Intern Intern Survival Survival GuideGuide

Newborn NurseryNewborn Nursery

OutlineOutline IntroductionIntroduction SchedulesSchedules Where things areWhere things are When things When things

happenhappen Pre-rounding:Pre-rounding:

– Newborn ExamNewborn Exam– AdmissionsAdmissions– Progress NotesProgress Notes– DischargesDischarges

OrdersOrders Transfers to/from Transfers to/from

NICUNICU Attending RoundsAttending Rounds Family RoundsFamily Rounds Important PeopleImportant People Medical StudentsMedical Students Weekend CallWeekend Call

So you’re starting the newborn So you’re starting the newborn nursery…nursery…

The newborn nursery is located in the new mother-baby The newborn nursery is located in the new mother-baby ward of the hospital. To get there, hang a right at ward of the hospital. To get there, hang a right at Starbucks and take the elevator to the 6Starbucks and take the elevator to the 6thth floor. You’ll need floor. You’ll need your ID at practically every entrance so don’t forget it!your ID at practically every entrance so don’t forget it!

The nursery itself is located about halfway down the The nursery itself is located about halfway down the hallway. The front door is on the north side (higher hallway. The front door is on the north side (higher numbers); the door closest to where the resident hangs numbers); the door closest to where the resident hangs out is on the south side (lower numbers). Only the south out is on the south side (lower numbers). Only the south entrance requires your ID to let you in.entrance requires your ID to let you in.

When the census is low, most moms (and babies) reside on When the census is low, most moms (and babies) reside on the 6the 6thth floor. There is, however, overflow to the 5 floor. There is, however, overflow to the 5thth floor floor (usually antepartum), so pay attention to where your (usually antepartum), so pay attention to where your patients actually are.patients actually are.

Dress codeDress code is business attire ± white coat. If you’re on is business attire ± white coat. If you’re on over the weekend, you may wear scrubs.over the weekend, you may wear scrubs.

Schedules

As the newborn resident, you’ll be working from whenever you arrive in the morning (more on that later) until 5pm.

You will work one weekend day for three weekends with one golden weekend. To check the Newborn schedule, go to New Innovations Scheduling

Assignment Monthly Schedule

Schedule AccessSchedule Access

To access your personal schedule, go to:To access your personal schedule, go to:– New Innovations: https://rms1.newinnov.com/L

ogin/Login.aspx– After logging in, hit After logging in, hit – View:View:

Take a couple of hours one day and just Take a couple of hours one day and just browse through new innovations. It does browse through new innovations. It does take some getting used to.take some getting used to.

Where Things Are: Babies and Where Things Are: Babies and AccessoriesAccessories

BabiesBabies themselves will either be in the themselves will either be in the nursery or in with their moms. If you need to nursery or in with their moms. If you need to examine a baby and the baby is not in the examine a baby and the baby is not in the nursery, the easiest thing to do is to go into nursery, the easiest thing to do is to go into the mom’s room and examine the baby there. the mom’s room and examine the baby there. You can also bring the baby back to the You can also bring the baby back to the nursery with you or (very nicely!) ask the floor nursery with you or (very nicely!) ask the floor nurse to bring the baby to you.nurse to bring the baby to you.

Bassinettes are stocked with pretty much Bassinettes are stocked with pretty much everything you need: diapers, wipes, everything you need: diapers, wipes, receiving blankets, etc.receiving blankets, etc.

Ophthalmoscopes are located here and there Ophthalmoscopes are located here and there around the two nurseries for easy access.around the two nurseries for easy access.

Where Things Are: ChartsWhere Things Are: Charts

BlueBlue Baby Charts Baby Charts– Located in the nursery during the early morning hours and out on their Located in the nursery during the early morning hours and out on their

appropriate floors after rounds.appropriate floors after rounds.– Things you will find in the charts that are important to you, in order from Things you will find in the charts that are important to you, in order from

front to back:front to back: NBN report sheet – when the nurse from L&D delivers the baby to the NBN report sheet – when the nurse from L&D delivers the baby to the

nursery, the newborn nurse takes notes on this sheet. Provides a summary nursery, the newborn nurse takes notes on this sheet. Provides a summary of information.of information.

Inpatient Admitting Face Sheet – with insurance informationInpatient Admitting Face Sheet – with insurance information Assessments/H&P section Assessments/H&P section

– NB nursery summary sheet – the infamous “columns” sheet in duplicate. Serves NB nursery summary sheet – the infamous “columns” sheet in duplicate. Serves as your history, admission and discharge physicals.as your history, admission and discharge physicals.

– Admission/Delivery Summary – usually put in the day after admission, details Admission/Delivery Summary – usually put in the day after admission, details information printed from the CIS system.information printed from the CIS system.

