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Discharging a baby with abnormal labs?

Ob/Gyn   (1,995 Views 8 Comments)

LuvofNursing has 17 years experience as a BSN, MSN, RN and specializes in Obstetrics, M/S, Family medicine.

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Looking for comments on the following scenario....

Mom delivered vaginally, GBS + treated only once, no other risk factors for baby to have an infection. We automatically order a CBC, CRP, blood culture on the baby since it had less than 2 treatments and GBS +. Labs come back (drawn approx 3 hours after birth). WBC 26.4 (critical high in our unit), CRP

During the night, one RR is observed to be 64 (the others were normal, mid to upper 50's, just like the previous shift). The MD was mad that he hadn't been called with this bit of information, THEN orders a f/u cbc, crp, which comes back WBC 17.9, CRP 0.23, Bands 6. He sends the baby home. He also states that had that ONE 64 RR not been observed, he wouldn't have ordered a f/u lab and sent the baby home (with a 25.9 wbc and 17 bands!)

Would you be comfortable with this as an RN?

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NPinWCH has 15 years experience and specializes in Family NP, OB Nursing.

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I'd still wait for the blood culture results before discharge and the prelim should have at least been back by the time the baby was ready for discharge. If I didn't have that last set of labs I would NOT have discharged the baby. Heck, in all honesty, I probably would have covered the baby with ABX based on that first set of labs and maternal history.

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Feeding well and afebrile? I wouldn't be concerned. I wouldn't even worry too much about that one RR of 64, but I can see where the MD would want to cover his butt with the follow up labs.

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Bobbkat specializes in NICU.

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In my hospital the first set of labs would have been enough to have the baby sent down to me in the NICU and had a 48 hour course of abx started until the initial culture results could come back.

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serenity1 has 7 years experience and specializes in labor & delivery.

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Baby would not have been discharged until 48 hour blood cultures were back at my facility...as another poster stated, the first set of labs would have sent baby to NICU for abx.

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bagladyrn is a RN and specializes in OB.

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My "comfort level" with this would have depended a lot on the parents: multip, well informed, lives local to the hospital, certain to follow up with new baby office visit and report any signs of illness - I'd be fine with sending them home. A young, uneducated mom with poor support system, maybe with a history or missing multiple prenatal visits I would want to keep until the results resolved.

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NPinWCH has 15 years experience and specializes in Family NP, OB Nursing.

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I agree that the parents would make a difference, but I'm still pretty sure that I would have treated the baby based on that first set of labs and maternal history. I've seen "healthy" babies go from pink, vigorous, good feeders to limp and septic in one shift because of GBS.

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Elvish is a BSN, DNP, RN, NP and specializes in Community, OB, Nursery.

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We wouldn't have sent kiddo home until the 48hr blood cultures came back negative. Based on the first couple sets of labs, the peds would have at least instituted q4h vitals/assessments with call parameters. It's rare that we treat with abx unless the culture pops up positive (which I've seen once or twice in almost six years) or the kid is acting funny. But I wouldn't have felt comfortable sending a kid home before a full 48hr negative blood cultures.

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