Prior to Admission

• CPAP incubator to DU/OT for delivery.

Admission

• Appropriate respiratory support (optimal CPAP).
• Baseline observations / monitor
  • HR
  • Respirations
  • SaO₂ as per oxygen saturation targets (range 85 – 92% with O2 requirement / alarm limits set appropriately)
  • BP (mean blood pressure ≥ gestational age)
  • Temperature (monitor skin temperature initially)
• Commence incubator humidity 50% (discontinue 3 weeks of age or 32 weeks gestation, whichever comes first)
• IV 10% Dextrose 60-90mls/kg per day.
• FBC.
• Blood cultures if risk factors for sepsis or baby unwell.
  • Commence antibiotics if indicated.
• Blood glucose.
• Capillary gas.
• Commence urine weighs.

Ongoing Care

• May need 1-2 hourly cuff BP measurement initially,
    then 4 hourly,
    then minimum 8 hourly till stable.
  • Discuss frequency on ward round.
  • Report hypotension or fluctuations in blood pressure to medical staff.
• Continue:
  • urine weighs.
  • urine testing for glucose, blood, and protein.
    Test 8-hourly initially then discuss frequency on ward round.
  • blood glucoses as indicated.
  • capillary gases/electrolytes/SBR as indicated.
• Careful observation / assessment / documentation of respiratory status
  • Report changes to medical staff.
  • Have a low threshold for restarting babies back on CPAP if they are being trialled off and become symptomatic with increasing tachypnoea, desaturations, oxygen requirement, or apnoea.
• Discuss and assist mother with expressing.
• Demonstrate and encourage parents’ safe handling of baby
  • nappy changes
  • top and tail
  • positioning / settling
  • Kangaroo care
    • <30 weeks not in first 5 days
    • ≥30 weeks consider stability
    • Monitor infant's physiological status carefully.
    • Discuss on ward round if unsure.

NB: Read appropriate parts of Developmental Care Protocol