– Birth Report (sometimes)Birth Report (sometimes) Physician Orders – where discharge orders are written. Physician Orders – where discharge orders are written. Consents – HepB and circumcision.Consents – HepB and circumcision. Progress NotesProgress Notes Report of Operation – Birth report will be found here if not in the H&P Report of Operation – Birth report will be found here if not in the H&P

sectionsection Nursing Records – NICU/NBN nursing admission sheetNursing Records – NICU/NBN nursing admission sheet

Where Things Are: ChartsWhere Things Are: Charts

RedRed Mom Charts Mom Charts– Located in L&D with mom immediately after Located in L&D with mom immediately after

delivery. Comes over with mom when she is taken delivery. Comes over with mom when she is taken to her room.to her room.

– There are 2 things in this chart important to you:There are 2 things in this chart important to you: Prenatal RecordsPrenatal Records – usually clipped to the front – usually clipped to the front

of the chart or in the H&P sectionsof the chart or in the H&P sections Admission NoteAdmission Note – in the H&P section. Will – in the H&P section. Will

provide a wealth of information, including the provide a wealth of information, including the number of antenatal visits.number of antenatal visits.

– HIV, GBS, HepB and blood type will be HIV, GBS, HepB and blood type will be written in a number of places. RPR and DAT written in a number of places. RPR and DAT are usually done when the mom is admitted, are usually done when the mom is admitted, so check mom’s so check mom’s PowerchartPowerchart for those. for those.

Where Things Are: ChartsWhere Things Are: Charts

YellowYellow Bedside Charts Bedside Charts– Clipped to the baby’s bassinette.Clipped to the baby’s bassinette.– Record of:Record of:

Day of lifeDay of life Birth weightBirth weight Daily weight and changeDaily weight and change

TipTip: Nurses weigh the babies at 5pm each night. If the : Nurses weigh the babies at 5pm each night. If the new day’s flow sheet is missing a weight, check the flow new day’s flow sheet is missing a weight, check the flow sheet from the day before. It’s often recorded in a column sheet from the day before. It’s often recorded in a column there.there.

Vital signsVital signs Voids and stoolsVoids and stools FeedingsFeedings NAS scoring (if applicable)NAS scoring (if applicable)

Where Things Are: PaperworkWhere Things Are: Paperwork Blank Flow Sheets/Progress NotesBlank Flow Sheets/Progress Notes

– Newborn nursery is a lot of Newborn nursery is a lot of paperworkpaperwork. Paperwork has its place . Paperwork has its place in medical education - not only does it keep you on top of what is in medical education - not only does it keep you on top of what is going on with your patient, but you learn the very important skill going on with your patient, but you learn the very important skill of proper documentation and time-management.of proper documentation and time-management.

– You will find most necessary documentation in the filing cabinet You will find most necessary documentation in the filing cabinet near the resident’s table. From top to bottom:near the resident’s table. From top to bottom:

Growth charts Admission/Progress flow sheets Newborn Admission Note* Progress notes Bilirubin curves Attending flow sheets*

Resident Binder– Big, black binder that houses flow sheets in three sections (in

order of priority): Discharges New patients Interim patients

*attending-only paperwork

When Things HappenWhen Things Happen

DailyDaily~ 6am Get sign-out from night resident

Prior to 9:30am: See all babies, do all paperwork

9:30am: Attending Rounds

Afternoon Make clinic appointments, mommy rounds

Throughout the day: New admissions, work, etc.

5pm Sign-out to night resident.

*Note – When you are on newborn, you do not go to morning report but you DO attend Grand Rounds and Wednesday lectures.

Pre-Rounding Your arrival time each day to the nursery should be based

upon how many patients are on your census (at our busiest, we can get up to 25-30), how comfortable you are with the paperwork and how well you can manage your time. In general:– If you are the only person in the nursery or your medical students

are very new, you should arrive between 5:30am – 6:00am.– If you have seasoned medical students or are lucky enough to

have another MD in the nursery with you (another intern or a family medicine resident), you should get here between 6:00am and 6:30am, 7am at the latest.

The first thing you should do when you hit the nursery is scrub, surgical style, at one of the sinks. Stay on the good side of the nurses. Trust us.

Next, print two copies of the census (hit task print print) from PowerChart. One is for you, one is for the attending. Take a big, black marker and cross off any babies who aren’t staff (see next slide).

