CoNP Resources
Neonatal Nursing Guidelines
Explore a wide range of resources, tools, and information designed to enhance the well-being of newborns, mothers, and their families.
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A comprehensive model for scaling up care for small and/or sick newborns at district level-based on country experiences presented at a WHO-UNICEF expert consultation.
Current trends indicate that 63 countries are not on track to achieve the 2030 Sustainable Development Goals (SDG) target of a neonatal mortality rate ≤12 per 1000 live births, with 55 needing to double the annual rate of decline in neonatal mortality to do so [1].
WHO-UNICEF expert consultation. J Glob Health 2023;11:03023 (Open Access)
Resource Link: https://jogh.org/wp-content/uploads/2023/04/jogh-13-03023.pdf
Preterm babies are at particular risk of hypothermia with associated adverse effects including an increased risk of hypoglycaemia, hypoxia and metabolic acidosis, respiratory distress and chronic lung disease, necrotising enterocolitis, intraventricular haemorrhage, late-onset sepsis and death. (Open Access)
By The British Association of Perinatal Medicine in collaboration with the NNAP
Resource Link: https://www.bapm.org/pages/105-normothermia-toolkit
Oxygen is important in the care of newborn infants because many conditions that affect babies in the first days of life can result in low levels of oxygen in the body. Hypoxemia, or low level of oxygen in the blood, is a life-threatening condition that results in increased mortality and morbidity. Prematurity and respiratory distress syndrome (surfactant deficiency), pneumonia and other severe infections, asphyxia and difficulties in the transition from fetal to neonatal life can all result in hypoxemia. Supplemental oxygen is an essential lifesaving treatment. (Open Access)
Resource Link: https://www.healthynewbornnetwork.org/hnn-content/uploads/DNH_TechBrief_Oxygen_7.6.17-1.pdf
When cared for in a nurturing environment, babies not only survive, they are also helped to thrive. However, too many infants are deprived of their right to receive nurturing care, including when they require inpatient hospital care. (Open Access)
Resource Link: https://iris.who.int/bitstream/handle/10665/345297/9789240035201-eng.pdf
The purpose of this framework is to give a career pathway to ANNPs working in any level or unit or within the transport setting. This model makes clear how ANNPs can progress outside the limitations of the clinical rota by setting out a variety of career development pathways using the four pillars of advanced practice: clinical practice, leadership and management, education and research.
The framework sets out the capabilities expected under each of these pillars at the level of ANNP, Senior ANNP and Consultant Nurse. (2021, Open Access)
Resource Link: https://www.bapm.org/resources/300-advanced-neonatal-nurse-practitioner-capabilities-framework
Hypoglycaemia is a leading cause of term admission to neonatal units. In 2016 NHS Improvement and BAPM convened a working group to develop a Framework for Practice to address variation in practices in the definition of hypoglycaemia, the identification, management and admission thresholds of babies admitted to neonatal units for hypoglycaemia, and to promote safer practices that avoid unnecessary separation of mother and baby.
This document is aimed at all healthcare professionals involved in the care of infants born at term during the first 48 - 72 hours after birth. The framework should be delivered in partnership with parents. (2024, Open Access)
Resource Link: https://www.bapm.org/resources/identification-and-management-of-neonatal-hypoglycaemia-in-the-full-term-infant-birth-72-hours
Resuscitation Council UK (RCUK) has produced these Newborn Life Support Guidelines, based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. [NLS CoSTR’s 2019 and 2020], and the European Resuscitation Council Guidelines for Newborn resuscitation and support of transition of infants at birth. The guidelines cover the management of the term and preterm infant.
By Joe Fawke, Jonathan Wyllie, John Madar, Sean Ainsworth, Robert Tinnion, Rachel Chittick, Nicola Wenlock, Jonathan Cusack, Victoria Monnelly, Andrew Lockey, Sue Hampshire, Published May 2021.
