiratory tract 

• heat loss is intensified by failing to completely dry after bathing

• Dry baby quickly and remove wet towels/blankets 

Conduction (Newborn heat loss)

 Heat loss from the body surface to cooler surfaces in direct contact

• Prewarm incubator/radiant warmer to ensure warm mattress 

• Cover x-ray plates and scales 

• Prewarm hands, stethoscopes, blankets and other equipment

• weighing the newborn should have a protective cover to minimize conductive heat loss

• Anything that touches baby must be warmed prior to touching baby (notes)

Radiation (Newborn heat loss)

Heat lost to surrounding colder solid objects (not in direct contact) but in close proximity 

• Keep incubator, warmer, examination table, crib cot away from outside walls and windows 

• Dress baby 

• Care providers need to avoid exposing the newborn to direct air drafts.

Convection (Newborn heat loss)

 Heat lost from the body surface to cooler ambient air 

• Raise surrounding 22° and 26°C

• Cover baby’s head 

• Wrap and dress baby 

• Warm O2

Effects of Cold stress

When a newborn is stressed by cold, oxygen consumption increases and pulmonary and peripheral vasoconstriction occur, thereby decreasing oxygen uptake by the lungs and oxygen to the tissues; anaerobic glycolysis increases; and there is a decrease in Po₂ and pH, leading to metabolic acidosis.

• If the baby doesn’t get enough oxygen, the body switches to anaerobic metabolism, producing lactic acid → causing acidosis.

Newborn assessment

• Immediately after Birth

• Head to Toe

• APGAR score

Immediate Newborn assessment-Apgar scoring

• Immediate assessment of the newborn done at 1 and 5 minutes after birth

  • Scores of 0 to 3-indicate severe distress,

  • Scores of 4 to 6 indicate moderate difficulty

  • Scores of 7 to 10 indicate that the newborn is having minimal or no difficulty adjusting to extrauterine life

• Reassessment is at 10 and 20 minutes if the score is less than 7 at 5 minutes

• Resuscitation may occur at any point when the newborn is compromised and should not wait until the initial 1-minute Apgar score 

Score 2 (APGAR score)

• Appearance: Pink

• Pulse: >100 bpm

• Grimace: Cries and pulls away

• Activity: active movement

• Respiration: Strong cry

Score 1 (APGAR score)

• Appearance: Extremities blue

• Pulse: <100 bpm

• Grimace: grimaces or weak cry

• Activity: arms and legs flexed

• Respiration: slow irregular

Score 0 (APGAR score)

• Appearance: Pale or blue

• Pulse: No pulse

• Grimace: No response to stimulation

• Activity: no movement

• Respiration: no breathing

Respiratory system-Newborn assessment

• Observe rise/fall of chest for 1 full minute

• Auscultate lung sounds

• Normal – 30-60 bpm, 

• shallow & irregular; 

• apneic periods of 5-10 seconds as fluid is being absorbed/expelled

• Possible crackles - 1^st hr. after birth

•  Acrocyanosis – normal finding during transition

• Look for signs of respiratory distress 

  • Chest retractions 

  • Grunting with expirations

  • Increase use of the intercostals muscles

  • Nasal flaring

  • Respiratory rate < 30 or > 60 breaths/min should be reported

Cardiovascular system-Newborn assessment

• heart rate between 110 and 160 beats/min

• Heart rate <110 or >160 re-evaluate after 30 to 1 hour  

• Heart murmurs heard during the first few weeks have no pathologic significance

  • murmurs disappear by 6 months

  • Average systolic BP is 60 to 80 mm Hg, and average diastolic BP is 40 to 50 mm Hg

  • Fetal Hb – high affinity for oxygen to promote oxygenation while infant begins producing own Hb postnatally

  • Hb level 14-24 g/dl

  • Blood volume 300mls 

    • Time taken to clamp cord 

Signs of Cardiovascular concern- Newborn assessment

• Persistent tachycardia (more than 160 bpm) 

• anemia, hypovolemia, hyperthermia, or sepsis. 