Staff Babies Hospitalists

– Maribeth Chitkara– Rachel Boykan– Carolyn Milana– Lisa Wilks-Gallo

Clinic Attendings– Tech Park

Robyn Blair Leslie Quinn Lycia Ryder Taranjeet Ahuja

– East Moriches Susan Walker Tracy Down Rosa Cataldo

More Clinics– Patchogue

Cathy Coleman Fred Reindl Robyn Labarca

– Islip Liliana Tique

– Southhold Nancy Pearson

– Riverhead Ann Hansen

Pre-Rounding Note on your census which babies need to be admitted, which

ones you think should be discharged and which ones are interim. – An anticipated discharge list (with total and direct bili levels) will be

hanging up on a clipboard to your right as you walk in.– Compare the anticipated discharges with patients you think should be

discharged home (day 2 NSVD, day 3 CS). Anyone missing from the anticipated list could still be discharged. Check with the floor nurses – or better yet, moms themselves – to find out.

Organize yourself using your census as a to-do list. (Appendix 1) Examine all of the babies, discharges with priority.

Tip: If the census is manageable, see all the babies in the nursery first. Then, take your black binder and ophthalmoscope out onto the floor and see the babies in their mothers’ rooms.

– If the census is crazy, ask the nurses very nicely if you could please have, at the very least, the discharges brought to you.

– The night newborn resident should have done all of the admissions overnight, but you should still examine all of the new babies in the morning if you have time to do so (especially if they were admitted before midnight).

Before or after your exam, note on your flow sheet the date, DOL, weight, change from birth weight, feeds, voids, stools and physical exam.

The Newborn Exam The Newborn Exam:

– General Appearance: alert, active, NAD– Skin

Look at color – pink, cyanotic, acrocyanotic Feel for temperature – is baby cold, or warm Look for any rashes Nevi (red, brown, blue), stork bites on back

of neck… Look for Mongolian spots

– Nails Are nails short or long Are they stained with meconium

– Head Feel for fontanelles Feel for caput succedaneum – crosses

sutures Feel for cephalohematoma – does not cross

sutures Look for any bruising, stork bites, nevi Look for molding

– Eyes Check for red reflex Look for red nevi on eyelids Look for conjunctival hemorrhage Look for cataracts by placing light from the

side Look for any discharge from the eye –

conjunctivitis? – Ears

Look for patency Look for any tags

– Nose Check for patency by placing one

finger on one nare and listening for air on the other.

– Mouth Check for cleft palate and suck reflex by

placing gloved finger in the mouth and feeling for the palate.

Look for Epstein Pearls (white lesions) Uvula – normal versus bifid Symmetry when crying

– Neck Supple? Feel for nodes or masses Check clavicles by feeling for fractures/

crepitus – Lungs

CTAB good aeration vs otherwise– Heart

Listen with bell RRR, nl S1 and S2, any murmurs? Good

pulses? Cyanosis? – Abdomen

Softness Diastesis rectus (gap where rectus

muscles should be) with hernia? Bowel sounds present? Any masses or HSM? Feel for liver edge.

– Cord: 3 vessels by exam or report

The Newborn Exam– Genitalia

Male– Circumcision?– Scrotal sacs for descended testes– Patency of anus

Female– Check labia– Check for any vaginal tags– Patency of anus

– Extremities/Back Check for symmetry Feel for any lymph nodes under armpits Check for hip dislocation:

– Ortolani: Grab knee, placing 4th and 5th fingers on hips, then external rotation (O = OUT)

– Barlow: Grab knee and press back down with fingers in the same position. (B = BACK)

Check for hip laxity Turn the baby over and check for:

– Tufts of hair– Angle and symmetry of spine– Dimpling

Brachial/Femoral pulses– Neurologic

Tone: Lift baby from under the arms - does baby slip between your fingers?

Check for all 4 reflexes: grasp, suck, moro, and rooting Check for tremors

Pre-Rounding Paperwork: Pre-Rounding Paperwork: After examining all of the babies, After examining all of the babies,

gather all of the charts and sit down to gather all of the charts and sit down to get all of your paperwork done, get all of your paperwork done, discharges again with priority.discharges again with priority.

The night newborn resident should The night newborn resident should have done all overnight admissions, but have done all overnight admissions, but make sure all of the information on make sure all of the information on your flow sheet and summary sheet is your flow sheet and summary sheet is complete. complete.

The following slides will detail the The following slides will detail the necessary paperwork for admissions, necessary paperwork for admissions, discharges and interim patients.discharges and interim patients.

Admissions To keep on top of admissions, refresh your

census frequently, keep your ears open for calls from L&D and listen for the printer (it will print lots of pages with new admits).

When the baby first gets here, listen to the L&D nurse sign-out to the nursery nurse. If you miss it, don’t worry. All the initial information goes on the first sheet in the chart, the Newborn Nursery Report Sheet.

Double check which pediatrician is written on the green Newborn Physician Information sheet that comes with the baby. If it’s not staff, it’s not your admission, no matter what the computer says. If it is, roll on.