Resource Link: https://www.resus.org.uk/library/2021-resuscitation-guidelines/newborn-resuscitation-and-support-transition-infants-birth
Clinically significant neonatal hypoglycemia (NH) is the result of an imbalance between glucose supply and other fuels such as ketone bodies, and lactate. As part of the physiological adaptation to extra uterine life, blood glucose concentrations often dip to 30 mg/dL (1.6mmol/L) within 1 to 2 hours after birth in healthy neonates, but they typically return to more than 45 mg/dL (2.5 mmol/L) with normal feeding within 12 hours. There is no evidence that this is in anyway harmful.
This LOP is developed to guide clinical practice at the Royal Hospital for Women. Individual patient circumstances may mean that practice diverges from this LOP.
Resource Link: https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/Hypoglycaemianeonate_0.pdf
Protecting your baby from low blood glucose
Resource Link: https://www.ruh.nhs.uk/patients/patient_information/NIC012_Neonatal_Hypoglycaemia.pdf
Hypoglycemia is low level of plasma or blood glucose in the neonate. In healthy term neonates, there is a transient, physiological fall in the blood glucose concentration with a nadir at 60–90 minutes after birth, without any symptoms later rising to levels above 60 mg/dL by 4 hours. Breastfed infants may tolerate lower blood sugar levels because of bioavailable alternate fuels like ketone bodies, thus facilitating adaptation during transition.
Resource Link: https://iapindia.org/pdf/X9ceMoHV2pAF6UR_STG-NEONATAL-HYPOGLYCEMIA.pdf
The Kingdom of Eswatini is a lower middle-income country with an estimated population of approximately 1.1 million people (Population Census 2017). The fertility rate is 3.14 children per woman of childbearing age. The proportion of births attended by skilled personnel is approximately 88% (MICS 2014), with a neonatal mortality rate of 20 deaths per 1,000 live births (compared to the infant mortality rate of 85 deaths per 1,000 live births). In 2016, neonatal deaths ranked 12th in the list of childhood mortality in Swaziland and ranked 6th of all causes of years of life lost in 2016. Preterm births composed about 1 out of 9 births and ranked 7th of all causes of death and disability combined in Eswatini.
By Unicef & WHO
Resource Link: https://www.unicef.org/eswatini/media/631/file/UNICEF-Sd-Neonatal-Guidelines-report-2018.pdf
This is a clinical practice guideline. While the guideline is useful in approaching the care of the neonate at risk for hypoglycemia, clinical judgment and / or new evidence may favor an alternative plan of care, the rationale for which should be documented in the medical record.
Resource Link: https://www.brighamandwomens.org/assets/bwh/pediatric-newborn-medicine/pdfs/dpnm-hypoglycemia-revised-12-19-16.pdf
These guidelines have been developed, at the request of the Ministry of Health, as an aidememoire for all staff concerned with the management of neonates to work towards a better and more uniform standard of neonatal care across the country of Belize. The topics selected are the major and most frequent issues encountered in neonatology. The guidelines are based on the best available evidence and opinions from the most recent published literature and at points, directly from experts. It is quite straight forward, easy to read and understand. At the end of each topic, a further reading section is clearly highlighted for additional reference and in-depth explanation. Most articles stated are open access.
This new compendium gives you a single place to look for the most recent and trustworthy recommendations on quality care of pregnant women and their newborn infants.
Resource Link: https://publications.aap.org/aapbooks/book/563/Neonatal-Care-A-Compendium-of-AAP-Clinical?autologincheck=redirected
Assessment is a key component of nursing practice, required for planning and provision of patient and family centered care. The Nursing and Midwifery Board of Australia (NMBA) in the national competency standard four for registered nurses' highlights that nurses conduct a comprehensive and systematic nursing assessment in order to plan holistic and patient family centered nursing care and responds effectively to unexpected or rapidly changing situations.
Resource Link: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Nursing_Assessment/
This Comprehensive Newborn Care Protocols provide guidance on newborn care to clinicians and nurses. These protocols in this handbook are underpinned on the ‘Newborn Care Quality Statements’ outlined in this handbook.
This pocket book consists of guidelines on triage, assessment & classification of illness severity, criteria for admission, and inpatient management of the major causes of childhood morbidity & mortality such as pneumonia, diarrhea, malaria, severe acute malnutrition, meningitis, HIV, TB and neonatal conditions. The guidelines target management of the seriously ill newborn or child in the first 24 - 48 hours of arrival at a health facility.
