Unique Plan Description: Newborn Admission 36 to 36.6 weeks gestation
Plan Selection Display: Newborn Admission 36 to 36.6 weeks gestation
PlanType: Medical                                 
Version: 3          
Begin Effective Date: 2021-12-28 09:10:01
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-03-24 08:55:50
Available at all facilities: Yes

Newborn Admission 36 to 36.6 weeks gestation
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
Vital Signs
	Vital Signs
		Routine - If axillary temp <97.5 or >100.0 take rectal temp
			Comment: If newborn's axillary temperature is < 97.5° F and newborn is < 12 hours of age: Place newborn in warmer; Reassess temperature every 30 minutes until > 97.5 º F; Once temperature is > 97.5 º F, reassess in 1 hour - If temperature remains > 97.5 º F, return newborn to crib. Reassess temperature every 1 hour x2.                                                                                                                                                    If newborn's axillary temperature is < 97.5° F and newborn is > 12 hours of age: Place newborn skin to skin; Reassess temperature within 30 minutes - Temperature > 97.5 º F, swaddle newborn and place in crib, Temperature < 97.5 º F, place newborn in warmer and notify provider; If the newborn has a new temperature < 97.5 º F after being removed from the warmer, notify provider and a consult with NICU should be ordered.
	Newborn Weight
		T;N, Once
			Comment: weight and measurement at birth
		T;N, DAILY
			Comment: weight at approximately 12AM every day.
Diet
	Newborn Feeding Guidelines
		T;N
			Comment: For infant 36 weeks gestation. Bottle Feeding: Feed infant within 1 hr of age, and then a minimum of Q3H. Formula of choice via bottle. Breast Feeding: Feed infant within 1 hr of age, and then a minimum of Q3H. Mother's breast milk. If no breast milk, may use donor milk. Pump after every feeding. RN to enter donor breast milk order in EMR if needed. Order details as follows: "breast milk (donor milk) Feed Frequency per Hypoglycemia Protocol, Feed Base Donor Breast Milk, Base Caloric Density 20, Route Nipple, Final Caloric Density 20, If no Breast Milk available None
Laboratory
	Transcutaneous Bilirubin - JE
		T+2;0600, Routine, spec type = Transcutaneous
			Comment: A TcB will be completed by RN on newborn prior to 48 hours of age.  Nurse may adjust timing of exam to correspond with 24 - 48 hours or prior to discharge.If TcB is >/= to 15 mg/dL TSB will be completed
	Transcutaneous Bilirubin - RN (MH WH FH)
		T;N+2160
			Comment: A TcB will be completed by RN on newborn prior to 48 hours of age.  Nurse may adjust timing of exam to correspond with 24 - 48 hours or prior to discharge.If TcB is >/= to 15 mg/dL TSB will be completed
	Transcutaneous Bilirubin - JE
		T;0600, Timed, spec type = Transcutaneous
	Transcutaneous Bilirubin - RN (MH WH FH)
		T;N, Q12H-End of Shift
	Newborn Screen Nebraska
		T;N+1500, Routine, spec type = Blood Spot
	IA NB Screen
		T;N+1500, Routine, spec type = Blood Spot
		Mother with positive drug screen after admission to Labor & Delivery, select the Umbilical Cord Tissue Complete Drug Screen and Umbilical Cord Tissue Marijuana Metabolite orders in Newborn Drug Screen order set below.(NOTE)*
Medications
	erythromycin ophth 0.5% oint 1gm
		1 appl, Ointment, Eye, Both, Once, T;N
	Vitamin K
		1 mg, Injection, IM-IntraMUSCULAR, Once, T;N
	hepatitis B pediatric vaccine 10 mcg/0.5 mL intramuscular suspension
		0.5 mL, Suspension-Injection, IM-Intramuscular, Once, T;N
	Recombivax HB Pediatric/Adolescent
		0.5 mL, Solution-Injection, IM-Intramuscular, Once, T;N
	Ayr Saline Nasal No-Drip Spray
		1 gtt, Solution, NASAL, Q1H, PRN, congestion
			Comment: Notify provider if no improvement from saline.
	Sucrose 24%
		0.2 mL, Liquid, By Mouth, Q5MIN, PRN, discomfort
			Comment: As needed for mild pain or discomfort. Place on tongue.
	Hyperhep B
		0.5 mL, Syringe, IM-Intramuscular, Once, T;N
			Comment: For infants of mothers with positive hepatitis B surface antigen.
	HepaGam B
		1 mL, Solution, IM-Intramuscular, Once, T;N
			Comment: For infants of mothers with positive hepatitis B surface antigen
Patient Care
	Resuscitation Status
		Full Code
		No Code
	Intake and Output
		T;N, Q12H-End of Shift
	Glucose POC - RN
		as needed
			Comment: for symptoms of hypoglycemia-irritability, tremors, jitteriness, exaggerated moro reflex, high-piched cry, seizures, lethargy, floppiness, cyanosis, twitching, hypothermia, or hypotonia.
