Pediatric Newborn Medicine Guidelines for Clinical Care

In November 2014, the Department of Pediatric Newborn Medicine established the multidisciplinary Clinical Practice Council (CPC). The CPC, led by Katherine Gregory, PhD, RN, Director of Newborn Care Improvement and Analytics, is compromised of leaders of the various disciplines caring for newborns and their families across the Center for Women and Newborns at Brigham and Women’s Hospital. The aim of the CPC is to facilitate the development of clinical practice guidelines (CPGs) and policies (CPPs) that are uniformly excellent and evidence-based, and to support the implementation and analysis of these guidelines within our complex clinical setting. 

Cardiac

Assessment and Treatment for Patent Ductus Arteriosus

Endocrine

Neonatal Glucose Assessment and Clinical Management

Family Care

Care of Families Considering or Requesting Discharge of their Newborn Against Medical Advice (AMA)

Worksheet for Threatened AMA Situations

Feeding & Nutrition

Enteral Nutrition

Parenteral Nutrition

Feeding in the Weeks Leading Up to Discharge

Hematology

Evaluation and Management of Hyperbilirubinemia in the Newborn Nursery and NICU

Vitamin K Administration in Newborn Infants 

Infant Transport

Transfer of Infants To and From BWH Newborn Intensive Care Unit (NICU)

Infectious Disease

Initial Evaluation of Newborns with Possible Congenital Zika Virus Infection

Newborn Infection Control & Prevention Guidelines

Cytomegalovirus (CMV) Screening Protocol

Late Preterm Infant

Care of the Late Preterm Newborn

Musculoskeletal

Initial Evaluation of Newborns with Developmental Dysplasia of the Hip

Parent Information Sheet: Developmental Dysplasia of the Hips (DDH)

Neurology

Therapeutic Hypothermia

Appendix 1: TH Evaluation Checklist

Appendix 2: Overview of Management by System

Appendix 3: Detailed Encephalopathy Scale Score

Parent Information Sheet (TH)

Care of the Neonate with Neonatal Abstinence Syndrome (NAS)

Infant Sleep and Therapeutic Positioning

Neonatal Seizures

Management of a Neonatal Fall During Initial Hospitalization

Head Ultrasound (HUS) Screening in Premature Infants

Term Equivalent Brain MRIs for Very Preterm Infants

Respiratory

Pharmacologic Strategies for the Prevention of Bronchopulmonary Dysplasia

Target O2 Sats for Infants in the Neonatal Intensive Care Unit

Guidelines for Use of CPAP And High Flow and Low Flow Nasal Cannula in the Special Care Nursery (SCN)

Diagnosis and Management of the Infant with Suspected or Known Pulmonary Hypertension of the Newborn

Echo Algorithm

Resp Algorithm

Parent Information Sheet

Management of the Infant with Evolving/Established BPD

Infants with BPD: Weaning Strategies from Assisted Ventilation

Skin Care

Diaper Dermatitis

Vascular Access

Neonatal Skin Care

Administration of Altepase via a Peripherally Inserted Central Catheter (PICC)

Peripherally Inserted Central Catheter (PICC) Insertion, Including Modified Seldinger Technique

The CPGs are developed by multidisciplinary guideline development groups who have an interest and expertise in a specific clinical topic. Once this group has written the initial draft of the CPG, it is reviewed by the CPC and if approved, it is circulated with the entire clinical team as part of our staff review process. During the staff review, feedback from all care providers who will be using the CPG in practice is welcomed. This feedback is assessed by the guideline development group and when appropriate, incorporated into the document. We have found that the staff review process has significantly improved the development and implementation of our CPGs.

Once the final CPG is ready for implementation, the CPC works with the leaders in clinical administration and education to determine a “go-live” date and communicate any changes in practice that will result from the new CPG. The communication plan includes updates at faculty and staff meetings, change-of-shift shared announcements, information in the weekly Brigham Baby News newsletter, and discussion at the weekly NICU operations meeting. All of the guidelines are posted on the departmental Intranet site, which is organized by system for easy access to the clinical team. In addition, respiratory policies, drug administration guidelines (DAGs), or any nursing policy, procedure, and guidelines that are related to the CPGs are linked to the document. 

Learn more about the Clinical Practice Council and the process of clinical practice guideline development.

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