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Neonatal Handbook

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Near Term Infant

 Summary

  • refers to babies born 35 - 36.6 weeks' gestation and/or 2.0 - 2.5 kg birth weight
  • where possible the aim is to keep mothers and babies together and therefore these babies may not require admission to a Special Care Nursery
  • breast feeding (link) should be encouraged and supported
  • these babies are at higher risk of acute complications and have special needs and require closer observation
  • these babies should be managed by a Paediatrician

Risks

The near term infant is at increased risk of the following

  • hypoglycaemia
  • hypothermia
  • respiratory distress 
  • sepsis
  • jaundice which may be prolonged
  • feeding difficulties
  • poor weight gain
  • psychosocial issues for the parent(s)

Birth Suite Management

  • a Paediatrician or doctor with experience in neonatal resuscitation  should be in attendance if the gestation is 35 - 36.6 weeks or the baby is expected to have a birth weight < 2.5 kg
  • provide skin-to-skin contact with mother immediately, dry infant on mother's chest, remove wet wrap and cover infant with dry warm wraps, cover head 
  • if no respiratory distress attempt feeding as soon as possible
  • perform blood sugar level prior to leaving birthing suite

Observations in the ward

  • the baby should have axillary temperature, pulse and respiratory measurements performed following admission to the ward and then before feeds for the first 24 hours
    • normal parameters are
      • temperature 36.5 - 37.3o Celsius
      • pulse rate 100 - 180 beats per minute
      • respiratory rate 40 - 60 breaths per minute
    • if any of these are abnormal the baby requires admission to a Special Care Nursery for closer observation and a medical review
    • if the above measurements have remained normal in the first 24 hours they can be ceased however the axillary temperature should be measured before each feed until it has been in the normal range for at least 24 hours
  • blood sugars should be performed before each feed until at least three consecutive measurements are > 2.5 mmol/L
    • if at any time the blood sugar level is < 2.6 mmol/L the requires a medical review and consideration of admission to the Special Care Nursery

Weight 

  • the baby should be weighed as soon as practicable after birth
  • weigh the baby every 48 hours thereafter
  • a weight loss of greater than 10% requires a medical review
  • after day 3 it expected that the baby will gain at least 10 g/kg/day
  • babies of 35 - 35.6 weeks gestation at birth should not be discharged until they have regained their birthweight
  • babies 36 - 36.6 weeks gestation at birth should not be discharged unless they are gaining weight and heading back towards their birthweight
  • more mature babies (weighing < 2.5 kg) should not be discharged until they are at least 2.2 kg or if birth weight above this gaining weight and heading back towards their birthweight

Warmth

  •  the baby may require an extra blanket or cardigan to stay warm (on top of a singlet, nappy, jump suit, hat, blanket)
  • avoid draughts
  • the baby should have their first bath only once their observations and blood sugar levels are normal
  • if the baby's axillary temperature remains  < 36.0o Celsius despite warming the baby should be admitted to the Special Care Nursery and requires a medical review
  • temperature instability may be a sign of sepsis

Feeding

  • breastfeeding  is recommended and should be encouraged
  • breastfed babies should not be offered complementary feeds unless frequent (at least 3 hourly) breastfeeding is associated with a blood sugar level < 2.6 mmol/L or there is significant weight loss (>10% below birth weight) or poor weight gain despite frequent breastfeeding
  • the baby should be fed as soon as stable after birth and 3 hourly until either 37 weeks corrected age or 2.5 kg
  • babies who are feeding poorly should be admitted to the Special Care Nursery and have a medical review
  • babies should not  be gavage (tube) fed in the ward

Discharge

The baby may be discharged home when the following criteria are met

  •  Paediatrician approval
  • at least 36 weeks corrected age
  • at least 2.2 kg (provided not > 10% below birth weight)
  • feeding well 3 hourly
  • good urine and stool output
  • parent(s) are agreeable to taking the baby home
  • home visiting by experienced and qualified midwives or neonatally trained nurses is available
  • the parent(s) are supported and encouraged to contact the Hospital if they have any concerns following discharge and readmission is possible and practicable
  • arrangements are made for medical follow up no later than 40 weeks' corrected age

References:

Management of the Well Near Term &/or 2.0-2.5 kg Infant (Southern Health) 2010
Darcy AE. Complications of the Late Preterm Infant. J Perinat Neonat Nurs 2009;23:78-86
Wight NE. Breastfeeding the borderline (near term) preterm infant. Pediatr Ann 2003;329-36

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