	Newborn Glucose Management
		T;N
			Comment: If glucose is >120 draw serum glucose. If serum glucose is >120, Notify MD. If any glucose POC value is <40, follow Newborn Hypoglycemia Algorithm for feeding and follow-up management of blood sugars and enter Newborn Hypoglycemia Interventions PowerPlanNewborn Hypoglycemia Algorithm 1.	Check initial blood glucose (40 minutes after START of feeding)	a. If glucose result >/= 40		i. Feed every 2-3 hours following Newborn Glucose Management protocol and risk factors	b. If glucose result < 40		i. Administer oral glucose gel based on weight of infant     		ii. Feed the baby 			1. Give a minimum of 15 mL donor breast milk, pumped breast milk or hypoallergenic formula via bottle or gavage. ***For remainder of hospitalization, supplement with a bottle*** 			2. May put back to breast after supplementation if breastfeeding 		ii. RN to check initial postprandial POC glucose 40 minutes after start of supplementation/feeding.  This value will be used for treatment. 			1. If initial post-treatment POC glucose is >/= 40				a. Pre-prandial POC glucose every 2-3 hours x3 per the “Follow-Up Blood Sugar Schedule” section				b. Feed every 2-3 hours				c.  Supplement a minimum of 15 mL donor breastmilk, pumped breastmilk or hypoallergenic formula after every feeding for remainder of hospital stay.				d. Follow Newborn Hypoglycemia Algorithm as needed			2. If initial post-treatment POC glucose is < 40				a. Administer oral glucose gel based on weight of infant  				b. Feed the baby					i. Give a minimum of 15 mL donor breast milk, pumped breast milk or hypoallergenic formula via bottle or gavage						1. If parent requests formula:							a. Continue to use hypoallergenic formula with presence of risk factors or history of MSPI							b. Use formula of provider's or mom's choice if no history of MSPI present						2. May put back to breast after supplementation if breastfeeding				c. RN to check repeat post-prandial POC glucose 40 minutes after start of supplementation/feeding				i. If repeat post-prandial POC glucose < 40, notify provider for plan of care				ii. If repeat post-prandial POC glucose >/= 40						1. Pre-prandial POC glucose every 2-3 hours x3 per the “Follow-Up Blood Sugar Schedule” section						2. Feed every 2-3 hours						3. Supplement a minimum of 15 mL donor breastmilk, pumped breastmilk or hypoallergenic formula after every feeding for remainder of hospital stay.						4. Follow Newborn Hypoglycemia algorithm as needed. 2. Follow-Up Blood Sugar Schedule - after treatment of a POC glucose < 40, all infants will have a minimum of 3 follow-up pre-prandial (AC) POC glucoses completed.	a. Enter order for pre-prandial (AC) POC Glucose every 2-3 hours x3, use the Newborn Hypoglycemia Interventions power plan		i. If any pre-prandial (AC) POC glucose is < 40			1. Notify MD			2. May give oral glucose gel if the maximum 2 doses have not been given			3. Feed the baby				a. Give a minimum of 15 mL donor breast milk, pumped breast milk or hypoallergenic formula via bottle or gavage				b. May put back to breast after supplementation if breastfeeding 				c. If parent requests formula:					i. Continue to use hypoallergenic formula with presence of risk factors or history of MSPIUse formula of provider's or mom's choice if no history of MSPI present
	Newborn Glucose Management (JE/FH)
		T;N
			Comment: If glucose is >120 draw serum glucoseIf serum glucose is >120, Notify MD                                                        If any glucose value is <40, follow Newborn Hypoglycemia Algorithm (JE/FH) for feeding and follow-up management of blood sugars and enter Newborn Hypoglycemia Algorithm (JE/FH) PowerPlan By 24 hours of age, glucose POC value should be >/=50.  If not >/=50, notify MD.				   Newborn Hypoglycemia Algorithm1. Check initial blood glucose (40 minutes after START of feeding)	a. If Glucose result >/=40:		i. Feed every 2-3 hours following Hypoglycemia Protocol according to risk factors	b. If Glucose result 30-39:  		i. Administer oral glucose gel based on weight of infant		ii. Feed the baby			1. May breastfeed if asymptomatic			2. Give a minimum of 15 mL donor breast milk, pumped breast milk or hypoallergenic formula via bottle or gavage if symptomatic                                    or baby not latching and nursing well for at least 10 minutes				a. If parent requests formula:                                              	                                                        	1. Continue to use hypoallergenic formula with presence of risk factors or history of MSPI                                              			2. Use formula of provider's or mom's choice if no history of MSPI present                                   			3. May put back to breast after supplementation if breastfeeding				iii. Check second postprandial POC glucose 40 minutes after start of supplementation/feeding  					1. If second postprandial POC glucose >40:						a. Feed every 2-3 hours and continue with pre-prandial POC glucose every 2-3 hours x3. Follow Newborn Hypoglycemia Algorithm (JE/FH) as needed.   					