Strategies for Near-Term Infant Initiatives in
A Large Multicultural Teaching Facility
JPS Health Network

1500 South Main Street

Fort Worth, Texas 76104

Andrea Hidinger MSN RNC-MNN IBCLC                                     ahidinge@jpshealth.org

Perinatal Specialist

JPS Health Network

817-920-6949 Submitted under Innovative Program Paper and Poster Presentation Information:
AWHONN 2009 Convention Goal/Objective of Project

1.      Identify the unique needs of near-term infants

2.      Design a comprehensive program for the nursing staff caring for near term infants  in the newborn nursery

3.      Revise standard nursing care for the near-term infants in the normal newborn nursery JPS Health Network’s goal is to improve nursing care and clinical outcomes of near-term infants in the newborn nursery. JPS Hospital delivers approximately 6600 babies a year, serving an at risk population, made up of 80% Hispanic women. The goal for this project was to raise awareness of the near- term infant population’s needs amongst the medical and nursing staff, as well as to educate the nursing staff on  care of these patients. Prior to this all infants were receiving the same care as full-term infants. AWHONN has established that near-term infants have unique needs typically requiring special care. These issues may include temperature instability, hyperbilirubinemia, and hypoglycemia, feeding issues and increased respiratory distress after delivery. Inclusion criteria for near-term infants includes infants who are <37 weeks gestation or <2500 grams. We built and implemented a comprehensive program for the nursing staff including: implementation of level II orders, a specific newborn hypoglycemia order set and an early feeding protocol. Moreover, we developed increased monitoring parameters, such as, more frequent vital signs, 48 hours of hospital observation, car seat challenge test prior to discharge, and a follow- up scheduled 2-3 days post-discharge. In identifying and addressing these issues we will dramatically improve the care our near- term infants receive, identifying problems early and decreasing re-admission rates for more complex medical issues. Nurses need to be involved in standardizing and advancing knowledge of near-term infant care so that all infants receive the best possible, developmentally appropriate care improving clinical outcomes.     Key Points for Improving Care of Near Term Infants:      Define criteria for Near Term Infants 34-37 weeks or 2000-2500 grams      Car Seat Testing- equipment, process and training      Implementing Order sets:

o       Level II Newborn Nursery Admission Orders

o       Newborn Hypoglycemia Screening Orders

o       Hyperbilirubinemia Protocol

o       Car Seat Testing evaluation

References

 American Academy of Pediatrics and The American College of Obstetricians and Gynecologists.  (2007) Guidelines for perinatal care. ElkGrove Village, Illinois

Simpson, K. R., & Creehan, P. A. (2008).  Association of Women's Health Obstetric and Neonatal Nurses (AWHONN): Perinatal Nursing 3rd ed . Philadelphia: Lippincott.