The third trimester of gestation is a period of intense growth and development for the fetal central nervous system. Preterm birth disrupts this delicate process and forces fetal development to continue within the potentially noxious extrauterine environment of the NICU. Parents and professional caregivers can work together to minimize the negative impact of the NICU experience, hopefully reducing subsequent impairment and disability.
Resource Link: https://cdn-links.lww.com/permalink/mcn/a/mcn_43_2_2017_12_18_lockeridge_0040_sdc01.pdf
Introduction Neurodevelopmental outcomes of preterm infant are still a contemporary concern. To counter the detrimental effects resulting from the hospitalisation in the neonatal intensive care unit (NICU), developmental care (DC) interventions have emerged as a philosophy of care aimed at protecting and enhancing preterm infant’s development and promoting parental outcomes. In the past two decades, many authors have suggested DC models, core measures, practice guidelines and standards of care but outlined different groupings of interventions rather than specific interventions that can be used in NICU clinical practice. Moreover, as these DC interventions are mostly implemented by neonatal nurses, it would be strategic and valuable to identify specific outcome indicators to make visible the contribution of NICU nurses to DC.
By Marjolaine Héon ,1,2 Marilyn Aita ,1,2,3 Andréane Lavallée ,1,3 Gwenaëlle De Clifford-Faugère ,1,3 Geneviève Laporte ,1,3 Annie Boisvert,1,4 Nancy Feeley.
Resource Link: https://bmjopen.bmj.com/content/bmjopen/12/1/e046807.full.pdf
This document has been developed for neonates cared for in critical care settings across the Sydney Children’s Hospital Network including the Children’s Intensive Care Unit (CICU - SCH), Edgar Stephens Ward (ESW-CHW), Grace Centre for Newborn Intensive Care (GCNIC – CHW) and Paediatric Intensive Care Unit (PICU – CHW). However neonates cared for throughout the hospital would benefit from this approach to underpin their care.
Resource Link: https://resources.schn.health.nsw.gov.au/policies/policies/pdf/2006-0027.pdf
To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU.
Resource Link: https://journals.lww.com/ccmjournal/Fulltext/2017/01000/Guidelines_for_Family_Centered_Care_in_the.12.aspx
This guideline provides recommendations for the skin care of neonates (birth to 28 days of age) of all gestational ages. Additional considerations for preterm neonates and product suggestions are identified in the boxes below each section.
Resource Link: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neonatal___infant_skin_care/
The following neonatal skin care guidelines are based on the 4th Edition of the Association of Women’s Health, Obstetric, and Neonatal Nursing (AWHONN) Neonatal Skin Care Guidelines (2018). Summary information regarding skin assessment, bathing, cord and circumcision care, disinfectants, water loss, use of skin care products and adhesives, skin breakdown and intravenous infiltration are included below. More information can be found in the AWHONN Skin Care Guideline manuals, which are available in the NICU tea.
This statement amalgamates and updates two previous Canadian Paediatric Society documents: ‘Going home: Facilitating discharge of the preterm infant’ and ‘Safe discharge of the late preterm infant’ [1][2].
Resource Link: https://cps.ca/en/documents/position/discharge-planning-of-the-preterm-infant
Evidence for engaging patients and families in discharge planning.
In this section, we present Interdisciplinary Guidelines and Recommendations for Neonatal Intensive Care Unit (NICU) Discharge Preparation and Transition Planning. The foundation for these guidelines and recommendations is based on existing literature, practice, available policy statements, and expert opinions. These guidelines and recommendations are divided into the following sections: Basic Information, Anticipatory Guidance, Family and Home Needs Assessment, Transfer and Coordination of Care, and Other Important Considerations. Each section includes brief introductory comments, followed by the text of the guidelines and recommendations in table format. After each table, there may be further details or descriptions that support a guideline or recommendation. Our goal was to create recommendations that are both general and adaptable while also being specific and actionable. Each NICU’s implementation of this guidance will be dependent on the unique makeup and skills of their team, as well as the availability of local programs and resources. The recommendations based only on expert opinion could be topics for future research.
