3) Determine amount of Alteplase required to fill the catheter (no more than 0.5 mL in any catheter). after birth in a health care facility. Position bed flat with patient prone and reservoir side up. /SMask /None>> Neonatal Intensive Care Units (NICU). American Academy of Pediatric Recommendations for Management of Infants Born to Mothers with Suspected or Presumed Group B Streptococcal Infections. In addition, we hope to gain the additional benefit of decreasing the severity of PDA effects by adopting some of the most successful prophylactic Indocin protocols. 11) If catheter is not patent after 120 minutes of dwell time, you may repeat Alteplase dosing cycle. 2018-2019 NEONATAL INTENSIVE CARE UNIT RESIDENT HANDBOOK, To Evaluate at-risk Infants for Intraventricular Hemorrhage (IVH) and Periventricular Leukomalacia (PVL). • Timeframes between 72 hours and 7 days are often used. Selected infants may be screened at < 7 days at the discretion of the Attending. 7) Install Alteplase into catheter (NOT INTO THE PATIENT). neonatal intensive care unit (NICU) patients. 5) Any infant with neurological symptomatology should have an LP performed as part of a sepsis evaluation (no matter what his or her postnatal age). Not severely asphyxiated, platelet count > 50,000 and mild-to-moderate bilirubin levels, 3. “Low-dose Indomethacin and Prevention of Intraventricular Hemorrhage: A Multicenter Randomized Trial.” Pediatr. Neonatal intensive care unit protocols pdf 2018 - 2019 RESIDENT REFERENCE NICU STUDIES, PROTOCOLS, AND PROCEDURESThe purpose of this document is to serve as a guide for residents of clinical protocols and procedures in the NICU. The presumed mechanism of action is via stabilization of cerebral blood flow and/or closure of an open PDA. /ca 1.0 /BitsPerComponent 8 Neonatal mortality, as opposed to infant mortality, is death within the first 28 days of birth and, once again, rates in the United States are higher than comparable OECD countries.1 Preterm birth is the leading cause of death in the first month of life.4 Risk factors for having a preterm birth include lack of prenatal care, smoking, substance abuse, and lower socio-economic ), The bedside computer monitor and keyboard, All electronic monitors and intravenous pumps, Any other device touching an infant (IVs, central lines, chest tubes, etc. Use a sterile field around the area of the reservoir. endobj is required for all parents and health care personnel entering the NICU. 4 0 obj 3. A pretreatment Echocardiogram may be considered in the most high-risk premature infants but is not necessary. Cochrane Collaborative meta-analysis of well designed clinical trials using prophylactic Indomethacin therapy to prevent severe IVH demonstrates that prophylactically administered Indomethacin begun before 12 hours of age in preterm infants, (generally < 1500 gms birthweight) decreases the incidence of severe IVH in this population. 5) Attempt to flush line with normal saline using a 10 mL syringe. Prep skin with betadine swabs and let sit for 3-5 minutes. %PDF-1.4 x����_w��q����h���zΞ=u۪@/����t-�崮gw�=�����RK�Rl�¶Z����@�(� �E @�B.�����|�0�L� ��~>��>�L&C}��;3���lV�U���t:�V{ |�\R4)�P�����ݻw鋑�������: ���JeU��������F��8 �D��hR:YU)�v��&����) ��P:YU)�4Q��t�5�v�� `���RF)�4Qe�#a� Neonatal Intensive Care Units (NICU). /Type /XObject al. /CA 1.0 ~��-����J�Eu�*=�Q6�(�2�]ҜSz�����K��u7�z�L#f+��y�W$ �F����a���X6�ٸ�7~ˏ 4��F�k�o��M��W���(ů_?�)w�_�>�U�z�j���J�^�6��k2�R[�rX�T �%u�4r�����m��8���6^��1�����*�}���\����ź㏽�x��_E��E�������O�jN�����X�����{KCR �o4g�Z�}���WZ����p@��~��T�T�%}��P6^q��]���g�,��#�Yq|y�"4";4"'4"�g���X������k��h�����l_�l�n�T ��5�����]Qۼ7�9�`o���S_I}9㑈�+"��""cyĩЈ,��e�yl������)�d��Ta���^���{�z�ℤ �=bU��驾Ҹ��vKZߛ�X�=�JR��2Y~|y��#�K���]S�پ���à�f��*m��6�?0:b��LV�T �w�,J�������]'Z�N�v��GR�'u���a��O.�'uIX���W�R��;�?�6��%�v�]�g��������9��� �,(aC�Wn���>:ud*ST�Yj�3��ԟ��� /Producer (�� Q t 4 . O2 % on RIGHT Hand Neonatal Intensive Care Unit (NICU) Protocol Pulse oximetry screening for Critical Congenital Heart Disease (CCHD) Perform on all infants once stable on Room Air for 24 hours 5. • Timeframes between 72 hours and 7 days are often used. 93: 543-550, 1994 and the Cochrane Collaborative Database (, Consider the risk / benefit ration of initiating or continuing Indocin therapy in ALL PATIENTS. 58:1726-1738, 2002. /AIS false They may not reflect our current practice, they may be in the process of being updated and they may contain errors or practices that are not consistent with practices elsewhere. /Filter /FlateDecode Send CSF sample in three separate tubes for glucose, protein, cell counts and culture at least every other day, and as directed by the Neonatologist. � �l%��Ž��� �W��H* �=BR d�J:::�� �$ @H* �,�T Y � �@R d�� �I �� Check patient’s activity, need for suctioning, feeds, etc. Many physical and emotional changes occur for mother and baby. /Creator (�� w k h t m l t o p d f 0 . << 2. 1 0 obj Routine Cranial ultrasounds of other infants should be at the discretion of the Attending Neonatologist. 6) Inspect Alteplase syringe for any contaminants or discoloration (should be clear to a slight yellow color). Milliman Guidelines NICU Levels* Neonatal Intensive Care Unit Level IV If the following conditions/procedures exist, in additi on to the fulfillment of Level III Criteria, the approved inpatient days s hould be assigned at Level IV Nurse: Patient Ratio of 1:1 or 2:1 1. 4. Level 2 and Level 3 neonatal care refer to neonates requiring special and intensive care respectively. Strategies to Decrease Nosocomial Infection in the Neonatal Intensive Care UnitOur goal is decrease the number of positive blood cultures to less than 15% of all infants < 1500 grams birth weight or less than 8 infections/1000 central line catheter days in infants < 1500 grams birth weight. Patients with known hypersensitivity to Alteplase or any component of the formulation, Patients with known increased risk of bleeding. If the initial CUS demonstrates a Grade I, II, III, or IV hemorrhage, follow up CUS exams may be every 1-2 weeks until the lesion is stable or intervention is required. 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