Course Title: Newborn Diagnostic Lab Tests & Procedures

Course Syllabus ©National College of Midwifery 2017 11/2017

Course Title: Newborn Diagnostic Lab Tests & Procedures

Credits: 0.5

Course Description: This course examines diagnostic tests commonly used during the neonatal period. Student will learn what the community standards regarding the indications for, administration of and the risks/benefits of bio-technical screening techniques. Emphasis is placed on understanding normal lab values in the healthy newborn and the significance of abnormal test results. This course uses current research in midwifery and obstetrics to broaden the student’s understanding of the following NARM skills and MANA core competencies learned under clinical supervision:

NARM Skills

I. Midwifery Counseling, Education and Communication

(7)-I G. Applies the principles of informed consent

(8)-I H. Provides individualized care

(9)-I I. Advocates for the mother during pregnancy, birth and postpartum

(19)-I J 10. Newborn care including normal/abnormal newborn activity, responses, vital signs, appearance, behavior, etc

II. General Healthcare Skills

(21)-II A. Demonstrates Universal Precautions

(22)-II B. Demonstrates the application of OSHA regulations as they relate to midwifery workplace

(23)-II C. Demonstrates the application of aseptic technique

II D. Demonstrates the use of instruments and equipment including:

(28)-II D 5. Cord clamp and/or cord tape

(34)-II D 11. Lancets

(37)-II D 14. Needle and syringe

(47)-II D 24. Vacutainer/blood collection tube

VII. Well-Baby Care

(149)-VII A. Provides well-baby care 2-6 weeks

Learning Activities:

1. Student reads appropriate sections from the Learning Materials/Resources.

1. Student answers the questions listed in the Learning Objectives by researching the Learning Materials/Resources for the course and correctly cites the sources and page numbers for each of their answers.

1. Student presents answers the questions listed in the Learning Objectives for review by preceptor.

1. Student participates in preceptor elaboration/discussion of Learning Objectives.

1. The student must research, prepare & present a summary of current best midwifery care/practices appropriate to a topic covered in this course from a current journal article/study, less than 5 years old.

1. Recommended Role-playing and/or Clinical Interactions

Note: The clinical requirement of NARM /Clinical Skills is completed at any time throughout the ASM apprenticeship during actual clinical practice and is NOT a requirement to complete this academic course.

Activities specific to NARM skills learned in this section:

1. Talk through or role play collecting cord blood at birth and ordering the direct coombs, type and Rh. Practice filling out a lab requisition form for these tests.
2. Talk through or role play collecting a newborn specimen for the newborn metabolic screen. Role play educating the parents about newborn metabolic screens.
3. Talk through or role play collecting a glucose screen on a newborn. Practice collecting and analyzing the glucose of another student or your instructor if you have a glucometer available.
4. On all of the above practice sessions, be sure to include how you would demonstrate universal precautions while drawing blood samples.
5. Observe blood culture testing of a newborn in a hospital newborn intensive care nursery.

Learning Materials / Resources:

Please use textbooks less than 5 years old or most recent edition.

1.  Frye, Anne. Understanding Diagnostic Tests in the Childbearing Year: A Wholistic Approach. 7th edition. Labrys Press. 2007

2.  Johnson, Ruth and Taylor, Wendy. Skills for Midwifery Practice. 4th edition. Elsevier Churchill Livingston. 2016.

3.  Weaver, Pam and Evans, Sharon K. Practical Skills Guide for Midwifery, 5th Edition. Morningstar Publishing Co. Wasilla. 2012.

4.  Thureen, et al. Assessment and Care of the well newborn. 2nd ed. Elsevier Saunders. 2004.

5.  Davis, Elizabeth. Heart and Hands: A midwife’s guide to pregnancy and birth. 5th Edition. Celestial Arts Press. 2012

6.  Marshall, Jayne E, Raynor, Maureen D(editor). Myles Textbook for Midwives. Churchill Livingstone; 16 edition. 2014.

7.  Varney, Helen. Varney's Midwifery, 5th Edition. Jones and Bartlett Publishers. 2014.

8.  MEAC Abbreviated NARM Skills Form: http://www.midwiferycollege.org/AcademicProgram/Downloads/ASM/Clinical/Form-NARMSkills.pdf

