Neobook — clinical reference

Neonatology ward 2B1. Before discharging any infant, check the following:

Ensure that all the mother’s antenatal blood results (WR, HIV and Rh) are available and have been acted upon appropriately eg if mother is HIV positive, make sure that the baby has received and is discharged on the appropriate drugs to prevent mother to child transmission of HIV. Feeding choice must be clearly documented. If the mother is WR positive, check that the baby has received bicillin before discharge.
Relevant obstetric history should be reviewed and documented appropriately eg chorioamnionitis, maternal diabetes, thyroid disease, medication, abnormal sonographic findings, the newborn’s Apgars and haemoglobin soon after birth.
Infant is well and has passed urine, stools, is feeding well and has no jaundice.
Those who were admitted for monitoring of glucose (LBW <2.5kg and LGA’s >4kg), check that they have normal glucose levels (≥ 2.6mmols/l) for at least 12 hours before discharge.
For those admitted with birth weight <2000g, recheck weight before discharge and if weight loss is predicted to be >15% by 7 days of life, do not discharge but admit to 2B2/KMC. Check if feeding well, Hgt, hydration status and discuss patient with consultant.
Do Ballard gestational age estimation/foot length on all infants <2000g or who appear very prematurely born during their physical examination.
Weight must be at least 1800g and CGA at least 35 weeks before discharge.
Infants born to mothers with tuberculosis must be worked up, prescribed TB prophylaxis and given an appointment to come back to POPD in ±6 weeks time for clinical exam, CXR and gastric washing results.
Do not give BCG to these babies on discharge (deferred until after 3 month TB check at local clinic and after prophylaxis is stopped).
Ensure that all infants have been immunised before discharge. (Including Hepatitis B vaccines ± Ig if maternal status is known and of concern).

Postnatal ward 2B2. Before discharging any infant, check the following:

Infant is well, weighs at least 1800g & 35weeks CGA, is feeding well and on full feeds, maintaining temperature and glucose and is passing urine and stools. (If in doubt for premature babies, complete KMC readiness chart.)
Ensure that all mother’s antenatal blood results (WR, HIV and Rh) are available and have been acted upon appropriately.
Growth chart must be completed (weight, length and head circumference). In the case of a premature baby, a copy of the premature baby growth chart should be attached to the RTHC in order for the clinic to monitor the baby according the CGA (and not as a regular term baby).
All infants must have a standard neonatal discharge summary completed (one copy in folder and one copy to be stapled into RTHC). Include copies of relevant reports and investigations from the notes eg TBH NICU summary/MRI report etc.
All mothers should be provided with a SIDS prevention information leaflet on D/C (available in nursery – Afr, English and Xhosa).
All premature babies to receive a TTO of Vidaylin and Fe (6mg/kg elemental Fe) for 3 months at least.
Ensure that all infants have been immunised before discharge. (Including Hepatitis B vaccines ± Ig if maternal status is known and of concern).
Any concerns about the baby’s social circumstances eg mom <18 years, substance abuse, extreme poverty, maternal mental illness has been reported and acted upon by the social worker.
Give an appointment for neonatal F/U clinic for infants with the following: (unless already booked for TBH F/U) - 3097 on week days or on weekends, write F/U date and patient details/sticker in POPD F/U notebook in nursery.

General notes:

Transfer non-local babies back to their local hospital as soon as they are suitable for level 1 care eg premature babies >1.4kg, on full feeds not needing nasogastric tube anymore and have no increased risk of apnoea. In the event of severe overcrowding, the benefit of discharge may outweigh the benefit of admission and babies may be discussed with the consultant for earlier discharge.

In cases where the baby died, post mortem examinations should be performed in all cases where the cause of death is not obvious. Complete the forms immediately (available in nursery) and get consent from the parent(s). During office hours, pm request should be approved by the CEO, a copy faxed through to the fax number on the request form and Paarl mortuary informed of the pm request (so they can transport the body to TBH).

A discharge summary for all diseased babies should be completed on the Paarlpaeds program.

Babies for adoption must have had a TFT (cord blood or after day 5) and HIV test (maternal Elisa or if not available Elisa on baby) before discharge.