is this normal newborn care? advice please

Published

for the past two years i have worked in a small community hospital in the birth center. we deal with low-risk cases and average 20-40 deliveries a month. the management have recently hired a neonatal co-ordinator to primarily update our skills with sick babies who need transferred to NICU's in larger hospitals. this is great but this lady is now changing our normal newborn polices so that EVERY newborn regardless of apgars and absence of predisposing factors gets a rectal temp and a blood sugar as part of our routine care. the staff here are not NICU trained so we may be in the dark ages as to new standards/ research etc, but we feel this is a little over the top for a birth center that deals with "normal "babies. We would be very grateful for any opinions or advice anyone has about this matter and if anyone could suggest research for or against then we would welcome it. A big thank-you to all who help:)

Up Vote Up Vote ×
Specializes in ER.

The rectal temp is but we had criteria for glucoscans, like below 5 lb, more than 10lb, apgar less than 7 diabetic or preeclamptic mom, I forget all of them. I worked in a small hospital that had about 1500 deliveries a year.

Up Vote Up Vote ×

I've worked in several hospitals (I'm currently in a 70 bed level 3 NICU, the hospital births about 5000 babies a year). We have never done rectal temps, and babies only get bloodsugars done if there are any risk factors for hypoglycemia.

Up Vote Up Vote ×
Specializes in Maternal - Child Health.

I started my nursing career in a level III NICU. For 3 years, I never saw or cared for a normal, healthy newborn. When I changed jobs and went to a normal newborn nursery, I had a difficult time adjusting to the notion that not all babies require interventions. A very experienced colleague helped me to "get over it". I think your new neonatal coordinator needs to "get over it" too!

I would not recommend either rectal temps or glucose checks on a regular basis.

Up Vote Up Vote ×
Specializes in NICU.

I work in a level III NICU, and it's very rare that we do any rectal temps. The only times we consider it appropriate is when we have a larger baby (usually a former micropreemie who is now a big, post-term chronic BPD-er) whose axillary temperatures are all over the place. So sometimes when they're really chubby and sweaty, we'll do Q8H rectal temps on them. However, if they're not showing any S/S of illness, we might just stick to axillary and consider those truly a degree lower than normal. If a kid has a central line, though, we'll do the rectals because we don't want to miss early sepsis clues.

As for the glucose checks - I just don't really get what the problem is. It's just one heelstick, and to me piece of mind is worth it. I know I'm biased because I don't see "normal" babies but I sure as heck have seen a bunch who were treated as "normal" in NBN end up coming to us with sugar issues later on.

Up Vote Up Vote ×

I have also done NICU for many years, with a short period of time in a normal newborn nursery (years ago). It was a difficult transition to make to not treat the well babies as if something "might" be wrong with them. As for blood sugars, don't you need to have a doctor's order for this? If your docs aren't used to having blood sugars done routinely, they probably won't want it, and that will take care of that.

Up Vote Up Vote ×
Specializes in Neonatal ICU.

It's probably a good idea to do a rectal once upon admission to make sure that the rectum is patent (r/o imperforate orifice), unless the baby has already passed stool, then axillary is fine. As for blood sugar -ONLY if there are risk factors. A normal newborn's blood sugar should not be an issue.

Up Vote Up Vote ×

I work in NICU and get pulled to NBN occasionally. We do one rectal temp in both areas upon admission to check patency of the orifice. In NICU all infants get a blood sugar check within 15 minutes of admission. One of our Docs likes them q4h x 24 hours at least (for all her NICU babies) The other one doesn't require them but he tends to order more labs more frequently (BPM qd while on oxygen and NPO) whereas the other one does not. I'm not exactly sure what the protocol is for checking sugars in NBN. I know if the infant is LGA or mom is diabetic then they get checked, but I don't remember if otherwise normal newborns get checked.

Up Vote Up Vote ×

I floated as a tech to Labor/delivery at the same hospital I did my clinical maternity rotation in school and all babies got accuchecks for glucose and I think it was just nurses pref. on rectal vs axillary temp because I saw them do it both ways. I think some nurses like the supposably more accurate rectal temp. Better safe than sorry! For example, a fellow student of mine had a 12 hour post-part couplet. The infant appeared fine on immediate assessment, but had a temp of 97.0. She pulled the infant out of the room and the rectal temp was very similar, like 97.2. They proceded to check glucose, which was about 20 (give or take.) The baby spent the next days in a NICU, but they wished they would have checked the sugar sooner!

Up Vote Up Vote ×
I have also done NICU for many years, with a short period of time in a normal newborn nursery (years ago). It was a difficult transition to make to not treat the well babies as if something "might" be wrong with them. As for blood sugars, don't you need to have a doctor's order for this? If your docs aren't used to having blood sugars done routinely, they probably won't want it, and that will take care of that.

If the neonatal coordinator is certified as NNP, they have the authority to do the orders (I think). Does anyone know for sure if that is right? That's one thing that I'm not sure about, what exactly is the role of an NNP? I am just about to start my job in the NICU and if I like it enough after getting years of experience, I thought it may be something to be interested in, although I wish I knew what the actual role is!!

Up Vote Up Vote ×
Specializes in Babies, peds, pain management.

I work in a community hospital with a Level II nursery (we handle everything from mod resp distress to sespis but extreme preemies, vented and surgical babies are sent "down the road to the childrens hospital). We do rectal temps on all nb, we actually had a baby ready to dc when it was realized no anal opening (missed by nurses and peds!). But we have protocol for glucose and hct checks, some meet the criteria (IDDM, SGA, smoker moms, etc) some don"t.

We also have protocol to get lab if repeatedly hypothermic or tachypniec. I prefer to have the protocol to work with. Usually everythings WNL. Work with her and ask her reasoning behind the changes. I learn better when I know the rationale behind the actions. Maybe there's room to compromise on all sides. :)

Up Vote Up Vote ×
Specializes in OB.

Not all newborns are healthy... every so often there will be babies in our normal newborn nursery that appear healthy, but hide their "illness" very well... at least until their ready to be discharged and then end up in the NICU. As Hannahrn and JVanRN mentioned, we also do rectals after admission to R/O an imperforate orifice. We also may do a rectal if there are temp instabilities and the doc wants a more accurate temp. However, I do think your new neonatal coordinator is going overboard with EVERY newborn getting blood sugars done. At my facility, we have a policy to only do blood sugars if there are any risk factors or if there is signs and symptoms of hypoglycemia.

Up Vote Up Vote ×
+ Join the Discussion