| Transcutaneous Bilirubin (TcB) | Every baby @DRMC gets a TcB at 12 hours of life and at 24 if elevated. TcB underestimates the TSB (Total Serum Bili), get serum bilirubin if TcB is elevated. |
| When do you check the baby’s blood type and DAT? | If the mother is O+ or any negative blood type you send for babies blood type and Coombs at the same time. It gets done in labor and delivery. If mum is any negative type, and baby is any positive type, mum gets Rhogam after delivery. Any negative type = A-, B-, AB-, or O- |
| Rhogam | -All Rh negative mothers get Rhogam at 28weeks. -When they give birth, all Rh-negative mothers with Rh-positive babies will get an additional Rhogam within 1 to 3 days of delivery. |
| Urination | A baby should have at least 1 urination in the first 24hrs of life. 2 in the second 24hrs. It should increase from 1, 2, 3, 4, 5… as the days increase because initially, the mother’s milk is not flowing. By day 3 our four when milk starts coming more, they start having many wet diapers. |
| BMs | Baby should have 1BM, usually before 24hrs and certainly before they are discharged. See AAFP article, Failure to pass meconium: Diagnosing neonatal intestinal obstruction. After that, the BMs may vary. 3 or 4 days after birth, the meconium (thick black or dark green in color) will be replaced by yellow-green stools. Breastfed: If baby is breastfed, stools will resemble light mustard with seedlike particles. Until the baby starts to eat solid foods, the consistency of the stools may range from very soft to loose and runny. Formula fed: If baby is formula-fed, stools will usually be tan or yellow in color. They will be firmer than in a baby who is breastfed, but no firmer than peanut butter. |
| Babies less than 60 days | Any fever or infection (e.g. ear infection) requires admission. E.g. a 5 week old with an ear infection who has no other symptoms, no fever; who is F/V/S well and otherwise is very healthy; who had no risk factors for sepsis at birth (GBS negative, no PROM, etc) NEEDs to be sent to the hospital for admission and placement on abx like ceftriaxone for 36hrs. The goal is to r/o sepsis which can easily happen in a baby with a source of infection. When BCx come back negative, you will D/C the baby home with abx to finish treating the source if known. Pediatrician, Dr. K admitted a 5 weeker with ear infection. You treat them as an infant with a fever and r/o sepsis. Look at the Rochester Criteria for Febrile Infant 0 to 60 days. |
| Hypoglycemia in neonate | If recurrent requires transfer to NICU |
| Greenish Vomitus | Greenish (bilious) vomitus in a newborn should immediately make you think bilious vomitus and so r/o things like atresia, volvulus, etc. Get KUB and consult NICU. |
| Failure to pass meconium | Failure to pass meconium: Diagnosing neonatal intestinal obstruction. |
| Lotion | No lotion on kids for the first 4 weeks of life. |
| Jaundice | Bilirubin peaks at day 5 of life. Then goes down after that. So if there is concern, you want to check to make sure it’s not elevated. |
| When can you tell the baby’s eye color? | Dr. Gill’s response: At six months of age. Baby’s skins don’t produce pigment till about that time. That’s also why you don’t put sunscreen for babies. You just have to cover them. |
| 10% Weight loss | 10% weight loss is concerning in a newborn. Upon d/c from the nursery, a 7% weight loss would make you want to make extra effort to ensure that the baby is eating well and will have a follow up weight check in 2-3 days. |
| Maternal Chorioamnionitis | = Maternal Fever (an intrapartum temperature >100.4ºF or >37.8ºC) Plus any one of the following signs: Significant maternal tachycardia (>120 beats per minute [bpm]) Fetal tachycardia (>160-180 bpm) Purulent or foul-smelling amniotic fluid or vaginal discharge Uterine tenderness Maternal leukocytosis (total blood leukocyte count >15,000-18,000 cells/μL) |
| GBS Algorithm from CDC | Algorithm for secondary prevention of early-onset group B streptococcal (GBS) disease among newborns |
