Admission and Care of the

Neonate to the Special Care

Nursery/ Neonatal Intensive
Care Unit
 OBJECTIVES
• Identify reasons for admission to the
SCN/NICU
• Explain the process of admission
• Identify the needs of the Neonate
• Discuss the management of the neonate
admitted to the SCN/NICU
 Reasons for Admission
• Prematurity- < 37 weeks gestation
• Medical problem- Sepsis, Infant of
Diabetic Mother, Severe Asphyxia,
Jaundice
• Surgical problem- Abdominal wall defect,
Congenital Diaphragmatic Hernia
• Post respiratory Arrest
• Cardio respiratory monitoring
 Admission Process
• - A brief history is given by doctor/mother
• -The resusitaire/ incubator is heated, or a
cot is prepared
• -Suction apparatus is checked and put in
place
• -Oxygen apparatus is checked and a
headbox /Cpap apparatus/ventilator put in
place
• -A scale for baseline weight
 Admission Process Cont’d
• -An assessment is done to determine the
need for suctioning and supplemental
oxygen( if not intubated)
• -The infant is weighed
• -Vital signs are done
• -A baseline glucose check is done
• - A physical assessment is done
 Admission Process Cont’d
• -The doctor is assisted with the IV
preparation/umbilical catheterization/ if required
• -Assistance with a full/partial Sepsis screen is
given if required. Full-LP, Bld.Studies, CXR,
Urine, Partial- Bld. studies, CXR, LP
• The infant is placed in a
cot/incubator/resuscitaire and attached to the
ventilator
• -The doctors orders are noted and implemented
• -Delay or defer bathing
• -Documentation is done
 The Needs of the Neonate
• Oxygenation
• Circulation
• Thermoregulation
• Nutrition/fluids
• Elimination
• Sensory/Comfort
• Hygiene/skin care
• Mobility
• Emotional/communication
• Educational
 Management of the Neonate in
SCN/ICU
• Oxygenation
• Ensure ETT is properly secured
• -Assess rate, movements, respiratory status, colour
• -Administer sedatives as ordered (NICU)
• -Apply non-invasive monitor, titrate FiO2 to maintain
Sats 92-94% (NICU)
• -Handle gently minimally
• -Position prone to maximize oxygenation
• -Delay or defer bathing (admission)
• -Suction when necessary
• -Ascultate lung field
• -Take specimen for trapped sputum
• -Monitor ABG results
• -Ensure ETT is properly secured
 Circulation

• -Skin perfusion, apex beat, pulses, blood

pressure,
• haematological status, signs of
constriction/oedema
 Thermoregulation

• -Monitor peripheral/central/environmental temperature

• -Maintain stability of temperature-axillary (36.5-37 C in
term infants), skin (36-36.5 C in preterm infants). Do
temp. 4hrly
• -Apply heat conserving/losing measures eg. swaddling
• -Pre-warm linen, scales, radiant warmer, incubator
• Decrease heat loss with positioning ie. Prone, flexion
• -Use warm water on skin
• -Delay or defer bathing (admission), if temp. is ,97.2F do
not bathe
 Nutrition/fluids

• -Monitor fluid balance biochemical status, tolerance of

enteric feeds, feeding readiness, feeding performance,
feeding plan, information on lactation and expression.
• -Administer fluids and or calories orally or intravenously
as ordered
• Decrease energy expenditure by decreasing internal
(hypoxia, hypothermia) and external (ie noise stressors)
• -Do glucose checks Q4hrly, for infants with
hypoglycaemic episodes do more often
 Elimination

• -Output assessment, bilirubin status, stool

chart, urine tests
• -Observe and document frequency of
stools, consistency.
 Sensory/comfort

• -Assess tolerance of handling

• -Ensure rest periods between procedure/handling
• -Handle gently and minimally, support and maintain in
flexion
• -Visual – shield from bright, direct light. Dim light as soon
as possible
• cover incubator with blanket or cover
• -Auditory- talk quietly, respond quickly to alarms, advise
parents to talk softly
• keep ill neonates away from crying babies
• -Pain- minimize painful stimuli, relieve pain with
pharmacologic management
• Provide comfort measures eg. graspings, pacifiers
 Hygiene/skin care

• -Assess skin integrity

• -Observe pressure areas, IV sites. Do
eye/mouth care, wound care, dressings,
• groin care, skin protection
• -Use barrier creams as indicated
Mobility
• -Do position changes, postural changes,
note reaction to handling
 Emotional/Communication

• -The goals of care should be family-centred. It is the

patient we treat, but it is the family of whatever construct,
with whom the baby will go home.
• -Inform parent(s) of visiting/residential arrangements,
social support and responsibilities, access
arrangements, parent support groups.
• -Ascertain religious beliefs and practices, ethnic or
cultural beliefs and practices.
• Provide for communication between parent/s and
primary care team communication
 Educational

• -Assess parent/s knowledge re-disease

process/illness
• -Identify areas in which information is needed
• -Initiate a teaching programme/or refer
• -Provide supporting material
• -Arrange interview schedule
• -Give information re-discharge, follow-up
arrangements, access to self-help groups and
specialist centres.
 Reference

• Ali, Z. (1998) Medical Care of the Newborn

Trinidad and Tobago: C.P.P.P

• Boxwell, G. (2001) Neonatal Intensive Care Nursing

London, Routledge

• Merestein B, G., Gardner L, S (1998) Handbook of

Neonatal Intensive Care
St. Louis,Missouri: Mosby

L/M 2005