• Persistent bradycardia (less than 100 bpm) congenital heart block, hypoxemia, normal sinus bradycardia, or hypothermia.

• Unequal or absent pulses, bounding pulses, and decreased or elevated blood pressure can indicate cardiovascular concerns 

Fontanelles (only two types)

• Anterior fontanel 5-cm, diamond shaped, increases as moulding resolves

  • Closes within 18 months

• Posterior fontanel triangle 0.5x1 cm, smaller than anterior

  • Closes within 8-12 weeks after birth

Sutures (Allow for brain growth)

• Should be palpable and separated suture, possible overlap of sutures with moulding

  • Widely spaced (hydrocephalus)-too much fluid in brain

  • Premature closure (fused) (craniosynostosis)-skull bones close too early

Signs of Fontanel concerns

• Full, bulging (tumour, hemorrhage, infection)

• Large, flat, soft (malnutrition, hydrocephalus, delayed bone age, hypothyroidism) -> ask about mother feeding patterns (note)

• Depressed (dehydration)

Cephalhematoma (Fontanelle)

•  is the collection of blood between the skull bone and its periosteum caused by external 

  • Pressure during L & D

  • Forceps delivery 

• Largest on the second or third day,

• Feels boggy, edematous to touch

• Does not cross suture lines

• Resolves in 3 to 6 weeks 

• Not aspirated due to risk of infection

• Increase risk of jaundice

Caput succedaneum (Fontanelle)

• Localized edematous area of the soft tissues of the scalp.

  • Presenting part causes compression of local vessels slowing venous  return 

    • increase in tissue fluids within the skin of the scalp

    •  edematous swelling develops.

• Extends across the suture lines of the skull

Disappears spontaneously within 3 to 4 days.

Mouth-Newborn assessment

• Lips should be symmetrical

• Pink, moist lips and mucosa

• Sucking blisters  - from breastfeeding latch

• Saliva not excessive

• Intact hard and soft palate; freely moving tongue

• Tongue not protruding; freely movable; symmetrical movement

• Sucking pads inside cheeks

• Uvula in midline

• Epstein’s pearls: small, firm white cysts on gums. Resolve on its own during 1^st weeks

• Anatomical groove in palate to accommodate nipple, disappearance by 3–4 yr of age

Common conditions (Mouth-Newborn assessment)

• Thrush: White plaque – similar to milk curds, does not easily scrape off

• Precocious (or natal), predeciduous-presence of teeth at birth (hereditary)

Cleft lip/palate (Mouth- Newborn Assessment)

• Cyanosis, circumoral pallor (respiratory distress, hypothermia)

• Asymmetry in movement of lips (seventh cranial nerve paralysis)

• Short lingual frenulum (ankyloglossia- tongue-tie)

Female genitalia (Genito-Urinary system Newborn assessment)

• Labia – examined for size. Labia majora develops close to term

  • Assess to ensure that labia are not fused

  • Assess ambiguous genitalia

• Milky vaginal discharge- due to circulating maternal hormones

• Pseudomenses: blood tinged mucous – due to hormones of pregnancy

• Vaginal tag: (hymenal tag) usually disappears in first few weeks after birth

• Swelling of the breast tissue in term newborns of both sexes-due to hyperestrogenism in utero 

  • few newborns a thin discharge can be seen. 

Male Genitalia (Genito-Urinary system Newborn assessment)

Male genitalia

• Hypospadias-urine will drip down
  needs surgery to correct before circumcision: Urinary meatus on ventral surface of penis (underside). 

