Newborn Nursery

Mother Baby Unit

Welcome to the Newborn Nursery!

The Daily Flow

Arrive 6am

Look up the new admissions and fill in the little cards. Go see the babies.
Each baby has half of the paper that includes maternal history, physical exam, lab results, vitals, discharge
Around 9am - rounds. After rounds, finish your notes. When you leave, give clear instructions to the nurses about what to do with any pending labs
Helpful stuff: Bilitool.org, for when to start phototherapy, Lactmed for breastfeeding while on meds, Peditool for growth
Babies you'll see: normal, neonatal abstinence syndrome, hypoglycemia
Babies born vaginally usually are discharge after 36-48hr, those by C-section after 48-72hr. Ask mom or look at the OB note to find their discharge date
Check the on call list to see who your attending will be for the day
The binder has lots of great resources: articles, growth curves, protocols for hypoglycemia/NAS/hyperbili/GBS, derm pictures
The MCV at birth is expected to be around 100 or more. Ie.
- An MCV between 80-100 is microcytic even though this is normal for an older kid. Dr. Turkovich will want you to order a Hb Barts (as per folklore)
If the cord gas is acidotic, repeat it
If the mom is O+, then order a Neonatal Coombs test
Ophthalmoscopes are in the nursery/circ area. Make sure check red reflex and document its presence bilaterally on the H&P and Discharge Summary
Notes are short and all the senior residents have templates- just ask one of us! Choose “progress SOAP note”, “H&P Newborn” and “Discharge Summary Newborn”

*The max newborns that residents should be taking care of in the MBU is 12. After that, the attendings will be writing the rest of the notes. And to clarify, this means that residents need to know about 12 patients and write notes on them. Not know 20 patients, but only write notes on 12*

Here are some useful guides!

MBU Rotation Files

Stanford Newborn Nursery (so useful!)

(More) Expectations

ASCOM is to be used for communication
Staffed generally by 1-2 pediatric and/or med/peds interns throughout the course of the year.
Schedule:
- 6 days a week. One weekend day will be covered by a intern or senior resident on ambulatory week who have previously done the rotation.
- 6am to 5pm
  - 5pm --> ASCOM is taken to J10/J11/J12 (team with less patients)
Day to day
- Arrive at 6am to round on patients -- there can be many admissions overnight!
- Fill out flowsheet to maintain organization and use as communication for covering residents over the weekend or in case of calling out.
- Please follow Dr. Murak's daily schedule
  - List of Pediatric Attendings
- Every baby MUST have a daily physical exam.
Documentation:
- First note - full H&P with all pertinent historical information from mom (icluding prenatal infections, screening, care etc).
- Each subsequent day requires a progress note, except for the day of discharge, a discharge summary can be written instead.
Goal at end of rotation
- Comfortable with the well baby examination
- Identify abnormal findings that need follow up, including but not limited to hip dysplasia, shoulder dystocia, congenital cataracts, jaundice, hydrocele, cephalohematoma, caput medusa etc.
- Comfortable with anticipatory guidance to new parents about well baby care, including back-to-sleep, umbilical stump care, breastfeeding, vaccinations, shaking babies, etc.
- Complete educational readings/sessions as outlined in the rotation outline.

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