Management of Paediatric Problems on Postnatal Wards by Obstetric House Staff and LMCs

 

Reviewed by Salim Aftimos
January
2001
Clinical Guidelines back Newborn Services Home Page
Tachypnoea Meconium Exposure Infants of Diabetic Mothers Low Birth Weight and IUGR
Prematurity Temperature Control Risk Factors for Sepsis Risk Factors for GBS Sepsis
Heart Murmurs Jaundice Cord Flare
 

The following are some guidelines and list of conditions which may be managed by obstetric house staff and Lead Maternity Carers on postnatal wards.

Please note that all referrals are to be directed to the Paediatric Registrar or Paediatric House Surgeon who with Dr Aftimos is on for the postnatal wards. All signatures must be clear, printed if necessary so that we can audit problems when they occur.

Tachypnoea

Meconium Exposure

NB If the infant is feeding well and pink on examination, and seems normal despite the presence of a fever or tachypnoea, then a chest x-ray and full blood count could be organised before being seen by the Paediatric Registrar.

Infants of Diabetic Mothers

See the guideline for management of infants of diabetic mothers on the postnatal ward.

Low Birthweight (<2.5kg) and Intrauterine Growth Retardation

See guideline on 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.

Risk Factors for Group B Streptococcal Sepsis

If mother has any of these risk factors then the guidelines for NWH suggests antibiotics in labour.

Jaundice

(see also Neonatal Jaundice on the Postnatal Ward)

  1. Clinically present before 24 hours of age.
  2. Whenever other symptoms/signs of illness are present.
  3. When the serum bilirubin is >200mmol/L on the second day of life.
  4. When the serum bilirubin is >250mmol/L.
  5. When jaundice is of late onset (7-10 days or later) or is prolonged with serum bilirubin >200mmol/L after 7-10 days of life.

Heart Murmurs

Cord Flare