Purpose for the program: To create a process by which newborns with/or at risk for complications of neonatal head trauma are identified and assessed and monitored differently with the goal of improving safety.

Proposed change: To create and implement a Neonatal Head Trauma Algorithm that is part of the Newborn Standing Orders across a large multihospital health system to ensure that newborns who are at risk for, or who have head trauma are evaluated more closely to ensure their safety.   

Implementation, outcomes and evaluation: Neonatal head trauma can result in catastrophic outcomes, and it is essential that babies at risk for complications of a difficult or instrumented delivery are identified and monitored more closely.  Complications such as subgaleal hemorrhages may manifest at birth, or may occur over many hours, so identification of babies at risk and increased vigilance is important for patient safety.  After a review of the literature, a multidisciplinary team of neonatal and birthing clinical nurse specialists, pediatricians, a neonatologist, and neonatal nurse practitioner created a Neonatal Head Trauma Algorithm to become part of Newborn Standing Orders.  Staff and physician education was done regarding neonatal head trauma, and the Neonatal Head Trauma Algorithm was implemented across a large multihospital health system.  The evaluation of this change is ongoing.

Implications for nursing practice: Nurses caring for newborns are in a key position to identify complications of neonatal head trauma that may result from the birthing process.  A standardized approach can ensure the identification and closer monitoring of babies who may have an injury that may not manifest for many hours after delivery.  Education about neonatal head trauma increases awareness of the risks, promote appropriate pain management, and will help to keep newborns safe.

Keywords: Neonatal head trauma, vacuum extraction, forceps delivery, subgaleal hemorrhage.