timing of newborn bath

SmilingBluEyes · Nov 21, 2003

Dubowitz exam

The Dubowitz scale is a standardised scale for the estimation of newborn gestational age by neurological examination. The full exam is very extensive and scores 33 specific responses in four major areas: habituBallard scale

The Ballard scale is a more simplified maturity rating scale for estimating newborn gestational age. It consists of six evaluation areas for neuromuscular maturity and seven items of observed physical maturity. It is the scale probably most often used in the nursery. See also Dubowitz exam.

http://www.drhull.com/EncyMaster/B/Ballard.html

hope this helps!

SmilingBluEyes · Nov 21, 2003

much more detailed descripiton of Dubowitz exam:

http://216.239.57.104/search?q=cache:sF6IvZZc4YAJ:www.paclac.org/Manuals_Guidelines/Gestational_Age_Assessment_Final_4.1.98.pdf+ballard+dubowitz+scores&hl=en&ie=UTF-8

susancox · Nov 21, 2003

1) The whole RT thing seems weird I guess because it's different, sorry. Without that person being a RN, can he/she do the ballard/dubowitz, meds (Vit K and Erythro.)? Because of the "assessments" is why we don't use any LPNs. How does that work with RTs?

2) Thanks for the dubowitz info. We must do an abreviated version or something. It looks at 1-the skin (peeling?, visible veins?Leather? Cracked?,etc.) 2-the nipple bud size, 3-the creases on the soles of the feet, 4-ears (well formed pinna, recoil, stiffness, etc.) 5-the genitals (boy-rugae deep?, pendulous? Testicles descened? etc. and Girl-proportions of labia majora vs. minora) it only takes a couple of minutes.

What is on the Ballard?

3) I love the idea of the blanket warmers in the room!!! How cool!!

4) Yea, what is up with the picture of the floating babies???

L&D_RN_OH · Nov 21, 2003

Originally posted by susancox
1) Without that person being a RN, can he/she do the ballard/dubowitz, meds (Vit K and Erythro.)?

2) It looks at 1-the skin (peeling?, visible veins?Leather? Cracked?,etc.) 2-the nipple bud size, 3-the creases on the soles of the feet, 4-ears (well formed pinna, recoil, stiffness, etc.) 5-the genitals (boy-rugae deep?, pendulous? Testicles descened? etc. and Girl-proportions of labia majora vs. minora) it only takes a couple of minutes.
What is on the Ballard?

The RT is only in the room for delivery. They assign Apgars. They only assess the baby immediately after birth. That is it. The full assessment, Ballard, Vit K, etc. is done in the NSY during transition which is 1-2 hours after delivery, after Mom and babe have had time together.

What you're describing sounds like half of the Ballard scale.

dawngloves, BSN, RN · Nov 21, 2003

We call it "Ballard" because she's our Chief of Neonatolgy.

But it's all the same animal.

BTW, I'm lookink at that pic and predicting that is how we will keep preemies in the future!

imenid37 · Nov 21, 2003

I am jealous of the blanket warmers in the room. This was suggested when we got our new unit several years ago, but was too costly (we had to buy ugly carpeting for the nurses' station instead). We basically do the LDRP thing for healthy newborns. The bath fits in when baby is warm enough, stable enough, and parents are ok w/ it. ie. they are done, nursing, holding, admiring, etc. Some things are a rush, but not the bath. I used to work in a much busier place (250 del/mo vs. 60/mo), so I know some people don't have the ability to be as flexible w/ their time as they have other moms in labour or couplets to attend to.:)

Mimi2RN, ASN, RN · Nov 22, 2003

We have a radiant warmer and warm blankets at every delivery, but I find that they aren't thick enough to do a good job, especially if the babe is left on mom to breastfeed....and have everybody and the dog wanting to look at it (I'm kidding about the dog) :chuckle

Normal deliveries here have the L&D nurse taking care of the baby, she will also be responsible for the assessment. An LVN, or another labor nurse will do all the other baby stuff. I only come into the picture if there is a problem.

We are doing 350+ deliveries a month now, and a high risk population...teen moms, older moms with many kids, fertility tx babies, and of course the moms on various kinds of illegal substances (and the legal methadone is just as bad).

Mira · Nov 22, 2003

Originally posted by Jolie
Dawngloves,

It's an attempt to prevent an asymptommatic hypoglycemic infant from bottoming out during a bath. Most units check blood sugars only on babies that fit their protocol or are symptommatic. But it is possible to have a hypoglycemic baby that neither fits the protocol nor is symptommatic. If such a baby is fed prior to bathing, chances are that he will tolerate the bath without dropping his sugar too badly.

Sorry I can't seem to get the point,maybe I'm thinking about the theory of having your meal and going in a rollercoaster ride, or maybe I'm thinking about bathing the baby right after feeding.Is'nt it they have glucose reserve from maternal influence and unless they have a metabolic problem and they had cold stress they should maintain their glucose level within normal range? :confused: :)

BETSRN · Nov 22, 2003

Most of our baby baths are done at the bedside and as a teaching demonstration for the parents. We hold the bath until the baby is about 99.6. Baby needs to nurse and be skin to skin with Mom for a while. We don't separate the babies at all in the first few hours if we can help it.When we do the bath, we do it under the warmer usually. Occasioally some of the gals do them in an isolette (if the baby is in one) but personally, I find bathing in an isolette very awkward.

BETSRN · Nov 22, 2003

Someone said the assessment must be done within the first two hours. Isn't that one of the jobs of the L&D RN taking care of the mother??? I guess I just assume that, as we do LDRP and have to do everything for mother and baby. That is certainly something that could be taken on by the L&D nurse doing the recovery. She is there with the mother and baby anyway.

BETSRN · Nov 22, 2003

I ha to laugh about this "stress on the L&D nurse! All nurses who work with infants ha to be NRP certified. All the L&D nurse has to do after delivery is help with breastfeeding initiation and check a fundus every so often. This is hardly stressful (I say this because I am an LDRP nurse). Those of you who work in an old fashioned places have a chance to make some positive changes within your institution. I think there is a tremendous waste in resources some of the places that some of you work.:chuckle

L&D_RN_OH · Nov 22, 2003

Originally posted by BETSRN
Someone said the assessment must be done within the first two hours. Isn't that one of the jobs of the L&D RN taking care of the mother???

Nope. That was me that said that. We do quick assessments and check VS, but the full assessment: VS + BP, measurements, Vit K, erythromycin, Ballard scale, bath, et. is done by the NSY nurse. I would love to offer bedside transition more often. Unfortunately, we have nurses that are resistant to change. Several of the NSY RN's HATE coming out of the NSY. It's a fight with them to keep the babies in the room with Moms.