2. If second postprandial POC glucose 30-39:						a. Administer oral glucose gel based on weight of infant						b. Feed the baby							i. Give a minimum of 15 mL donor breast milk, pumped breast milk or hypoallergenic formula via bottle or gavage							ii. May put back to breast after supplementation if breastfeeding						c. Check third postprandial POC glucose 40 minutes after start of supplementation						d. Notify MD					3. If second postprandial POC glucose <30:						a. Administer oral glucose gel based on weight of infant						b. Start IV D10W bolus 2 mL/kg						c. Feed the baby							i. Give a minimum of 15 mL donor breast milk, pumped breast milk or hypoallergenic formula via bottle or gavage							ii. May put back to breast after supplementation if breastfeeding						d. Check third postprandial POC glucose 40 minutes after start of supplementation						e. Notify MD  	c. If Glucose < 30:		i. Administer oral glucose gel based on weight of infant		ii. Start IV D10W bolus 2 mL/kg		iii. Feed the baby			1. Give a minimum of 15 mL donor breast milk, pumped breast milk or hypoallergenic formula via bottle or gavage if symptomatic                                    or baby not latching and nursing well for at least 10 minutes				a. If parent requests formula:                                              	                  			1. Continue to use hypoallergenic formula with presence of risk factors or history of MSPI                                            		2. Use formula of provider's or mom's choice if no history of MSPI present                                   			2. May put back to breast after supplementation if breastfeeding  		iv. Notify MD                  	v. Check second postprandial POC glucose 40 minutes after start of supplementation/feeding.			1. If second postprandial POC glucose > 40:				a. Feed every 2-3 hours and continue with pre-prandial POC glucose every 2-3 hours x3. Follow Newborn Hypoglycemia Algorithm (JE/FH) as needed.   			2. If second postprandial POC glucose 30-39:				a. Administer oral glucose gel based on weight of infant				b. Feed the baby					i. Give a minimum of 15 mL donor breast milk, pumped breast milk or hypoallergenic formula via bottle or gavage					ii. May put back to breast after supplementation if breastfeeding				c. Check third postprandial POC glucose 40 minutes after start of supplementation				d. Notify MD			3. If second postprandial POC glucose <30:				a. Administer oral glucose gel based on weight of infant				b. Start IV D10W bolus 2 mL/kg				c. Feed the baby					i. Give a minimum of 15 mL donor breast milk, pumped breast milk or hypoallergenic formula via bottle or gavage					ii. May put back to breast after supplementation if breastfeeding				d. Check third postprandial POC glucose 40 minutes after start of supplementation				e. Notify MD  2. After treatment of a POC glucose <40, all infants will have a minimum of 3 follow-up pre-prandial (AC) POC glucoses completed.	a. Enter order for pre-prandial (AC) POC Glucose every 2-3 hours x3, use the Newborn Hypoglycemia Algorithm (JE/FH) power plan              		i. If any pre-pr
	Newborn Hearing Screening
		T;N+1440
	Follow Bilirubin Protocol
		T;N
			Comment: Document the presence or absence of jaundice when taking vital signs.                                         If Jaundice present at 24 hrs or less, or significant jaundice during stay especially in darkly pigmented baby, order TcB
		T;N
			Comment: A TcB will be completed by RN on newborn prior to 48 hours of age.  Nurse may adjust timing of exam to correspond with 24 - 48 hours or prior to discharge.
		T;N
			Comment: Comment: A TcB will be completed by RN when newborn DAT is positive
		T;N
			Comment: If TcB is >/= to 15 mg/dL or if TcB exceeds or is within 3 mg/dL of the phototherapy treatment threshold, TSB will be completed.  RN to enter order for TSB
	Notify MD
		T;N, immediately if VS unstable, lethargic, symptoms of respiratory distress present (tachypnea, retractions, nasal flaring, grunting and cyanosis)
		T;N, if rectal temp <97.5 or >100.
		T;N, if oxygen saturation is less than 90% on supplemental oxygen.
		T;N, if signs of hypoglycemia
		T;N, if serum glucose >120
		T;N, if serum glucose < 30
		T;N, if newborn has had 10% weight loss  by discharge.
	Free Flow Oxygen, Nurse to Administer
		Via Free Flow Oxygen, Continuous
			Comment: if cyanosis or respiratory distress present
	Newborn Oxygen Check
		as needed
	Newborn Respiratory Guidelines
		T;N
			Comment: Newborn may go to nursery for close observation if experiencing nasal flaring, grunting, retractions, increased work of breathing
	Congenital Heart Disease Screening
		T+2;0400

Newborn Drug Screen
Laboratory
		Umbilical cord is preferred over meconium for drug screening(NOTE)*
	Drug Screen Meconium - JE
		T;N, Routine, spec type = Meconium
	Drug Panel Meconium Qualitative-MH/WH/FH
		T;N, Routine, spec type = Meconium
	Drug Screen Urine - FH
		T;N, Routine, Urine Random, spec type = Urine
	Toxicology Screen DAU - MH/WH/JE
		T;N, Routine, Urine Random, spec type = Urine
	Umbilical Cord Tissue Drug Scr and THC Metabolite - Qual
		T;N, Routine, spec type = Umbilical Cord

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase