In this section
Note: the guideline is currently under review.
Neonates are a specialized cohort of patients requiring an individualized approach in nursing care. The four major components of neonatal nursing care are keeping them warm, pink, sweet and calm.
Goals of care include the following:
To provide safe care of a neonate on the ward, when there is no requirement for a Neonatal Intensive Care Unit (NICU) bed.
A Registrar or Consultant should assess the neonate and consider the neonate to be stable for ward care, and not requiring a Butterfly ward bed prior to the ward accepting care for the neonatal patient. A Registrar or Consultant should assess the neonate and consider the neonate to be stable for ward care, and not requiring a Butterfly ward bed.
Baseline and ongoing observations should occur as per the
Clinical Guideline (Nursing) Observation and Continuous Monitoring and
Clinical Guideline (Nursing): Nursing Assessment.
The Neonate needs to be admitted onto the monitor profile so that alarm limits are specific to age and weight.
For Neonatal patient’s particular attention should be placed on the following aspects of assessment:
Neonates are particularly vulnerable to heat loss via convection, conduction, evaporation and radiation.
Clinical Guidelines (Nursing): Neonatal Hypoglycaemia
Day 1 - 4
Commence at 30 to 60 ml/kg/day and increase over the next few days as tolerated
Day 5 - 3 months
150ml/kg/day; some infants especially preterm may require 180-200ml/kg/day as clinically indicated
3 months - 6 months
Source: National Health and Medical Research Council (2012) Infant Feeding Guidelines. Canberra: National Health and Medical Research Council
The following should be assessed and documented:
All Intravenous Fluids require a current medical order as per usual protocol
Intravenous Fluids (IV):
0 - 24 hours
weight x 2.5
25 - 48 hours
49 - 72 hours
weight x 3
> 72 hours
weight x 4
Note* Ordered as 10 per cent dextrose 500 mL and 6.5 mL 20 per cent NaCl and 10 mL 7.5 per cent KCl (giving 22 mmol NaCl and 10 mmol KCl per 500 mL) Source: Neonatal eHandbook - IV Infusions for Special Care Nursery Admissions
Considerations if oral or nasogastric feeds are not tolerated or suitable, and IV fluid therapy is initiated. When selecting an appropriate IV fluid the following should be taken into account:
Illness and separation causes increased stress and anxiety on the infant and their family, and this has been proven to affect brain development and subsequent neurodevelopmental progress in childhood. Therefore, it is essential that every effort is made to nurture the parent-infant bond by encouraging families to interact with their babies as much as possible, from as early as possible. For more information refer to
Encourage engagement through:
For more information refer to
Comprehensive Neonatal Nursing. A Physiologic Perspective. Carole Kenner, Judy Wright Lott, Ann Applewhite Flandermeyer. WB Saunders Company. 2nd Edition, 1998.
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Please remember to read the
The development of this nursing guideline was coordinated by Di Sili, RN, Koala and Alanah Crowle, CNS, Butterfly, and approved by the Nursing Clinical Effectiveness Committee. Updated August 2017.