guidelines

Chorioamnionitis Pathway

1. All babies exposed to maternal chorio need an evaluation by NICU. Please write note “.nicuchorionote” and sign out to the resident/attending covering newborn nursery.

2. If chorio is diagnosed after delivery (fever up to 1 hour after delivery), and NICU is not notified, nursery may ask NICU to evaluate the baby once this mistake is noticed. Be prepared to do a NICU consult and write a note (“.nicuchorionote” is acceptable).

3. All other yellow risk babies do NOT need an evaluation or note by NICU, but nursery may ask for a NICU consult. In this event, please evaluate baby and write a note. Please support our nursery colleagues with these higher risk babies.

4. Remember, stable babies who are red on the sepsis calculator can still stay with their mothers at LLUCH and get their antibiotics in post-partum, but not at RUHS. At RUHS, they will need to be moved to the NICU.

5. Please continue to verify the sepsis score in EPIC by doing the calculations yourselves. If there is a discrepancy, verify that the info in EPIC calculator was placed correctly. If the info in the sepsis calculator is inaccurate, update the Newborn Sepsis Calculation values and recalculate the score in Epic. (See image below.) Remember, when recalculating the score, ALL values need to be put into the calculator again.

First Intention Jet

Hypoglycemia Pathway

Eat, Sleep, Console Pathway

Therapeutic Hypothermia

SARNAT Grading

Criteria:

A. Cord pH ≤ 7.0 or base deficit ≥ 12 (if criteria met, go to C), OR 

B. If no blood gas result is available or 1 st hour blood gas pH is between pH 7.01 to 7.15 or base deficit is between 10-11.9 AND at least two of the following: 

▪ History of an acute perinatal event 

▪ Such as but not limited to placental abruption, uterine rupture, cord prolapse/rupture, shoulder dystocia, nuchal cord, maternal trauma, hemorrhage, cardiorespiratory arrest, severe fetal heart rate abnormalities such as variable or late decelerations) 

• Apgar score ≤ 5 at 10 minutes 

• Prolonged resuscitation at birth: chest compressions and/or need for mechanical ventilation initiated at birth and continued for at least 10 minutes (mechanical ventilation includes any form of respiratory support providing CPAP or greater support) 

C. Evidence of moderate to severe encephalopathy - demonstrated by at least one or more of the following at any time within 6 hours of birth:

• Moderate or severe encephalopathy based on modified Sarnat Exam (Table 1 in Page 2). 

• Clinical seizures (presence of seizures is an automatic indication for cooling) 

• Abnormal amplitude integrated EEG (aEEG) or electrographic seizures 

UTI Pathway