By Vincent C. Smith, Kristin Love and Erika Goyer
Resource Link: https://downloads.aap.org/AAP/PDF/NPA%20discharge%20Guidelines%20Final.pdf
This Framework describes the overarching principles to support the delivery of the specific recommendations within Best Start. A number of appendices are included to support implementation, sharing of resources and consistency of practice. It is envisaged that Health Boards and individual units will use this framework to support local service delivery recognising that some variation will occur as a consequence of demographics, and geography.
Resource Link: https://perinatalnetwork.scot/neonatal/neonatal-discharge/
This guideline provides advice for neonates above 32 weeks and outside of a neonatal intensive care setting.
Resource Link: https://www.rch.org.au/clinicalguide/guideline_index/Neonatal_intravenous_fluids/
Careful fluid and electrolyte management is essential for the well being of the sick neonate. Inadequate administration of fluids can result in hypovolemia, hypersomolarity, metabolic abnormalities and renal failure. In the near term and term neonate excess fluid administration results in generalized edema and abnormalities of pulmonary function. Excess fluid administration in the very low birth weight infant is associated with patent ductus arteriosis and congestive heart failure, intraventricular hemorrhage, necrotizing enterocolitis and bronchopulmonary dysplasia. A rational approach to the management of fluid and electrolyte therapy in term and preterm neonates requires the understanding of several physiologic principles.
Resource Link: https://uihc.org/childrens/educational-resources/fluid-management-nicu-handbook
The Florida Neonatal Neurologic Network support the following management guidelines for infants with HIE. We acknowledge a variety of management styles, consensus statements and scientific data exist in this area, however, these Modification 4 State Meeting August 1, 2015 3 guidelines are based on the best available evidence and pooled expert opinions at the time of this document’s creation.
Resource Link: https://fn3.sites.medinfo.ufl.edu/files/2015/10/HIE-Supportive-Care-Management-Guidelines-08-1-2015-final1.pdf
Treatment of the sick neonate in specialized neonatal intensive care units (NICU) has been associated with decrease in mortality and morbidity. In the early 1960s, neonatal transport was first used to make intensive care accessible to those neonates who needed it.1 Subsequently, organized emergency neonatal transport systems developed and became an important component in the regionalization of perinatal care.2-5 In utero transfer is the safest transfer but unfortunately, preterm delivery, perinatal illness and congenital malformations cannot always be anticipated, resulting in a continued need for transfer of babies after delivery.6 These babies are often critically ill, and the outcome is partly dependent on the effectiveness of the transport system.7 Facilities for neonatal transport in India are dismal. Most neonates are transported without any pre-transport stabilization or care during transport. Any available vehicle is used, which often takes long hours and place where to take the baby is also not well recognized. There is an acute shortage of neonatal beds and majority of the sick neonate in need of urgent admission are dumped in pediatric wards with inadequate infrastructure. Often, these neonates are shunted from one health facility to another.
Resource Link: https://www.ontop-in.org/ontop-pen/Week-12-13/Transport%20of%20sick%20NB%20.pdf
Oxygen is important in the care of newborn infants because many conditions that affect babies in the first days of life can result in low levels of oxygen in the body. Hypoxemia, or low level of oxygen in the blood, is a life-threatening condition that results in increased mortality and morbidity. Prematurity and respiratory distress syndrome (surfactant deficiency), pneumonia and other severe infections, asphyxia and difficulties in the transition from fetal to neonatal life can all result in hypoxemia. Supplemental oxygen is an essential lifesaving treatment.
Resource Link: https://www.everypreemie.org/wp-content/uploads/2019/09/SafeOxygen_english_7.6.17.pdf
The aim of this guideline is to describe the indications and procedure for the use of oxygen therapy, and its modes of delivery.
Resource Link: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Oxygen_delivery/
Over the past few years there have been significant changes, based on high quality research, in our understanding of how to give the right amount of oxygen to babies, although most research has been in the preterm population. What has emerged is that too little oxygen and too much oxygen can both be harmful, and that ex-preterm babies who are more mature should not be considered to be the same as term babies born at term.
