Good resource for neonate lab values?

[RN*mommy]

I've been a nurse for almost 10 years and I've worked in peds and most recently a level II SCN. I've moved on to the challenge of a level III NICU and realized how much I've forgotten. The SCN I worked at had 24 hour NNP coverage and so any lab values were reported to them with little involvement from us nurses. I feel like I almost need to go back to the basics and relearn important lab values and what they indicate for this new job. Anyone know of a great pocket guide or even a book they recommend? A phone app wouldn't work as I don't keep my phone near me while working.

Thanks!

[babyNP., APRN]

I've been doing NICU for 5 years and I haven't seen anything in print or on this board...

Most neonatal levels are similar to adults/peds with a few exceptions.

Hematocrit-varies on facility, but generally don't want about 40% or below 30%. Some places let them go down to 23-25% before transfusing, but that's getting on the low side.

Potassium-Levels are the same, but because most of them are heel sticks, the sample tends to get hemolyzed, causing a false high level. Arterial sticks tend to be more accurate.

Each kid may have different levels they will tolerate based on their own disease/genetic process. I've taken care of kids who live at sodium levels of 130, no matter how much salt we push on them and the docs are fine as long as it's not below that.

We want calcium/phos levels to be WNL because without it, the kids are prone to osteopenia and fractures. Keep in mind that infants receive most of their bone mineralization in the third trimester, so anyone below 28 weeks is at a greater risk. We can't give a ton of calcium through a peripheral line either compared to a central line.

Platelet counts vary by facility, but we don't transfuse unless the count is below 50 or active bleeding.

C-reactive protein (inflammation) is a newer diagnostic lab that's being used more frequently in conjunction with a CBC to check for s/s infection.

There are often RBCs in a spinal tap if the kid has IVH or the doc isn't able to get a clean sample because it can be harder than adults because of the smaller area or if the kid is dehydrated.

Coag labs will always be off than the norm because infants don't have the protective factors that older kids have (they develop by a year old). I've forgotten the name of it, but the kids have it until they're teenagers...

That's what I can think of off the top of my head. I'll let you know if I think of anything else...

[RN*mommy]

Oh wow, thank you so much! That's awesome. I did wonder about retic values as well...that was thrown around a lot on my first day regarding a baby from an abruption. I know it has to do with potential blood loss and anemia, but what's the cutoff for neonates where I'd be more concerned?