PLACE LABEL HERE
NEONATAL INTERMEDIATE CARE
ADMISSION ORDERS
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
All infants born at ≤ 326/7 weeks EGA should initially be admitted under ICU status and managed using ICU orders.
Diagnosis & Status: Admit as Inpatient ______(reason for admission)
Date: ______Time: ______Admit to intermediate status
Birth Weight: ______grams Current Weight: ______grams Gestational Age: ______weeks
Diagnosis: 1. ______2. ______3. ______
Bed Type:
1,800 grams, Incubator
> 1,800 grams, Radiant warmer bed
Monitoring:
Vital signs q 30 min x 3, then q 3-4 hrs if stable
Cardiopulmonary monitor, set apnea alarm at 20 seconds and HR 90 – 210 bpm
Continuous pulse oximeter, record pulse ox at least q 1 hour:
Target Range 90-95 %; Alarm Limits Set at 89 and 96 %
Target Range >93 %; Alarm Limits Set at 92 and 101 %
Target Range ____ - ____%; Alarm Limits Set at _____ and _____ %
Pulse oximetry not indicated, do not place pulse oximeter
Measurements:
Ballard exam unless conceived via in vitro fertilization
Weight on admission and then every Monday, Wednesday, and Friday if stable
Length and head circumference every Monday, plot all measurements against gestational age on growth curve
Fluids and Nutrition:
NPO
Strict I & O
D10W at ______ml/kg/day (______ml/hr)
Normal saline flush 0.9% q 4 hrs for maintenance of lumens of peripheral IV lines and intermittent IV access
May breastfeed or PO feed breast milk or term formula ad lib if no respiratory distress
______
Laboratory tests:
Blood glucose monitoring upon admission, then q 1 hr until stable, then q 4 hrs x 12 hrs, then q 12 hrs if WNL
Newborn Bloodspot Screening
- Send on admission prior to initiation of intravenous fluids, unless initial screening already obtained
- Send an additional newborn bloodspot screen at 72 hours of life on any infant initially tested prior to 24 hours of life.
- For infants less than 2000 grams at birth, send a newborn bloodspot screen at 28 days of life or at discharge, whichever comes first.
- For infants requiring blood product transfusion, collect initial newborn bloodspot screen prior to the transfusion. Collect an additional screen 120 days after the last transfusion.
- For infants being transferred to another hospital prior to 24 hours of age, collect initial newborn bloodpsot screen prior to transfer.
Blood culture now
CBC with diff at 6 hours of life
CBC with diff now
CRP at 24 hours of life
______
Copy to pharmacy Order writer’s initials ______
*3-16562* FORM 3-16562 REV. 04/2017 Page 1 of 2
PLACE LABEL HERE
NEONATAL INTERMEDIATE CARE
ADMISSION ORDERS
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
All infants born at ≤ 326/7 weeks EGA should initially be admitted under ICU status and managed using ICU orders.
Imaging:
CXR stat if patient is in respiratory distress
______
Medications:
Hepatitis B Vaccine 0.5 ml IM, after consent obtained
Erythromycin ophthalmic ointment both eyes on admission, if not given at delivery
Aquamephyton (2 mg/ml): 1 mg (0.5 ml) IM for infants greater than 1,000 grams, if not given at delivery
Ampicillin 50 mg/kg IV q 12 hrs (______mg)
Ampicillin 100 mg/kg IV q 12 hrs (______mg)
Gentamicin 4.5 mg/kg IV q 36 hrs (______mg) for infants 300/7–346/7 weeks AND 0-7 days old
Gentamicin 4 mg/kg IV q 24 hrs (______mg) for
- infants 300/7 - 346/7 weeks AND greater than or equal to 8 days old
- infants greater than or equal to 350/7 weeks
Gentamicin trough level just prior to 4th dose and peak level 30 min after 4th dose completed
Hold subsequent gentamicin doses if urine output less than 0.5 ml/kg/hr or trough level greater than 2 mg/dL
Claforan (cefotaxime) 50 mg/kg IV q 12 hrs (______mg)
Lactinex (lactobacillus) 125 mg/kg po/OG q 12 hrs (______mg), discontinue at 34 weeks corrected gestational age
______
______
Other:
Hearing screen, CCHD screen, and Purple Cry training before discharge
For infants less than 35 weeks at birth, CPR training before discharge
For infants less than 37 weeks at birth, upright position trial before discharge
Social services consult
Rehab consult for infants less than or equal to 34 weeks
For infants greater than or equal to 310/7 weeks AND a birth weight < 1500 grams, eye exam at 34 weeks or prior to
discharge, whichever occurs first
______
______
______
______
Date Time Physician Signature PID Number
Copy to pharmacy
FORM 3-16562 REV. 04/2017 Page 1 of 2