Resource Link: https://www.ashfordstpeters.net/Guidelines_Neonatal/Oxygen%20Guideline%20June%202015.pdf
UK guidance for blood services, including component specification, preparation, testing and donor selection for blood and tissues.
Aims to define guidelines for all materials produced by the UK Blood Transfusion Services for both therapeutic and diagnostic use, and to reflect an expert view of current best practice, provide specifications of products, and describe technical details of processes.
Resource Link: https://www.transfusionguidelines.org/
An exchange transfusion involves removing aliquots of patient blood and replacing with donor blood in order to remove abnormal blood components and circulating toxins whilst maintaining adequate circulating blood volume. It is primarily performed to remove antibodies and excess bilirubin in isoimmune disease, the incidence of exchange transfusion is decreasing secondary to the prevention, and improved prenatal management of alloimmune haemolytic disease and improvements in the management of neonatal hyperbilirubinaemia.
Resource Link: https://www.rch.org.au/uploadedFiles/Main/Content/neonatal_rch/EXCHANGE_TRANSFUSION.pdf
Subjects:
Evidence-Based Medicine, Hyperbilirubinemia
Topics: hyperbilirubinemia, phototherapy, bilirubin, exchange transfusion, whole blood
More than 80% of newborn infants will have some degree of jaundice.1,2 Careful monitoring of all newborn infants and the application of appropriate treatments are essential, because high bilirubin concentrations can cause acute bilirubin encephalopathy and kernicterus.3 Kernicterus is a permanent disabling neurologic condition characterized by some or all of the following: choreoathetoid cerebral palsy, upward gaze paresis, enamel dysplasia of deciduous teeth, sensorineural hearing loss or auditory neuropathy or dyssynchrony spectrum disorder, and characteristic findings on brain MRI.4 A description of kernicterus nomenclature is provided in Appendix A. Central to this guideline is having systems in place including policies in hospitals and other types of birthing locations to provide the care necessary to minimize the risk of kernicterus.
This article updates and replaces the 2004 American Academy of Pediatrics (AAP) clinical practice guideline for the management and prevention of hyperbilirubinemia in the newborn infant ≥35 weeks’ gestation.3 This clinical practice guideline, like the previous one, addresses issues of prevention, risk assessment, monitoring, and treatment.
Resource Link: https://publications.aap.org/pediatrics/article/150/3/e2022058859/188726/Clinical-Practice-Guideline-Revision-Management-of
The purpose of this framework is to give a career pathway to ANNPs working in any level or unit or within the transport setting. This model makes clear how ANNPs can progress outside the limitations of the clinical rota by setting out a variety of career development pathways using the four pillars of advanced practice: clinical practice, leadership and management, education and research.
The framework sets out the capabilities expected under each of these pillars at the level of ANNP, Senior ANNP and Consultant Nurse.
Resource Link: https://www.bapm.org/resources/300-advanced-neonatal-nurse-practitioner-capabilities-framework
Hypoglycaemia is a leading cause of term admission to neonatal units. In 2016 NHS Improvement and BAPM convened a working group to develop a Framework for Practice to address variation in practices in the definition of hypoglycaemia, the identification, management and admission thresholds of babies admitted to neonatal units for hypoglycaemia, and to promote safer practices that avoid unnecessary separation of mother and baby.
This document is aimed at all healthcare professionals involved in the care of infants born at term during the first 48 - 72 hours after birth. The framework should be delivered in partnership with parents.
Resource Link: https://www.bapm.org/resources/identification-and-management-of-neonatal-hypoglycaemia-in-the-full-term-infant-birth-72-hours
Resuscitation Council UK (RCUK) has produced these Newborn Life Support Guidelines, based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. [NLS CoSTR’s 2019 and 2020], and the European Resuscitation Council Guidelines for Newborn resuscitation and support of transition of infants at birth. The guidelines cover the management of the term and preterm infant.
By Joe Fawke Jonathan Wyllie John Madar Sean Ainsworth Robert Tinnion Rachel Chittick Nicola Wenlock Jonathan Cusack Victoria Monnelly Andrew Lockey Sue Hampshire Published May 2021.
