"Morning Care" protocol

[JACK]

We are in the process of reviewing our policy for "Morning Care" for neonates in NICU. We have noticed that "Morning Care" is a period of great stress for sick neonates and may be associated with deterioration if not done properly. I wanted to know from our colleagues in 99nicu regarding their protocols for "Morning Care".

Do you stagger the "Morning Care" for Intensive Care and intermediate care over different time periods in the night so as not to overload the staff?

Do you have a senior nurse to help the the nurses doing "Morning Care"?

Which babies do you weigh and which ones do you skip? What is the frequency of weight taking?

What steps do you take to minimize hypothermia during "Morning Care" especially while changing linens inside the incubator?

How do you minimize physical stress to preterm babies during "Morning Care"?

For extreme preterms, babies with PPHN and other critical babies how do you modify the "Morning Care"?

What is the weight cut-off and gestatinal age cut-off for giving a bath to your preterms?

We are trying to make the "Morning Care" baby-friendly

[MandaAnda]

Just a quick reply, as I need to get to bed.

We "top and tail" the babies in the mornings with first cares. Weights are done by the night staff, usually right before midnight, and only once a week unless required more often. We weigh the intensive care/high dependency babies on a Sunday night and the special care babies on a Wednesday and Saturday night. For baths, they need to have been in a normal cot and maintaining their temperature there for a bit; and they tend to be getting close to 2kg by that point.

[Stefan Johansson]

Hmm, I am not completely sure if we have a clear/written policy about this!

We weigh our infant pretty often, every other day usually, or even every day, especially if there are fluid / water balance issues. The most instable ones are not weighed at all during their instable periods. I'd say our strategy is a bit contradictory; we weigh the stable ones too often, and the instable ones to seldom...

Incubator change: linens are changed with the infant inside and when we need to clean the incubator, we just rollmove the infant from the old to a new and clean incubator.

Minimize stress: we let parents take care of as much of the care as possible, always "support" the infants (NIDCAP language!) In practise, the "top and tail" can be done during the morning, day or evening.

Baths: no limits in terms of gest-age or weight, but infants must be stable in circulation and breathing.

[valbourgoin]

We weigh our babies every day on the night shift (before midnight). Our babies that are in Level 3 unit (most critical care level) are not bathed or seldom bathed. When those babies are transferred in our Level 2 unit (intermediate care level), they get bathed once every other day (as assignment load permits!) and we change linens when they are bathed. For the smaller babies, they get bathed inside the incubator and we put an incontinence pad underneath them so as not to wet the whole bed. We dry them off, wrap them up and change the linens afterward.

All of our babies' incubators are changed on a weekly basis and we change the linens when we do the incubator switch.

As for our babies that are Level 1 care, they are usually bathed by their parents when they come for a visit as they are all in cribs by then.

Hope this was helpful!

[Guest luvnicubabies]

Our infants get weighed every day unless it is the first three to five days of life to prevent IVH. This infants, when weighed are on special bed scales so it is little risk to them to be lifted and placed back down.

When infants are much more stable, we weigh every day on a scale. Baths are not done unless absolutely necessary as it causes skin sheering. "Tops and tails" is good enough for most infants.

When infants are really stable, we allow parents to do most of that kind of care.

[hkhawahur]

sick babies in NICU(level111) are just wiped daily with sterile gause soaked with warm water . Those babies in SCBU (level 111), stable and larger > 1500g usually have daily bath in the early morning (night shift) . usually we change incubator weekly .

[drjha04]

We weigh our babies every day on the night shift If their cardiac and respiratory status is stable .

Infants with PPHN, on HFOV and unstable cardiac and respiratory status secondary to any system illness are not weighed.

All of our babies' incubators are changed on a weekly basis sometime earlier if it gets spoiled. Linens are changed q shift.

All Infants not on ventilator and stable cardiac and respiratory status get daily bath.

Hope this was helpful!

[Guest JoannieO]

We do not weigh unstable babies. All other babies are weighed every second day, usually during the day shift but not necessarily in the morning. They are "top and tailed" with cares - which can be 4hrly or 3hrly depending on how often the baby is feeding. Babies are not taken out for a full bath until they are able to maintain their temperature - usually at about 1500 grams. Linen is changed as needed. All of this is flexible timewise to fit in with the nurse's workload. We do not disturb a sleeping baby unless it is absolutely necessary. A diaper change can wait for an hour if the baby is sleeping.

[aridema]

We weigh our infant usually every day, in the morning, as they have fluid / water balance. We dont'mind about stabilization but our scales are into the incubator, so it's easy to weigh babies without stressing them. Incubators change every week. Every day linens are changed with the infant inside, slowly. To minimize stress, we let parents take care of their baby, teaching them "how to move". As to the bath we have no limits in terms of gestational age or weight, but infants must be stable.