  • Circumcision is contraindicated in the presence of hypospadias or epispadias since the foreskin is used in repair of these anomalies

  • Epispadias: Meatus on the dorsal surface

• Phimosis: Foreskin cannot be fully retracted 

• A tight prepuce (foreskin) is common in newborns and completely covers the glans-rounded tip of penis

• Hydrocele: Collection of fluid around testes

• Discoloration of testes – assess for testicular torsion

  • Crepitus in groin or scrotal sac indicates hernia 

• Undescended testes; (cryptorchidism)

  • Failure of testes to descend into scrotal sac in term infant

Skin (Newborn assessment)

• Pink varying with ethnic group, well perfused

• Perfusion assessed by capillary refill of 2 seconds or less

• Skin should spring back when pinched

• dehydration if fold of skin persisting after release of pinch) Skin is soft, dry texture. 

• Acrocyanosis:  Bluish discoloration of hands and feet 1^st 6 -8 hr. post birth (due to cardiovascular immaturity) 

• Post-mature infants may have dry skin, cracking on feet and hands

• Loose, wrinkled skin (prematurity,)

• Mottling:  due to temperature instability; overstimulation of autonomous nervous system

• Tense, tight, shiny skin (edema, extreme cold, shock, infection)

Extremities (Newborn assessment)

• Full range of motion of arms & shoulders

• Assess leg length – equal, with symmetrical gluteal creases

• Assess for club foot (talipes equinovarus)

• Back should be straight, flexible

• Pilonidal dimple  - cleft at base of sacrum, generally benign

• Digits

  • Extra digits: polydactyly

  • Webbing: Syndactyly

• Hip displacement, look at folds on thigh

Sucking-Newborn Reflexes (Newborn assessments)

When anything is placed in mouth or touches lips look for present

Rooting -Newborn Reflexes (Newborn assessments)

infant turns head when side of mouth/ cheek is stimulated. Present for 3-4 months. 

• Aids in latching

• look how long its been going on for

Moro -Newborn Reflexes (Newborn assessments)

Startling infant, - response by symmetrically extending arms outward while knees flex. Can last up to 6 months

• Most sensitive assessment for infant’s neurological system

Babinski -Newborn Reflexes (Newborn assessments)

(plantar reflex). Hyperextension of toes when the sole is stroked from heel up to ball of foot. Disappear by age  1 year.

Prophylactic & Screening Measures (Newborn assessment)

• 0.5% Erythromycin eye ointment within 1 hr. of birth to prevent eye infections caused by maternal gonococcal transmission

• Vitamin K injection within 1 hr. birth vs. hemorrhage

• Hep. B vaccine at birth (against all known Hep B subtypes), HBIG 12 hrs after birth If maternal hep. B surface antigen is positive or unknown

• Blood glucose monitoring – baseline at 2 hr. post-birth if gestational diabetes, LGA, or SGA; ½-1 hr. post birth if symptoms of hypoglycemia occur earlier

• Heel prick for bilirubin levels, phenylketonuria (PKU) & hypothyroidism (mental retardation if untreated), sickle cell

• Screening for congenital heart disease: pre-ductal (right hand) and post-ductal (any foot) oxygen saturation obtained. Repeat screen if >3% difference between 2 readings or if O2 sat is less than 94% on either extremity.

• Hearing to assess for hearing loss 

Pain in the Newborn

• Newborn responses to pain

• Assessment of pain in the newborn

• Goal of newborn pain management

  • minimize the intensity, duration, and physiological cost of the pain  

  • maximize the newborn’s ability to cope with and recover from the pain.

• Nonpharmacological management

• Pharmacological management

Observe for variations (Pain in the Newborn)

• Vital signs: increased heart rate, increased blood pressure, rapid, shallow respirations

• Oxygenation: increase oxygen saturation, decrease arterial oxygen saturation

• Skin-observe colour and character: pallor or flushing, diaphoresis, palmar sweating

• Vocalizations: Crying, whimpering, groaning

• Facial expression: Grimaces, brow furrowed, chin quivering, eyes tightly closed, mouth open and squarish

• Body movements and posture: Limb withdrawal, thrashing, rigidity, flaccidity, fist clenching

• Changes in state: changes in sleep-wake cycles, feeding behaviour, activity level, fussiness, irritability, listlessness

