Laboratory Testing

 

 Reviewed by Carl Kuschel
May
2002
Clinical Guidelines Back Newborn Services Home Page
Collecting Ordering Tests New Admissions Babies on the Neonatal Unit
Jaundice Respiratory Distress Infection Screen Drug Monitoring

Collecting

On NICU and PIN nurses do capillary and arterial line collects. Doctors and NS-ANPs do the venous collects. These can be ordered at any time although it is better to stick to ‘standard times’.

On Postnatal Wards, there is collecting round at 0900. At other times inform the laboratory (3051) that a collect is necessary. Group the collections at 1300, 1600 or 1700, 2100, 0100 and 0500. For serial glucoses, write the times on the first glucose form and the rest will be done.

Ordering tests

What tests to order

New Admissions

Preterm, IUGR, Unwell, >4kg, IDM
  • Blood glucose monitoring 2, 4, 8, 12 hours and after that as indicated
  • See hypoglycaemia guideline
  • FBC

Respiratory distress or possible infection
  • Surface swabs and gastric aspirate
  • Blood culture
  • FBC
  • Glucose monitoring
  • Consider LP
  • Urine if >24 hours old

Unwell, asphyxia, respiratory distress
  • Consider blood gas (arterial or capillary)
  • FBC

IUGR
  • Consider congenital infection screen:
  • Urine CMV, rubella/toxo serology ± IgM.
  • Get maternal information

Babies on the Neonatal Units

<1000gms for 1st few days
  • Regular blood gases include Na+, K+, ICa++ and glucoses. These do not need to be done separately.
  • Blood gases as indicated by baby’s condition.
  • Daily FBC, urea and creatinine.
  • SBR in first day and as indicated thereafter.
  • If no regular gases, glucoses 4 hourly initially, decreasing frequenct if stable. Electrolytes 8-12 hourly initially

<1500gms for 1st few days
  • Very dependant on clinical condition
  • Glucoses serially initially.
  • Electrolytes daily. Urea and creatinine daily initially.
  • FBC initially and daily if unwell.
  • Gases as indicated.
  • SBR if any sign of jaundice.

Babies on IV therapy
  • Glucoses 4-8 hourly until stable then daily.
  • Electrolytes, urea and creatinine daily initially.

Babies on IVN
  • Initially daily urea, electrolytes, blood gas, glucose, FBC.
  • When stable, 2 x weekly bloods. More frequent glucoses.

Preterm babies after first few days
  • Weekly electrolytes if indicated.
  • FBC if symptoms and/or signs of anaemia.

Babies <1000gms, or on IVN for >2 weeks, or diuretics/steroids for chronic lung disease
  • Ca2+, PO43-, and ALP as indicated clinically.

Jaundice

Respiratory Distress

Infection screen

Drug monitoring