PROTOCOL

Neonatal Observations
SCOPE (Area): Maternity SCOPE (Staff): Midwifery, Medical and Nursing

EXPECTED OUTCOME Early identification and intervention for neonates who develop complications following birth. INDICATIONS Indications for at risk neonates who require ongoing observations following birth include; Instrumental birth (forceps/vacuum extraction). GBS positive mothers who do NOT receive antibiotics in labour. GBS positive mothers who receive antibiotics less than 4 hours before birth. A mother with an unknown GBS status. Prolonged ruptured membranes >18 hours. Meconium liquour during labour or at delivery. Maternal fever during labour. Near term neonate <37 weeks medically cleared to stay on the postnatal unit. Low birth weight infant 2000 2500g medically cleared to stay on the postnatal unit. Babies of diabetic mothers or suspected diabetic mothers (macrosomic neonate) medically cleared to stay on the postnatal unit. Babies with low apgars medically cleared to stay on the postnatal unit. Specific observations ordered by the medical staff. DEFINITION GBS Group B Streptococcus

ISSUES TO CONSIDER Neonates may experience adverse outcomes following an operative/vaginal birth. These may include; Forceps Superficial scalp and facial markings Cephalhaematoma Facial nerve injury Corneal abrasions / external ocular trauma Intracranial haemorrhages Vacuum Extraction Scalp bruising and lacerations Cephalhaematoma Subgaleal haemorrhages Retinal haemorrhage Transient neonatal lateral rectus paralysis

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Group B Streptococcal disease is the most common bacterial pathogen affecting neonates. Transmission is vertical and occurs before or during labour. It is important to monitor a neonate of a carrier mother who is not adequately treated in labour or a mother with unknown GBS status. Normal parameters for neonatal vital signs (0-28 days of age) HR - awake - asleep RR Temperature (per axilla) SaO2 BP- diastolic - systolic ACTIONS The minimum vital signs for all neonates All neonates must have the temperature, heart rate, respirations, colour and any noted abnormalities or bruising recorded within an hour of birth. All observations should be recorded on the medical record. Observations outside of the normal parameters must be reported to medical staff with assessment and follow-up documented in the patient record. The minimum vital signs for at risk neonates In addition to birth observations; Temperature, heart rate, respirations and colour performed every 4 hours for 24 hours. Observe and document abnormalities, bruising, swelling or marks. AC observations should be performed between 24 48 hours of age if the infants mother was GBS positive and did not receive antibiotics or received antibiotics less than 4 hours before birth OR is GBS unknown. All observations should be recorded on the medical record. Observations outside of the normal parameters must be reported to medical staff with assessment and follow-up documented in the patient record. 100-180bpm 80-160 bpm 40-60/min 36.5-37.3 C >90% 20-60 mmHg 60-90 mmHg

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REFERENCES
Scott, J.R., Gibbs, R.S., Karlan, B.Y. & Haney, A.F. (Eds.) (2003). Danforths Obstetrics & Gynecology
th

(9 ed.). Lippincott Williams & Wilkins Royal Prince Alfred. Prevention and treatment of early onset Group B Streptococcal disease (EOGBSD) in neonates. Department of Neonatal Medicine Protocol Book. Accessed 16/12/06, from: http://www.cs.nsw.gov.au/rpa/neonatal/default2.htm Royal Womens Hospital. (2006). Management of infant to prevent Early Onset Group B Streptococcus Disease. Clinical Practice Guidelines. Accessed 16/12/06 from: http://www.rwh.org.au/rwhcpg/neonatal.cfm?doc_id=3798

Southern Health (2010) Procedure Well babies requiring additional observations quick reference. Accessed on 24/5/10 from http://www.southernhealth.org.au/icms_docs/3827_Well_babies_requiring_additional_observations .pdf

Reg. Authority: CEO, Executive Directors, Nursing/Residential Services, Medical, Subacute/Community & Mental Health Services, Clinical Director / DON of Womens & Childrens Health Review Responsibility: Maternity Unit Original Author: Maternity Unit Project Officer (2007) Updated by: Maternity Unit Project Officer (2010)

Date Effective: March 2007 Date Revised: July 2010 Date for Review: July 2013

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