Management of pain in the Newborn

• Non-nutritive sucking on a pacifier promote comfort

• Oral sucrose in small amounts given with a syringe with or without a pacifier for sucking reduces pain during single events

•  Skin-to-skin contact (kangaroo) care help reduce pain during a painful procedure 

• Breastfeeding or breast milk helps reduce pain during heel lancing and blood collection 

• Swaddling or snugly wrapping the newborn with a blanket aids in self-regulation, and reduces physiological and behavioural stress resulting from acute pain

  • Safe swaddling is important

• Touch, massage, rocking, holding, and environmental modification (e.g., low noise and lighting). 

Discharge planning and teaching for the Newborn

• Community follow-up

• Temperature

• Respirations

• Feeding patterns

• Elimination

• Prevention of sudden infant death syndrome (SIDS) 

• Rashes

  • Diaper rash

  • Other rashes

• Clothing

• Car seat safety 

• Non-nutritive sucking

• Bathing 

• Umbilical cord care

• Newborn follow-up care

• Cardiopulmonary resuscitation

• Practical suggestions for the first weeks at home

• Recognizing signs of illness

• Recommended not to sleep in the same bed as baby

• Not putting stuff in the crib

Caring for high risk Newborns

• Infants who are born considerably before term and survive are particularly susceptible to development of sequelae-a condition or complication that happens as a result of a previous illness or injury related to preterm birth.

• High-risk infants are most often classified according to:

  • birth weight

  • gestational age

  • common pathophysiological problems

• Jaundice

• Preterm 

• Diabetes

• Meconium aspiration in newborn

Jaundice in newborns

Hyperbilirubinemia

bilirubin greater than 340 mcmol/L in the first 28 days

Causes

• Increase bilirubin level due break down in RBC

• Short lifespan of  leads to RBC mass breakdown

• Immature liver to cannot break down bilirubin for excretion

• Hepatic obstruction

• Unconjugated bilirubin is highly toxic to neurons

Risk factors (Jaundice in Newborns)

•  Maternal fetal Rh or ABO incompatibility

• Sepsis

• Polycythemia (↑RBC)

• Biliary atresia-liver problem in babies where the tubes that carry bile from the liver to the intestine are blocked or missing

• Liver impairment

• Hypoglycemia

• Pre-term birth

• Delayed passage of meconium

• Large cephalohematoma at birth

• Hypoxia

• Hypothermia 

• two types

  • Pathologic

  • physiological

Physiological Jaundice (Types of Newborn jaundice)

• 60% of newborns born at term and 80% of preterm infants.  

• Appears after 24 hours of age and usually resolves without treatment.

  • unless bilirubin levels rise higher or faster than normal

Pathological Jaundice (Types of Newborn jaundice)

• Appears within 24 hours of birth

• Total unconjugated bilirubin levels >100 mcmcol/L in 24 hours

• level exceeds >256 mcmol/L at any time 

• Untreated ↑ unconjugated bilirubin is neuro toxic to brain

• Acute bilirubin encephalopathy (lethargy, hypotonia-low muscle tone makes muscles feel flopy or weak, poor sucking irritability, seizures, coma, and death)

• Kernicterus: irreversible long-term consequences of bilirubin toxicity, (hypotonia, delayed motor skills, hearing loss, cerebral palsy, and gaze abnormalities)

Phototherapy (Jaundice treatment)

• Use to reduce the level of circulating unconjugated bilirubin or to keep it from increasing

• bilirubin level begin to decrease within 4 to 6 hours after; within 24 hours decrease by 30 to 40%

• to discontinue therapy is based on a definite downward trend in bilirubin values

Precautions phototherapy (Jaundice treatment)

• Newborn’s eyes must be protected by a shield to prevent retinal damage

• Temperature should be closely monitored at least every 2 hours

• Possibility of heat loss and dehydration- due to stool loss

• (feeding is critical )

• No ointments- heath absorption and cause burns

• Loose stool due to bilirubin breakdown-buttocks must be cleaned after each stool to maintain skin integrity

  • Ensure consistent + proper cleasing 

  • no lubercant like vaseline should be used (note)

Preterm

• Preterm-born before completion of 37 weeks of gestation regardless of the weight of the infant

  • Organ and systems are immature

  • Lack of adequate physiological reserves to function in the extrauterine environment.

• Is the leading cause of newborn deaths globally

  • accounting for almost 40% in Canada

• Low birth weight (LBW)-newborns weighing 2 500 g or less Increase risk for health issues,

• Extremely low birth weight (ELBW)-birth weight of less than 1000 g (2 lb, 3 oz)

• Practical and ethical dimensions of resuscitation of extremely low-birth-weight infants (ELBW

Causes of preterm birth multifactorial 

• poverty (which can contribute to suboptimal health care and prenatal nutrition)

• maternal infections

• previous preterm birth

• multiple pregnancies

• pregnancy-induced hypertension, placental conditions that interrupt the normal course of gestation

• Smoking

• Advanced maternal age

• Fetal disorders

• intrauterine growth restriction (IUGR) 

(associated with LBW)

Preterm (risks)

• Respiratory distress

• Thermal instability 

• Hypoglycemia

• Jaundice’

• Feeding difficulties 

• Neurodevelopmental issues (speech, behavioural, and cognitive) 

• Infection 

Preterm (Complications)

• Respiratory distress syndrome (RDS)- most common reason for death

• Patent ductus arteriosus- when the ductus arteriosus (a blood vessel connecting the aorta and pulmonary artery) stays open after birth, causing abnormal blood flow between the heart and lungs.

• Periventricular-intraventricular hemorrhage

• Necrotizing enterocolitis- a serious intestinal disease in newborns where part of the bowel becomes inflamed and starts to die.

Respiratory support (Preterm nursing care)

• Oxygen therapy

  • Nasal cannula

  • Continuous distending pressure

  • Mechanical ventilation

  • Weaning from ventilatory support

Cardiovascular support (Preterm nursing care)

• Assess

  • heart rate and rhythm, skin colour, blood pressure, perfusion, peripheral pulses, oxygen saturation

Thermoregulation (Preterm nursing care)

• Maintaining a neutral thermal environment (NTE)

• Kangaroo care

Neurological (Preterm nursing care)

Monitor for seizure activity, hyperirritability, CNS depression, elevated intracranial pressure, and abnormal movements.

Nutrition and hydration (Preterm nursing care)

• Breastfeed if sucking and swallowing reflexes are adequate and no other contraindications.

• Gavage feeding (nasogastric or orogastric tube)

• Gastrostomy feeding (surgical placement of a tube through abdomen into the stomach. 

• Supplemental parenteral fluids to supply additional calories, electrolytes, or water.

Renal support (Preterm nursing care)

• Assess acid–base and electrolyte balance

• serum levels of medication for adequate therapeutic range for treatment and to prevent toxicity

• Hematological support

  • Signs of bleeding, anemia

Nurturing environment (Preterm nursing care)

• Avoid slamming doors (including isolette portholes), listening to radios, talking loudly, and handling equipment (e.g., trash containers), jarring chairs 

• Monitoring sound levels in the nursery

• Shielding newborns’ eyes from bright lights

• Clustering of care and assessments to enable undisturbed sleep periods

Skin care (Preterm nursing care)

• Care must be taken to avoid damage to the delicate structure.

• Use skin products (e.g., alcohol, chlorhexidine, povidone-iodine) with caution

• Rinsed with water afterward to prevent severe irritation and chemical burns in VLBW- very low birth weight and ELBW- extremely low birth weight infants. 

• Minimal use of adhesive tape, backing the tape with cotton, and delay removal adhesive until adherence is reduced

Protection from infection (Preterm nursing care)

• Strict hand hygiene is the single most important measure to prevent infections

Large for gestational age (LGA)

Newborn birth weight is above the ninetieth percentile on growth charts

• Higher incidence of birth injuries

• Asphyxia (lack of oxygen and buildup of carbon dioxide in the blood)

• Congenital anomalies such as heart defects.

Causes of large for gestational age

• Maternal diabetes in the mother (most common cause) 

• Maternal obesity

• Having had previous LGA babies

• Genetic abnormalities or syndromes 

• Excessive weight gain during pregnancy

Infants of Diabetic mothers

Higher Risk of Hypoglycemia

• High maternal blood glucose levels during fetal life stimulate the fetal islet cells to produce insulin

  • Leads to hypertrophy and hyperplasia of the pancreatic islet cells-transient state of hyperinsulinism

• Sudden removal of newborn’s glucose supply after birth + continued production of insulin  

  • depletes the blood of circulating glucose

  • creating a state of hyperinsulinism and hypoglycemia within 0.5 to 4 hours

• Quick drops in blood glucose levels leads to neurological damage or death

*Baby is used to be in sugary environment

when baby is out of insulin in being release as it is still in the womb*(note)

Clinical manifestations (Infants of diabetic mothers)

• Macrosomia or Large for gestational age

• Very plump and full faced

• Abundant vernix caseosa

• Plethora (ruddy complexion)

• Listless and lethargic

• Possibly meconium stained at birth

• Hypotonia 

Complications (Infants of diabetic mothers)

• Hypoglycemia, hypocalcemia, hypomagnesemia, polycythemia, hyperbilirubinemia, cardiomyopathy, 

• Respiratory Distress Syndrome

• CNS anomalies-anencephaly, spina bifida, and holoprosencephaly-abnormal development of the forebrain

• Cardiac anomalies- ventricular septal defects and coarctation of the aorta

• Sacral agenesis and caudal regression

• Increased risk for birth injuries

Sacral agenesis/caudal regression (Infants of Diabetic Mothers)

a rare birth defect where the lower spine (sacrum) and sometimes lower limbs don’t develop properly, affecting mobility and organ function

Management and nursing care (Infants of diabetic mothers)

• Feedings with breast milk or formula initiated within the first hour after birth if cardiorespiratory status stable

• If enteral supplementation failed or infant unable to feed 

  • continuous IV infusion of 10% dextrose at 4 to 6 mg/min/kg 

  • If blood blood glucose is below 1.8 mmol/L, a one-time bolus infusion of 10% dextrose (200 mg/kg) should be given over 2 to 4 minutes,

  • followed by a continuous IV infusion of 10% dextrose

• Evaluation of serum glucose 30 minutes 

• pharmacological agents (glucagon and diazoxide) may be required

• Monitoring for symptoms of hypoglycemia in an IDM include 

  • jitteriness or tremors

  • cyanotic episodes

  • seizures,

  • intermittent apneic(not breathing) episodes

  • difficulties feeding

• Assess for congenital anomalies, signs of possible respiratory or cardiac issues

• Maintenance of adequate thermoregulation

• Monitoring of serum blood glucose levels. 

• Monitored closely for hyperbilirubinemia.

Discharge planning for high-risk infants

• Parents should be given the opportunity to room-in and spend a night or two providing care

• Home care needs of infant's parents are assessed.

• Referrals for appropriate resources

• Assistance with medical supplies

• Parent teaching include bathing and skin care, infection prevention 

• Nutritional requirements for meeting nutritional needs

• Parent education and opportunity for return demonstrations care skills

• Age-appropriate car seat

• Health care provider contact

• Appropriate immunizations, metabolic screening, hematology assessment, and evaluation of hearing and for retinopathy of prematurity (ROP) before discharge

• Transport to a regional centre

  • Interprofessional and family-centred approach-Medical, nursing, social services, and other professionals (physiotherapy, occupational therapy, developmental follow-up specialist) are critical for successful transitioning and long term neurocognitive development