Download System level indicators (inputs)

Premature Newborn Hospital Management Chart Review GUIDE
Chart Sampling : any chart of newborn < 2500 gms or estimated gestation
age 36 weeks or less
Based on Liberia National Newborn Care guidelines and
Born Too Soon: The Global Action Report on Preterm Birth, 2012
(WHO, STC, Parternship for MNCH, March of Dimes)
For Modification per Liberia country-based experts
Admission of Mother in Labor or with ROM less than 36 weeks gestation
Gestational Age
 Estimated GA documented based on fundal height recorded
 Estimated GA based on Last Menstrual Period (LMP) documented
if known
Rupture of
 Presence/absence of ROM documented (fluid leaking from vagina)
Mebranes
Contractions
 Presence/absence of painful contractions recorded
Vaginal bleeding
 Presence/absence of vaginal bleeding recorded
Pre-eclampsia
 BP and urine protein recorded
Antenatal corticosteroids (ANCS) for Threatened Preterm Birth
Indications for
Gestational age 24 to 34 weeks AND one or more of the following:
ANCS (presence of
 Painful contractions (pre-term labor)
threatened
 Fluid leaking from vagina (pre-labor premature ROM or pPROM)
premature birth)
 Vaginal bleeding (antepartum hemorrhage)
 Signs of severe pre-eclampsia or eclampsia (DBP > 110 with 3+
proteinuria)
ANCS dosing
 Betamethasone 6mg IM and repeat every 12 hours for total of 4
doses administered (or until delivery even 1-2 doses reduces
complications)
Note : very high impact under-administered intervention to decrease
morbidity in premature neonate !!
Maternal Antiobiotics if Sepsis Risk Factors
Sepsis Risk
If maternal sepsis risk factors present at any timeadministration
Factors
ampicillin and gentamycin for mother
 Prolonged ROM > 18 hours
 Active labor > 24 hours
 Maternal fever (> 38 celcius)
 Foul-smelling discharge
Essential Newborn Care and Special Care for the Premature Neonate
Routine ENC
 Strict hygiene (handwashing, handwashing, handwashing!)
 Essential Newborn Care (thermal protection, eye care, umbilical
care—consider Chlorhexadine)
 Special Feeding Support (BF if possible; extra support with cup,
spoon or oral or nasal gastric tube if needed using expressed
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breastmilk if possible)
Begin Kangaroo Mother Care (KMC) as quickly as possible after
birth (skin to skin contact between baby and mother’s--or other
adult’s—chest with baby’s head covered, pre-warmed shirt open
to front and socks)
Care of
 Resuscitation if no spontaneous breathing in first golden minute of
Complications in
delivery (see resuscitation review guide)
Neonate
 Antibiotics if any sepsis risk factors or signs of sepsis (see
newborn sepsis guide: 5 mg/kg once daily if > 2 kg; 4 mg/kh once
daily if < 2 mg/kg)
 Supplemental oxygen if signs of Respiratory Distress Syndrome
AND if trained provider available to monitor with mandatory use of
pulsoximetry (CPAP and surfactant if high-level NICU with trained
experienced providers and nursing staff)
 Monitoring for jaundice with treatment for hyperbilirubinemia if
detected
Monitoring of Premature Newborn
 Weight recorded daily
 Temperature recorded at least once daily
 RR recorded at least once daily
 Respiratory status recorded daily
 Feeding status (nutrition source, quantity and frequency) recorded
daily (Breastmilk is best).
 Absence/presence of jaundice recorded at least one daily
Discharge

 Discharge deferred until normal temperature (> 35< 38 celcius),.
demonstrated weight gain and feeding well (at least every 2-3 hours)
 Documentation of normal physical exam at discharge
 Documentation of normal feeding status (BF or formula at least
every 2-3 hours) at discharge
 Counseling documented for prematurity care, danger signs and
care-seeking
 Follow up specified ; home-based support if possible
Note: Although there has historically been some debate about the gestational age
parameters for which ANCS should be administered for threatened premature labor,
recommendations issued by WHO at the April 2013 Global Newborn Conference are for
administration of ANCS for any threatened preterm labor between 24-36 weeks
gestational age based on the four risk factors detailed in table for ACNS indications.
Given the challenges with accurate estimation of gestational age in low-resource settings
(unless high-quality first trimester sonogram), gestational age should be based on fundal
height (# of cm=# of weeks gestational age).
This recommendation is based on the very strong evidence that ANCS reduces the
incidence and severity of lung problems, especially RDS, a leading cause of premature
infant morbidity and mortality. Although 4 doses of ACNS over 48 hours before delivery
is ideal, even 1-2 doses can reduce complications. The UN Commission on Lifesaving
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Commodities for Women and Children has recommended that Betamethasone (the ANCS
of choice) be part of every country’s essential drug list.
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