Resource Link: https://www.resus.org.uk/library/2021-resuscitation-guidelines/newborn-resuscitation-and-support-transition-infants-birth
The American Academy of Pediatrics (AAP) through funding from the Bill and Melinda Gates Foundation, and in collaboration with the World Health Organization, other implementing organizations and several national professional societies, is excited to showcase a series of webinars aimed at promoting new evidence on immediate Kangaroo Mother Care (iKMC), supporting a paradigm shift to zero separation between mothers and their newborn babies with a goal to improve quality of care and outcomes for small and sick newborns.
Resource Link: https://www.aap.org/en/aap-global/immediate-kangaroo-mother-care-ikmc/
The KMC implementation strategy targets a broad audience. These include policy-makers and programme managers at national, regional and local levels, government and nongovernmental organizations working in the area of maternal and newborn care, global and national professional associations, public and private hospital management at all levels of care, and facility- and community-based maternal and infant care providers.
Resource Link: https://www.who.int/publications/i/item/9789240071636
Establishment of risk-appropriate care was first proposed in 1976 when leaders in perinatal health proposed a model system of regionalized care for obstetrical and neonatal patients, including definitions of graded levels of hospital care.1 Risk-appropriate care, in which infants with mild to complex critical illness or physiologic immaturity are cared for in a facility with the personnel and resources appropriate for their needs and condition, results in improved outcomes. This concept is supported by the American Academy of Pediatrics (AAP) policy statement “Levels of Neonatal Care,” which provides a review of data supporting a tiered provision of neonatal care and reaffirms the need for nationally consistent standards of care to improve neonatal outcomes.
By Ann R. Stark, MD, FAAP; DeWayne M. Pursley, MD, MPH, FAAP; Lu-Ann Papile, MD, FAAP; Eric C. Eichenwald, MD, FAAP; Charles T. Hankins, MD, MBA, FAAP; Rosanne K. Buck, RN, MS, NNP-BC, C-ONQS; Tamara J. Wallace, DNP, APRN, NNP-BC; Patricia G. Bondurant, DNP, RN; Nicole E. Faster, MSN, RN, RNC-NIC (Open Acess)
The Toolkit for High-Quality Neonatal Services was published by the Department of Health in 2009, as guidance to help the NHS improve neonatal care. Eight principles cover the major areas of the neonatal pathway. There is a family-centred focus aiming to ensure the psychological and physiological needs are considered. The challenge now is for the NHS to implement this at a time of financial constraint.
Resource Link: https://www.infantjournal.co.uk/pdf/inf_032_hqs.pdf
Suck is a relatively mature ororhythmic motor behavior in a full-term infant and is integral to competent oral feeds. However, preterm infants often demonstrate oromotor discoordination and are unable to suck and feed orally (Comrie & Helm, 1997; Lau, 2006; Barlow, 2009a). This inability represents a serious challenge to both the neonatal intensive care unit (NICU) “graduates” and the physician-provider-parent teams.
By Steven M. Barlow, PhD, Meredith A. Poore, ABD, Emily A. Zimmerman, ABD, CCC-SLP and Don S. Finan, PhD.
Resource Link: https://leader.pubs.asha.org/doi/10.1044/leader.FTR3.15072010.22
This checklist is to be used to guide the transition from nasogastric (NG) to breastfeeds.
Resource Link: https://www.kznhealth.gov.za/neonates/records/Oral%20feeding%20transitionchecklist%202.pdf
These two Toolkits support the implementation of ten core elements to optimise the provision of Maternal Breast Milk (MBM) for preterm babies throughout the neonatal journey, to discharge and beyond.
Part One covers the foundational first five elements, focussing on the initiation of lactation.
Part Two delivers the subsequent five elements, focusing on sustaining lactation and transitioning to breastfeeding through the neonatal stay, to discharge and beyond.
Resource Link: https://www.bapm.org/pages/196-maternal-breast-milk-toolkit
Because of its unique nutritional composition, breast milk is the optimal nutrition for almost all infants, and it should be available immediately after birth - in particular for preterm infants. Breast milk is ideally adapted to an infant’s needs, contains an ideal combination of nutrients, and making it without a doubt the best and most natural form of food for infants in the first months of life.
