is this normal newborn care? advice please

allnurses Guide · May 21, 2005

Our first temps are always rectal. We don't do blood sugars unless indicated.

steph

lady_jezebel · May 21, 2005

these infants probably didn't have their glucose checked after birth & had normal apgars, though they later were readmitted for seizures or other complications & found to have hypoglycemia:

http://pediatrics.aappublications.org/cgi/content/full/103/4/837#T2

maybe by assessing the bg after birth, you would be alerted to an infant with a borderline sugar, or be able to see a trend?

palesarah · May 21, 2005

no, no you are not wrong for thinking thingd things are generally unecessary in a low risk population. We are a community hospital, LDRP model with a level 2 nursery doing 60-70 deliveries on average.

I don't have time to AWHONN, NANN, and AAP standards but I think that will be a good place to go becuase I don't think any of them support doing routine rectal temps and blood sugars. Routine rectal temps are a throwback to when they checks for imperforant orifice- we can clearly tell that if a baby is pooping, it works! And an axillary temp is just as accurate and much safer in a neonate (there have been documented rectal perforations in institutions that clung to myth that the rectal temp was the only accurate temp; does your hospital's risks management department want to take that on?)

For blood sugars- I have a story. We had a nurse start with us, she moved up from Texas where she had been working in the county hospital. Fast pace, quick pt overturn. She was shocked when she learned that we didn't automatically do a sugar on every baby- "how do you know which kids to check". "We check mom's rick factors during labor, or after delivery if the baby is LGA, or if the baby is showing signs of hypoglycemia, or cold stress...."

My point is, every baby doesn't need a blood sugar. All babies would be benefit more, IMO, if you had clear guidelines for which babies' sugars to check such as: infant of diabetic (gestational or preexisting) mothers, LGA with s/s hypoglycemia, SGA, cold stress, s/s hypoglycemia... I'm sure there are other good guidelines to go by too.

Hope that's a little helpful, at least; good luck!

lady_jezebel · May 21, 2005

http://www.merck.com/mrkshared/mmanual/section19/chapter260/260i.jsp

for temp: there may be "unrecognized cold stress" in an infant, increasing his/her demand for O2; if not delivered, may cause neurological demage & decreased growth.

for bg: hypoglycemia can occur in babies that are not recognized as high risk, ie. "glycogen depleted infants". many of these infants can be asymptomatic.

better to be safe than sorry, imo. the consequences of hypothermia or hypoglycemia can be devastating.

lady_jezebel · May 21, 2005

Detecting Fever in Young Infants: Reliability of Perceived, Pacifier, and Temporal Artery Temperatures in Infants Younger Than 3 Months of Age.

Pediatric Emergency Care. 19(4):240-243, August 2003.

Callanan, Deborah MD

http://www.pec-online.com/pt/re/pec/abstract.00006565-200308000-00004.htm;jsessionid=CPJwd1aMKjyTaHyN1EdOWR9qwXdBOCIgKRQT8zDTZ57v74FzHDEX!1058777245!-949856031!9001!-1

and

MEASURING TEMPERATURES.

Pediatric Infectious Disease Journal. 17(10):920-921, October 1998.

Loveys, Alice A. M.D

*** rectal temps are still the standard of care in pediatrics

allnurses Guide · May 21, 2005

Detecting Fever in Young Infants: Reliability of Perceived, Pacifier, and Temporal Artery Temperatures in Infants Younger Than 3 Months of Age.
Pediatric Emergency Care. 19(4):240-243, August 2003.
Callanan, Deborah MD
http://www.pec-online.com/pt/re/pec/abstract.00006565-200308000-00004.htm;jsessionid=CPJwd1aMKjyTaHyN1EdOWR9qwXdBOCIgKRQT8zDTZ57v74FzHDEX!1058777245!-949856031!9001!-1
and
MEASURING TEMPERATURES.
Pediatric Infectious Disease Journal. 17(10):920-921, October 1998.
Loveys, Alice A. M.D

*** rectal temps are still the standard of care in pediatrics

Which is what one of our new docs said . . .we weren't doing rectal temps anymore and now we are.

Still don't think there is a need for routine BS if you assess for all the risk factors noted already.

steph

tntrn, ASN, RN · May 21, 2005

We do axillary temps on all infants. Haven't seen or done a rectal in a very long time. We have a strict protocol on which babies get sugars checked, and then you can check if a baby not in any of the risk categories demonstrates any kind of symptom (jittery, for example) which makes you want to know.

fergus51 · May 21, 2005

I have never worked in a hospital that did rectal temps on babies. To me, that seems barbaric and I can guarantee you I wouldn't let someone do that to my baby. We also don't do "routine" blood sugar checks on healthy babies. I think that's going overboard and I work NICU.

allnurses Guide · May 21, 2005

I have never worked in a hospital that did rectal temps on babies. To me, that seems barbaric and I can guarantee you I wouldn't let someone do that to my baby. We also don't do "routine" blood sugar checks on healthy babies. I think that's going overboard and I work NICU.

I'm just wondering why rectal temps are barbaric. They don't hurt, the thermometer is barely in . . we just did one in the ER now on a one week old male with respiratory symptoms.

I did rectal temps on all my kids at home - nary a cry. Of course, when my oldest was a baby, we used those glass ones with the mercury . . . . :uhoh21:

steph

k_cole21 · May 21, 2005

I just don't think rectal temps are necessary when an axillary one is just as accurate. We have done ax temps on all newborns at the 4 hospitals that I have traveled to, all level 3 and strict guidelines on accuchecks (LGA, SGA, less that 37 wks, diabetic mom, etc...)

palesarah · May 21, 2005

To me, that seems barbaric

agreed. I can't speak for fergus but I also think rectals are barbaric and too risky- babies may fuss more with an axillary, but they are equally accurate and you're not risking rectal perforation.

BTW, apologies for the typos in my earlier post. I was coming off my third 12+ hour shift in a row