9.  MEAC Essential Competencies: http://www.midwiferycollege.org/downloads/worddocs/Curriculum-Checklist-of-Essential-Competencies-rev-2014.pdf

10. Midwives Model of Care®: http://cfmidwifery.org/mmoc/brochures.aspx

11. Students must find 1 article/study less than 5 years old. Recommended internet links as needed for latest developments in midwifery care: https://www.midwiferycollege.edu/resources-national-college-of-midwi

Evaluation Tools / Methods:

Minimum passing grade for each course is a cumulative 80% / B-. Students and preceptors are encouraged to work together until the student masters the information.

Final grade for the course is based on preceptor evaluation of the following:

A. Learning Objectives count for 50% of the final grade.

The preceptor evaluates each answer based on three elements:

1.  Answers should reflect a thorough review of current literature regarding best current practices in midwifery care.

2.  Each answer should be formed in the student’s own words or paraphrased from the text. The answer should be minimal, not a re-write of the entire text, but enough to show appropriate comprehension of the learning objective.

3.  Student identification of sources and page numbers for each of the Learning Objectives. (Preceptor should do a random check to determine that sources cited are correctly identified.)

B. Enrichment Activities, including research essays and summaries of articles: 20%

C. Discussions: 15%

D. Tests and Exams: 15%

Course credit:

One Academic credit equals approximately 15 hours of formal time plus 30 hours of additional study or homework. Formal time is defined as the amount of time taken to answer the Learning Objectives to the level of 80% and to complete any learning activities to the preceptor's satisfaction, including any time spent face to face with the preceptor. Informal time includes any time spent actively reading relevant sources and textbook/s, researching Learning Objectives, and studying for examinations.

Learning Objectives:

A. The student must research, prepare & present a summary of an aspect of current best midwifery care/practices appropriate a topic from this course from a current journal article/study.

B. Student answers the questions below and cites the sources and page numbers.

1.  Define PO2, PCO2, pH, and base excess.

2.  Describe what the expected acid/base balance should be in the normal newborn and why.

1. Describe the occasions when acid/base balance in the newborn should be checked and why.

1. Discuss the actions that can be taken to correct metabolic and respiratory acidosis.

5.  Describe the occasions when newborn hemoglobin/hematocrit should be checked and why. How is the test performed?

6.  Discuss the expected fluctuations in the neonate's hematocrit from the 10-minute-old term newborn, to the 1 hour old, to the 1 week old.

7.  How does hematocrit in the term newborn differ from that in the premature newborn and why?

8.  Discuss when it is important to perform a white blood cell count on a newborn.

9.  What is the expected normal range of white bloods cells in the newborn?

10. What values would be considered abnormal in the newborn and what is the significance of this test outcome?

11. Discuss what actions can be taken to correct high hematocrit and low hematocrit.

12. Discuss the expected range of normal glucose levels at birth and how they fluctuate in the first few hours of extrauterine life.

13. Describe the occasions when glucose levels in the newborn should be tested and why.

14. How is the glucose test performed on the newborn?

15. Discuss the actions that can be taken to correct low glucose levels.

16. Discuss the purpose of knowing the baby's blood type and Rh. How is this test performed?

17. Discuss the direct coombs test.

18. What are the expected results of the direct coombs test in a healthy newborn?

19. What is the significance of abnormal results of the direct coombs test?

20. What are the expected bilirubin levels in the first 3-4 days of life?

21. Describe the occasions when bilirubin levels should be checked and why.

22. How are bilirubin levels checked?

23. Describe the actions that can be taken to correct high bilirubin levels.

24. Cite the expected calcium levels in the newborn and when it might be necessary to determine calcium levels.

25. How is the test performed to check for calcium levels in the neonate?

26. Discuss the purpose of the metabolic screen.

27. Discuss how metabolic screening is performed.

28. Discuss the timing of the metabolic screen and why it is performed twice.

29. Describe in detail the most prevalent neonatal disorder that is screened for with the metabolic screen.

30. Describe what tests constitute a septic work-up on the newborn.

31. When would septic work-up be indicated?

32. List the signs and symptoms, indications for referral or transfer for newborn hypoglycemia.

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