In this section
Neonates are a specialised cohort of patients requiring an individualised approach in nursing care. The four major components of neonatal nursing care are warm, pink, sweet and calm. Goals of care should address these components and include the following:
To provide safe, comprehensive specialised care of a neonate in the ward environment when it is not clinically necessary for a Neonatal Intensive Care Unit (NICU) admission.
A Registrar or Consultant should assess the neonate and be considered clinically stable and appropriate for ward management prior to the ward accepting care of the neonatal patient.
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:
The normal temperature of a neonate ranges from < 36.5oC – 37.5oC, temperature should be measured per axilla every 4 hours, unless febrile or hypothermic. Clinical Guideline (Nursing): Temperature Management.
Neonates are particularly vulnerable to heat loss via convection, conduction, evaporation and radiation. Therefore ensure:
Procedural sedation for Koala ward neonates:
Clinical Guidelines (Nursing): Neonatal Hypoglycaemia
Please refer: Management of Expressed Breast Milk for Inpatients (RCH Access only)
The following table shows suggested feeding volumes by age, however this table is an approximate guide only and requirements will differ according to gestational age and disease process.
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:
0 - 24 hours
weight x 2.5
25 - 48 hours
49 - 72 hours
weight x 3
> 72 hours
weight x 4
* 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 considered:
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
Cheng, C., Franck, L., Ye, X., Hutchinson, S., Lee, S., & O'Brienon, K. (2021). Evaluating the effect of Family Integrated Care on maternal stress and anxiety in neonatal intensive care units. Journal of Reproductive and Infant Psychology, 39(2), 166-179.Cooke, E. (2019, August). Clinical Guidelines (Nursing) Temperature Management. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Temperature_Management/Cramer, S. (2019, June). Clinical Guidelines (Nursing) Neonatal hypoglycaemia. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neonatal_hypoglycaemia/Crowle, A. (2018, April). Clinical Guidelines (Nursing) Neonatal Intravenous Fluid Management. Retrieved from The Royal Children's Hospital Melbourne : https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neonatal_Intravenous_Fluid_Management/Devsam, B. (2020, December). Clinical Guidelines (Nursing) Neonatal Pain Assessment. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neonatal_Pain_Assessment/Donnellan, D., Moore, Z., Patton, D., O'Connor, T., & Nugent, L. (2020). The effect of thermoregulation quality improvementinitiatives on the admission temperature of premature/verylow birth‐weight infants in neonatal intensive care units: Asystematic review. J Spec Pediatr Nurs, 1-13.Doyle, T. (2018, December). Clinical Guidelines (Nursing) Breastfeeding support and promotion. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Breastfeeding_support_and_promotion/Fanham, A. (2020, January). Clinical Guidelines (Nursing) Extravasation injury management. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Extravasation_injury_management/Fanham, A. (2020, June). Clinical Guidelines (Nursing) Safe Sleeping. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Safe_sleeping/Gardner, S. (2020, June). Clinical Guidelines (Nursing) Assisted thermoregulation. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Thermoregulation_in_the_Preterm_Infant/Harding, J., Hegarty, J., Crowther, C., Edlin, R. G., & Alsweiler, J. (2021, January 28). Evaluation of oral dextrose gel for prevention of neonatal hypoglycemia (hPOD): A multicenter, double-blind randomized controlled trial. PLOS Medicine, pp. 1-16.Johnston, C., Campbell-Yeo, M., Disher, T., Benoit, B., Fernandes, A., Streiner, D., . . . Zee, R. (2017). Skin-to-skin care for procedural pain in neonates. Cochrane Database for Systematic Reviews(2).Kendrick, A. (2021, February). Clinical Guidelines (Nursing) Sucrose (oral) for procedural pain management in infants. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Sucrose_oral_for_procedural_pain_management_in_infants/Kennedy, R., & Crowle, A.-R. (2020, May). Clinical Guidelines (Nursing) Neonatal & Infant Skin Care. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neonatal___infant_skin_care/Long, K., & Holdbrooks, H. (2020). Achieving Normothermia in Low-Birth-Weight Neonates. JOGNN, 49, S73.Moore, L., & Stevens, A. (2020, March). Clinical Guidelines (Nursing) Neonatal sleep maximisation in the hospital environment. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neonatal_sleep_maximisation_in_the_hospital_environment/Penrose, S. (2019, February). Clinical Guidelines (Nursing) Pain assessment and measurement. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Pain_Assessment_and_Measurement/Safer Care Victoria . (2018, December ). Intravenous infusion for special care nursery admissions. Retrieved from Victorian Agency for Health Information : https://www.bettersafercare.vic.gov.au/clinical-guidance/neonatal/intravenous-infusion-for-special-care-nursery-admissionsSafer Care Victoria . (2019, January). Clinical Practice Guidelines Suprapubic aspirate. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/clinicalguide/guideline_index/Suprapubic_Aspirate_Guideline/Safer Care Victoria. (2018). The late preterm infant - care and management. Retrieved from Victorian Agency for Health Information: https://www.bettersafercare.vic.gov.au/clinical-guidance/neonatal/the-late-preterm-infant-care-and-managementSly, S., & Kinney, S. (2019, April). Clinical Guidelines (Nursing) Observation and continuous monitoring. Retrieved from The Royal Children's Hosptial Melbourne: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Observation_and_Continuous_Monitoring/The Royal Children's Hospital Melbourne. (2019, November). Clinical Practice Guidelines Hypoglycaemia. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/clinicalguide/guideline_index/Hypoglycaemia_Guideline/The Royal Children's Hospital Orthopaedics department. (2018, May). Kids Health Infomation. Retrieved from The Royal Children's Hospital Melbourne: https://www.rch.org.au/kidsinfo/fact_sheets/Wrapping_your_baby_safely_to_help_prevent_developmental_dysplasia_of_the_hip_VIDEO/The Royal Women's Hospital . (2020, July 29). Guideline: Infant feeding - Breastdeeing the Healthy Term Baby. Retrieved from The Royal Women's Hospital : https://thewomens.r.worldssl.net/images/uploads/downloadable-records/clinical-guidelines/infant-feeding-breastfeeding-the-healthy-term-baby_280720.pdf
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Please remember to read the
The development of this nursing guideline was coordinated by Azzadine Miles, RN, Koala Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated August 2021.