Resource Link: https://www.efcni.org/wp-content/uploads/2018/05/2018_05_08_EFCNI_Milkbank_Toolkit_web.pdf
An interprofessional committee of neonatal experts has convened for more than 5 years, to study the science, evidence, and best practice of developmental care; and the associated outcomes to the baby and family. The purpose was to establish a document of standardized practice to implement collaborative team management with babies and families through the continuum of hospital to home care. The committee identified gaps in care management/practice to include: a) lack of collaborative function of health care providers and caregivers to perform neurodevelopmental management of the baby, b) failure to consistently include the parents/family as members of the team, c) variation in the application of interventions to satisfy mutual goals for the health and wellbeing of babies, families, and staff, d) inability to recognize the communication of the baby in response to intervention, and e) inadequate education and mentoring to guide effective interaction with the baby. It is vital that care be managed “with” the baby, instead of “to” the baby.
By Erin Ross, PhD, CCC-SLP, Joan C. Arvedson, PhD, CCC-SLP, BCS-S, ASHA Honors & Fellow, Jacqueline McGrath, PhD, RN, FANP, FAAN
Resource Link: https://nicudesign.nd.edu/nicu-care-standards/introduction/
Enteral feeds are advanced with the goal of optimizing nutrition, reducing need for TPN and central lines, to reduce line related infection/ Late onset sepsis. In turn to increase enteral feeds quickly and safely to avoid NEC, a diagnosis with high morbidity and mortality in preterm infants. Studies have shown benefits to implementing a standardized protocol to advance and fortify enteral feeds. These benefits include reducing days on TPN, reducing days with central lines, and reducing NEC.
Resource Link: https://kcprematurebabies.com/wp-content/uploads/2020/pdf/NICU%20FEEDING%20PROTOCOL.pdf
By Susan J. Carlson, MMSc, RD, CSP, LD, CNSD and Ekhard E. Ziegler, MD
Resource Link: https://uihc.org/childrens/educational-resources/feeding-nicu-handbook
This guideline is applicable to all medical and nursing staff caring for preterm infants in neonatal units in the West of Scotland. It aims to describe safe feeding practices for preterm infants, especially those at increased risk of feed intolerance and necrotising enterocolitis. It is not applicable to babies with congenital abnormalities of the GI tract or babies commencing enteral feeds after GI surgery or following a conservatively managed episode of necrotising enterocolitis. This guidance must always be used in conjunction with careful, individualised, clinical assessment.
Resource Link: https://www.clinicalguidelines.scot.nhs.uk/nhsggc-guidelines/nhsggc-guidelines/neonatology/enteral-feeding-of-preterm-infants/
Feeding babies enterally with expressed breast milk has many benefits for their short and long term health. Babies of all gestations and ages should be provided with enteral milk within 6 hours of birth unless there is a specific contraindication discussed with a consultant and documented clearly.
By Samantha Edwards, Vennila Ponnusamy and Catherine Casewell
Resource Link: https://ashfordstpeters.net/Guidelines_Neonatal/Risk%20Stratified%20Approach%20to%20Enteral%20Feeding%20Mar%202023.pdf
Babies have the right to be protected from injury and infection, to breathe normally, to be warm and to be fed. All newborns should have access to essential newborn care, which is the critical care for all babies in the first days after birth. Essential newborn care involves immediate care at the time of birth, and essential care during the entire newborn period. It is needed both in the health facility and at home.
Resource Link: https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/newborn-health/essential-newborn-care
Every year, an estimated 15 million babies are born preterm – before 37 weeks of pregnancy. That is more than 1 in 10 live births. Approximately 1 million children die each year worldwide due to complications from their early birth. Those that survive often face a lifetime of ill-health including disability, learning difficulties, and visual and hearing problems. Half of the babies born at or below 32 weeks (2 months early) die in low-income settings, due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high-income countries, almost all these babies survive. Today, (November 2020) on World Prematurity Day, WHO launched a new Roadmap on human resource strategies to improve newborn care in health facilities in low- and middle-income countries, aimed at improving quality of care for newborns, including small and sick babies, and supporting countries to achieve the SDG target to reduce neonatal mortality to less than 12 per 1000 live births by 2030.
