CLERKS’ ORIENTATION

Section of Newborn Medicine

Department of Pediatrics

OBJECTIVE 1 To learn the common problems in the newborn period

Normal Newborn care Cord care Thermoregulation Eye Prophylaxis Vit. K Prophylaxis Latching on and breastfeeding support

Common newborn problems Jaundice Respiratory distress Sepsis

ACTIVITY: lectures; daily rounds in DRI/NXI

OBJECTIVE 2 To acquire the skills in common newborn procedure

Newborn resuscitation Cord care Latching on and breastfeeding support Assessment of the high risk neonate

ACTIVITY: In OBAS/DRI:

Attend deliveries Latch on newborn infant to mother while in the DR

In NICU: Assist / perform procedures (DVET, thora, CTT, cannulation) Assess on-call problems of high-risk neonates

OBJECTIVE 3 To learn how to manage stable growing

neonates

ACTIVITY: > NICU 1 and 2

Patient assignments and problem-oriented progress notes

Write daily orders (countersigned by resident / fellow) Follow up labs/ x-rays or accompany to procedures Do Hgt on infants

OBJECTIVE 4

To learn how to teach mothers on normal newborn care

For DRI : Teach mothers on normal newborn care Latching on and breastfeeding support Expressed breast milk donation Breastfeeding education

Value formation To develop empathy with parents of sick

newborns To develop a habit of sepsis prevention

Hand washing Maintaining a clean resuscitation area &equipment Breastfeeding

To develop an attitude of resourcefulness in treating newborn infants with limited resources

To develop an attitude of teamwork with medical and paramedical staffs for the management of newborn infants

Clerks’ Sked

Duty OBAS / LCB 24 hrs

Pre-duty 7:30 – 9 am

DRI

9 am – 4:30 pm

NXI

Post-duty 7:30 – 9 am

DRI

9 am (off except during conferences)

*pre-duty and post-duty must attend departmental conferences; pre-duty returns to post after the conference

*every Monday, clerk goes to High-Risk Clinic at 1:30 pm

Expectations in the NICU:(pre-duty)

CLERKS: (blue bond paper)

- 2 NICU patients every pre-duty

- presents the cases to the pre-duty senior

in the afternoon

- during weekends, get only 1 case and

presents the case before 12 nn to the pre-

duty senior

- acts as the junior of the NICU 2 intern

> accompanies patients during x-ray procedures

> assists in Hgt monitoring

> writes abstracts and discharge summaries

Expectations in the DRI (pre-duty and post-duty)

morning rounds with resident on ALL

patients

3 different patients daily:

> assess for newborn problems

> breastfeeding evaluation & support

> LATCH-ON (prioritize primis)

pre-duty: goes up to NICU at 9 am

POST-ROTATION evaluation

CLERKS:

> a post-rotation quiz on the last day (3 or 4 pm)

> 20 points (basic newborn issues)

> pre-duty NICU seniors evaluates NICU cases

presented (written on blue bond paper)

> evaluation sheets given to DRI resident and OBAS

resident who were able to observe the

performance of the clerk

REMINDERS!!!

NICU Group: Sign attendance on logbook at NICU

OBAS/DRI Group: Sign attendance on logbook at OBAS

ON MONDAYS 1 pm: All PRE-DUTY STUDENTS:

Presents 1 NICU case only before lunch Attend High Risk Clinic at Pedia-OPD Give vaccines at the High Risk Clinic.

Duty students (OBAS/LCB) Check admitting section for new admissions Monitor status of mothers in admitting section and labor

room Obtain maternal and perinatal data while mothers are in

labor room and start filling-in OB sheet. Inform resident/fellow of status of mothers Attend all deliveries Perform Apgar scores in completed first and fifth minute

(must not change scoring if demanded by OB residents), RETROSPECTIVE (not during resuscitation)

Stabilize and thermoregulate patients and decide level of care.

Duty students (OBAS/LCB) Latch baby on mother’s breast. Monitor baby and

mother during latching on. Once the OB student finishes his procedures, he may substitute the pedia intern in monitoring the mother and the baby.

Complete OB sheet Assist in transport of patient. Please log down if with

no UW is available during transport Log patient’s name on census logbook.. Note in communication logbook for any

remarks/problems

Pre-duty students (NICU)

NICU I assess patients for discharge and complete discharge forms

NICU II-III: performs procedures (blood extraction, Hgt monitoring, x-ray reading, BP)

Discuss findings with resident and/or fellows

ATTIRE DUTY AT OBAS/LCB:

Full scrubs (cap, mask,footwear) PRE-DUTY/POST-DUTY at DRI:

white uniform PRE-DUTY at NICU

Separate footwear (bring own slippers) Use NICU gown over white uniform on

entering NICU or may change to scrubs Change to street wear or white uniform if

leaving the NICU for meals, conferences, clinic, etc.

Hand Hygiene

• 5 minute anti-septic scrub up to the elbows upon entry to the NICU

• Strict hand washing or alcohol based rub between patients

• Avoid unnecessary hand contact with equipment and patients

Procedures Neonatal resuscitation

Bag and mask ventilation (Must know) Umbilical cannulation (Optional) Intubation (Optional)

Blood extraction Cord dressing Latching-on CAP and MASK when assisting cannulation

and DVET HANDWASH!

ConferencesAttend departmental conferences

Mondays, Wednesdays and Fridays (except when on duty)

Lectures by NICU residentsCATS presentation by residentsConsultant roundsNICU service and catchers’ audits

ESSENTIAL NEWBORN CARE

1.Cleanliness Clean delivery and cord care for the

prevention of newborn infections- clean hands with sterile gloves- clean perineum- clean delivery surface - cleanliness in cutting the umbilical cord- cleanliness for cord care of the

newborn baby.

Cord Care Keep the cord dry and clean at all times. Apply 70% isopropyl alcohol to the cord and

let it dry. Diaper should be fastened below the cord. Bandages, binders or dressings should be

avoided. The stump will dry and mummify easily if exposed to air.

Redness around the base, foul odor or drainage from the cord warrants immediate consult.

2. Thermoregulation Normal NB body temp. – 36.5 to 37.5 C Body heat is lost through:

a. Conduction- heat loss from the infant to the surface on which he or she lies.b. Convection- heat is lost from skin to moving air.c. Radiation- heat loss from the infant to a colder object in the environment.d. Evaporation- transfer of heat from skin and respiratory tract to a drier environment.

Prevention of HypothermiaDelivery of baby in a warm room.Drying the baby thoroughly after birth.Wrapping the baby in a dry warm cloth.Early skin-to-skin contact for the first

few hours after birth.The temperature of the infant should be

checked regularly.

3. BreastfeedingLatching-on Early contact between mother and

baby.Exclusive breastfeedingFeeding should be on a per demand

basis.Family education about the importance

of breastfeeding.

4. Eye CarePrevention of ophthalmia neonatorumAgents used: 1% silver nitrate

1% tetracycline

0.5% erythromycin

5. Immunization At birth, BCG and Hepatitis B vaccines are

recommended by WHO. BCG should be given as soon as possible

after birth. Hepatitis B vaccine should be integrated into

national immunization programmes. For Hep B (+) reactive mothers, pls prescribe

HBIG. Should be given w/in 12 hours. Study guidelines on Hep B prophylaxis posted at the catchers’ area.

ENJOY YOUR ROTATION!!!