NewBorn Nursery Tips

[medready2005]

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Hello All

So ill be starting on the Nursery early next week. So I have one month as an intern under my belt, can you all give me some tips/advice on how to make it through the nursery month?

thanks!!

cheers👍

 

[rotatores]

Hello All

So ill be starting on the Nursery early next week. So I have one month as an intern under my belt, can you all give me some tips/advice on how to make it through the nursery month?

thanks!!

cheers👍

1) Become efficient in the newborn PE
2) Learn your Cong Heart Lesions and be able to detect murmurs
3) Document Document Document...if you get called in the middle of the night...see the patient...then document your plan
4) Learn how to circ (depends on training location)
5) Learn your newborn rashes...benign (E. tox) vs. bad (HSV)
6) NRP...know this without thinking
7) Jaundice...have access to your nomogram and learn your differential
8) Learn your program's discharge criteria
9) Learn your program's protocol for sepsis screening


Those are just a few to get you started. Good luck!

 

[oldbearprofessor]

1) Become efficient in the newborn PE
2) Learn your Cong Heart Lesions and be able to detect murmurs
3) Document Document Document...if you get called in the middle of the night...see the patient...then document your plan
4) Learn how to circ (depends on training location)
5) Learn your newborn rashes...benign (E. tox) vs. bad (HSV)
6) NRP...know this without thinking
7) Jaundice...have access to your nomogram and learn your differential
8) Learn your program's discharge criteria
9) Learn your program's protocol for sepsis screening

10. Know when a first void or stool is "late" and how to evaluate this.
11. Recognize cephalohematoma, forceps marks, etc and explain to family how long they'll be present.
12. Know current vitamin recommendations for newborns.
13. Management of mild tachypnea in the newborn period. When to transfer and w/u for sepsis, when to be more patient.
14. Spend a few minutes with lactation support folks and learn basics of dealing with common early lactation problems.
15. Learn what a normal feeding volume and frequency are in the first 48 hours of life. If a baby only takes 1/2-1 oz of formula at 12 hours of age, is this normal?
16. Know how to manage IDMs and babies with low or marginally low glucose values.

Newborn actually has a lot of learning.....

 

[BigNavyPedsGuy]

10. Know when a first void or stool is "late" and how to evaluate this.
11. Recognize cephalohematoma, forceps marks, etc and explain to family how long they'll be present.
12. Know current vitamin recommendations for newborns.
13. Management of mild tachypnea in the newborn period. When to transfer and w/u for sepsis, when to be more patient.
14. Spend a few minutes with lactation support folks and learn basics of dealing with common early lactation problems.
15. Learn what a normal feeding volume and frequency are in the first 48 hours of life. If a baby only takes 1/2-1 oz of formula at 12 hours of age, is this normal?
16. Know how to manage IDMs and babies with low or marginally low glucose values.

Newborn actually has a lot of learning.....

17. Don't shake the babies!

 

[Mutterkuchen]

I think that the biggest thing is to maintain the highest ability to remain skeptical in the monotony. You see normal baby, after normal baby, after normal baby. . . it's easy to assume that the next one will also be normal and gloss over the exam.

My first week in the nursery, I missed a 6th digit on one of the hands. Mom asks me what we can do about the extra digit, and I'm like "uhhhh oh that, we'll look into that. Maybe I should take the baby and look him over one more time!"

So check every red reflex, count all the digits, listen carefully for that murmur, etc. so you don't become that intern who missed the imp. anus! (that one wasn't me, but she now has a reputation. . .)

 

[edmadison]

17. Don't shake the babies!

It is OK to jiggle a baby a little bit, however.

Ed

 

[Freibi]

It is OK to jiggle a baby a little bit, however.

Great advice in the previous posts ... at what degree of jiggling does it become shaking though? Just take care while handling babies. You're definitely allowed to rub their backs and to flick their feet if you need them to cry (see NRP), to turn them on their stomachs, to lift them up, etc.

It may sound weird, but if you want to be quick at a PE, try to do it slowly (no abrupt movements) so as not to startle the baby. That way, you won't likely have to take a break while (s)he is crying (plus, both baby and Mom will like it better). Start with the things where you need the baby to be quiet (auscultate heart, lungs, and belly first, with a warm stethoscope and warm hands). You can do a lot of the exam with the baby sleeping (most everything except eyes and ENT - if you want the baby to open her/his eyes, try sitting him/her up a little).
If the baby starts crying after all, it often helps to put him/her in a comfortable position, meaning sort of a fetal position, with a swaddling cloth around them or in Mom's arms. If Mom allows, you can put something in the baby's mouth to soothe them (even avid pacifier opponents usually allow the baby to suckle on a gloved finger during an exam. If you don't have anything else and the baby's arms are bent, try having them suck on their own hand).

Have fun and have a nice rotation!

 

[Sweet Tea]

Easiest way for me to look for a red reflex: pick up the baby. Babies are puffy and crying and it's a losing battle to try to force their little eyelids open while they're crying. If you pick them up and they calm down a bit, they open their eyes and then you can blind them with your opthalmoscope. 😉

 

[coldflare]

17. Don't shake the babies!

18. Sleep very, very close to L&D.
19. When L&D pages you . . . RUN.

 

[BigNavyPedsGuy]

It is OK to jiggle a baby a little bit, however.

Ed

Especially when they're in the NICU on the HiFi . . . . .

 

[oompaloompa]

At my program the Newborn Nursery and NICU are separate entities and rotations. When just covering the newborn nursery I would like to add to not get complacent. To be honest, most of them are going to be fine with the normal care nurses and moms provide and it can get a little tedious and boring at times. However, every once in a while, something crazy will happen that starts out as a minor anomaly. Try to stay on your guard.

 

[oompaloompa]

18. Sleep very, very close to L&D.
19. When L&D pages you . . . RUN.

This is highly variable in my experience. I try to make it over there quickly, but that's usually followed by 20+ minutes of waiting. However, you are right in that occasionally the OBs have an "oh f%ck" moment and need you there for a STAT section.

 

[coldflare]

...occasionally the OBs have an "oh f%ck" moment and need you there for a STAT section.

One of my scariest moments in residency was in July of my intern year on call in the NBN. I was asleep in the middle of the night when I was paged for "infant in distress" - a woman had walked off the street into L&D and pushed out a 27-week baby in triage. I was the only one there from peds/neo for about five minutes.

Five LOOOONNNGG minutes.