The recommendations in this guideline are intended to inform development of national and subnational health policies, clinical protocols and programmatic guides. The target audience includes national and subnational public health policy-makers, implementers and managers of maternal, newborn and child health programmes, health-care facility managers, supervisors/instructors for in-service training, health workers (including midwives, auxiliary nurse-midwives, nurses, paediatricians, neonatologists, general medical practitioners and community health workers), nongovernmental organizations, professional societies involved in the planning and management of maternal, newborn and child health services, academic staff involved in research and in the pre-service education and training of health workers, and those involved in the education of parents.
Resource Link: https://www.who.int/publications/i/item/9789240058262
This campaign is supported by more than 140 national and international parent- and patient organisations, international healthcare professionals and medical societies including the World Health Organization (WHO). Download their statement for your communication to advocate a zero separation policy in neonatal care.
Resource Link: https://www.glance-network.org/zero-separation-statements/
UNICEF is committed to providing affordable, high-quality health care to mothers and newborns before, during, and after pregnancy. To achieve this goal, UNICEF and partners have adopted the Every Newborn Action Plan, which provides a roadmap for reducing newborn mortality and stillbirths and improving maternal and newborn health by 2030. The updated targets and milestones for 2020-2025 include ensuring that every pregnant woman has four or more antenatal care contacts, every birth is attended by skilled health personnel, every woman and newborn receives early routine postnatal care within two days, and every small and sick newborn receives care. UNICEF is supporting countries in implementing these
recommendations and reaching these goals by providing essential packages of high-quality
maternal and newborn services, such as home visits, small and sick newborn care, and
kangaroo care. Four indicators have been identified to track progress towards these goals:
antenatal care, births attended by skilled health personnel, postnatal care within two days, and care for small and sick newborns. Currently, data on these indicators are derived from
population-based household surveys, but efforts are underway to strengthen routine health
information systems to capture this information rapidly at the subnational level.
Resource Link: https://data.unicef.org/resources/ending-preventable-newborn-deaths-and-stillbirths-by-2030/
The purpose of this framework is to give a career pathway to ANNPs working in any level or unit or within the transport setting. This model makes clear how ANNPs can progress outside the limitations of the clinical rota by setting out a variety of career development pathways using the four pillars of advanced practice: clinical practice, leadership and management, education and research.
The framework sets out the capabilities expected under each of these pillars at the level of ANNP, Senior ANNP and Consultant Nurse.
Resource Link: https://www.bapm.org/resources/300-advanced-neonatal-nurse-practitioner-capabilities-framework
Hypoglycaemia is a leading cause of term admission to neonatal units. In 2016 NHS Improvement and BAPM convened a working group to develop a Framework for Practice to address variation in practices in the definition of hypoglycaemia, the identification, management and admission thresholds of babies admitted to neonatal units for hypoglycaemia, and to promote safer practices that avoid unnecessary separation of mother and baby.
This update of the Framework is to ensure alignment of recommended clinical practice with the most up-to-date scientific evidence.
This document is aimed at all healthcare professionals involved in the care of infants born at term during the first 48 - 72 hours after birth.
The framework should be delivered in partnership with parents.
We welcome your comments on the update of this Framework for Practice.
Resource Link: https://www.bapm.org/resources/identification-and-management-of-neonatal-hypoglycaemia-in-the-full-term-infant-birth-72-hours
Resuscitation Council UK (RCUK) has produced these Newborn Life Support Guidelines, based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. [NLS CoSTR’s 2019 and 2020], and the European Resuscitation Council Guidelines for Newborn resuscitation and support of transition of infants at birth. The guidelines cover the management of the term and preterm infant.
By Joe Fawke, Jonathan Wyllie, John Madar, Sean Ainsworth, Robert Tinnion, Rachel Chittick, Nicola Wenlock, Jonathan Cusack, Victoria Monnelly, Andrew Lockey, Sue Hampshire, Published May 2021.
Resource Link: https://www.resus.org.uk/library/2021-resuscitation-guidelines/newborn-resuscitation-and-support-transition-infants-birth