Management of Infants on Postnatal Wards under Paediatric Care

 

Reviewed by Clinical Practice Committee
October 2016
Clinical Guidelines Back Newborn Services Home Page
Admission from Delivery Tachypnoea Infants of Diabetic Mothers Prematurity
Temperature Control Risk Factors for Sepsis Jaundice Abnormal Pulse Oximetry
Heart Murmurs Cord Flare Ventouse Deliveries Feeding on the PNW

Admission to Postnatal Ward from Delivery Suite or NICU

NB: Infants = 2.5kg or 37weeks gestation should remain under the paediatric service on the wards.
 

Tachypnoea

Infants of Diabetic Mothers

See Guidelines for the Management of hypoglycaemia

Prematurity

Temperature Control

Note: Hypothermia is often the first sign of sepsis and the possibility of major infection should always be considered.

Sepsis Risk Factors at Delivery

Take swabs at delivery (ear/axilla/gastric aspirate) and ask for a differential on a full blood count. Request AC temperature and respiratory recordings.

If the white blood count shows a left shift (band forms and immature forms >20% of total neutrophils), if the respiratory rate is >60/minute or the temperature is >37.5°C, or swabs subsequently grow Group B Streptococcus refer to the Paediatric Registrar.

If two or more risk factors present, or the baby has symptoms other than the above, immediate referral is necessary.

Jaundice

see Jaundice on the Postnatal Ward

Abnormal Pulse oximetry screening

Heart Murmurs

Pulse oximetry should have already been carried out. Regardless of result, refer infant to Paediatric Registrar. If asymptomatic, further investigations such as ECG, CXR and echocardiogram may be carried out on the ward. Follow-up with Cardiology or Newborn service needs to be arranged.

Cord flare

Ventouse deliveries

These infants are at risk of sub-galeal haemorrhage. They need to be monitored. Discuss the level of surveillance with the Registrar within 30 minutes of delivery.

Feeding infants on Postnatal Wards

The main aim is promotion of successful, exclusive breast feeding
Weight loss >10% on day 3 needs referral to lactation consultant and paediatrician for consideration of adequacy of lactation and consideration of medical causes.

Healthy Term infants

Infants should be nursed whenever they show signs of hunger, such as increased alertness or activity, mouthing or rooting –ideally 8-12 times per 24hours.

Milk delivery time varies between mothers –some infants may be satisfied with less frequent feeds.
Once breast feeding is established feeding frequency gradually decreases to around 6 feeds per day for most infants (usually post discharge).

Healthy term infants do not require supplements (water/formula). If there are risk factors for hypoglycaemia such as maternal diabetes/asphyxia etc. then blood glucose monitoring is required. See Management of hypoglycaemia

Late pre-term infants, SGA and LGA infants, other at risk infants.

see Guidelines for Management of hypoglycaemia

Place infant skin to skin with mother, offer breast feed as soon as possible after birth and demand feed up to 3hourly.

For infants who latch and suck well on the breast there is no need for supplementation but mothers should be shown how, and encouraged to hand express after breast feeds to stimulate milk production.

For those infants who do not feed well e.g. difficulty latching, do not suckle for long- a blood glucose should be checked and a supplementary feed may be required (expressed breast milk or formula). Feed volumes will vary and individualised feeding plan can be discussed with the ward lactation consultant. The method of delivery may be via cup, syringe or bottle.

Orogastric or nasogastric tube feeds should only be instituted on the advice of the paediatric staff. See guidelines for supplementary feeding on the postnatal ward. See alsoNewborn services feeding policy

Glucose monitoring as per hypoglycaemia guideline