is this normal newborn care? advice please

[wobble]

Worked for past two years in a small community hospital birth center in northern CA. Deal with low - risk cases and usually do about 25-40 deliveries per month. Recently the management have hired a NICU nurse from a larger hospital to be a neonatal co-ordinator here with the primary goal of educating the staff about sick babies, should the need ever arise to treat before transfer. This is fine, but now this lady wants to change our policies and have EVERY normal newborn regardless of apgars to have a rectal temp and a blood sugar done as part of the routine care. Is this the norm in other places? I feel like it is a bit extreme and have requested the evidence to back up this change - still waiting. Am I wrong in thinking this is unecessary for normal newborns in a community birth center? Can anyone suggest any research to argue against this or am i behind the times? Any help or opinons would be gratefully received.:)

[fergus51]

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

Because you can't perforate anything with an axillary temp and they are accurate. I wouldn't let anyone stick a thermometer in my kid's orifice, when they can get an axillary temp. There is no reason for it.

[Mimi2RN, ASN, RN]

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?

symptomatic hypoglycemia in otherwise healthy, breastfed term newborns.

i think the key word in this is "breastfed". i am not entirely surprised that these babies had problems.

we do blood sugars on idm babies, big babies over 9lb, little ones under 5lb, and any baby that we are worried about. not all moms are diagnosed as gdm, but a baby that looks like a sugar baby gets treated like one. that's during the transition period. breastfed babies who are poor feeders usually will get their glucose checked on the floor, before they talk to us (when the mom/baby nurse is worried about a baby). that's because they know that the first question we have is about the blood sugar.

breastfed babies, especially ones who are poor feeders, need a lactation consult ordered, and benefit from slower d/c. the problems occur when mom wants to leave, and is not aware (or doesn't want to know) that things can go wrong.

i think the peds are happy to have their babies go home, too. (one less inpatient, thank goodness!) if no-one talks about poor feeding, and low sugars, that's a disaster waiting to happen.

i'd much rather give some formula than worry about the baby's brain.

[pooh54]

In the 3 instances cited, all were jittery and were possibly not tested for hypoglycemia when this was observed, routine BG on no to low risk infants seems to be going overbard. These 3 should have had a BG test done to r/o hypoglycemia simply because of jitteriness, others that are high risk should follow the recommendations of NANN, AWHONN and the AAP. Best of luck to you. OH, rectal temps can actually cause perforations if done by someone not trained to do them. You may want to post this on the NICU forum for more responses.