The nurse will take the baby to the warmer and do her admission. Let her chart everything and bathe the baby. Her vitals and physical will go in the Nursing Records section. Once the chart is complete and the baby is nice and clean, you can start your admission.

Comb the chart for all the information necessary to fill out your admission flow sheet. Remember, maternal RPR and DAT will be in the computer.

Do your exam and fill the PE section. Transcribe all of the information you have onto

the blank Newborn Admission Summary Sheet found in the H&P section. Don’t forget to put the HIV and GBS status down by PNLs.

Admissions (Continued) Admission Orders

– Some orders will be put in by the L&D nurse.– Your admission orders will be found in your pediatric folder under

“Newborn Nursery Admission Power Plan.” Everything will be checked for you (except for social work/lacatation consults). Initiate and sign.

Mom’s Arrival– As you might have noticed, some things are missing from your

admit flow sheet/summary sheet. All of those things will be neatly filled in once mom arrives at postpartum.

– Mom will give consent/refuse HepB– Mom’s chart is a wealth of information:

Her medical history Her prenatal labs

Notifying the Attending– Unless you are unsure about a plan of action, there is no need to

notify an attending about an admission.– The attendings will see the new babies during evening rounds or

the next morning. The H&P and exam must be filled out within 24 hours of birth

time.

The Interim Babies For babies that are

neither coming nor going, fill out the back of the admission/interim flow sheet for that day.

Grab a blank “NP/MD” progress note and fill it out.

The attending will co-sign your note and/or write her own.

Because the attending must write a note on all of the interim babies, they are last on your priority list. If there is a huge number on the census and you don’t get to them, don’t worry.

DischargesDischarges Discharges are the number one priority in the Discharges are the number one priority in the

morning. Double-check the anticipated discharge list morning. Double-check the anticipated discharge list and see everyone.and see everyone.

Fill out the discharge weight, date and time of Fill out the discharge weight, date and time of discharge exam and the discharge columns on the discharge exam and the discharge columns on the summary sheet. Don’t forget:summary sheet. Don’t forget:– Date and hour of life of T/D bili (drawn the night before Date and hour of life of T/D bili (drawn the night before

at 4am), written in the lower left boxat 4am), written in the lower left box– Recording any labs doneRecording any labs done– Anything else that you would want to know if you were Anything else that you would want to know if you were

the primary pediatricianthe primary pediatrician Fill out the discharge orders (located in the “physician Fill out the discharge orders (located in the “physician

orders” section of the baby’s chart). Note the date orders” section of the baby’s chart). Note the date and time of their follow-up appointment and what the and time of their follow-up appointment and what the baby should be feeding.baby should be feeding.

After the attending sees the patient and gives his or After the attending sees the patient and gives his or her blessing, write discharge orders on PowerChart.her blessing, write discharge orders on PowerChart.

Transfers to/from NICUTransfers to/from NICU Transfers to NICU can be done at any time. Transfers to NICU can be done at any time.

– If you are especially worried about a baby, take the baby over first, If you are especially worried about a baby, take the baby over first, then talk to someone. then talk to someone.

This is true of notifying the attending, as well.This is true of notifying the attending, as well. Always go with the baby if they are transferred to NICU. Always go with the baby if they are transferred to NICU. When you get there, sign-out to the resident (and fellow, if necessary).When you get there, sign-out to the resident (and fellow, if necessary).

– If you just want the baby looked at and assessed by a NICU fellow, If you just want the baby looked at and assessed by a NICU fellow, have one paged.have one paged.

– As with any transfer, make sure to write a detailed As with any transfer, make sure to write a detailed transfer notetransfer note.. Transfers from NICUTransfers from NICU

– Babies admitted with gestations 34-35 wks may be transferred to Babies admitted with gestations 34-35 wks may be transferred to NBN after 24hrs of cardio-respiratory monitoring.  NBN after 24hrs of cardio-respiratory monitoring.  

– Infants > 35 weeks may go up anytime after determined to be Infants > 35 weeks may go up anytime after determined to be stable.stable.

– Newborns with any type of physiologic instability/delayed transition Newborns with any type of physiologic instability/delayed transition may be transferred to NBN after consultation with the accepting may be transferred to NBN after consultation with the accepting physician.physician.

– Transfer Orders from NICU should include the name of physician Transfer Orders from NICU should include the name of physician accepting transfer and any orders that should be continued, i.e., accepting transfer and any orders that should be continued, i.e., feeding, medications, etc. feeding, medications, etc.

– On admission to Newborn, fill out the H&P admission column. On admission to Newborn, fill out the H&P admission column. Gather all the information that you would with any other admission.Gather all the information that you would with any other admission.

All order writing is now done electronically through our CPOE All order writing is now done electronically through our CPOE system. Please refer to your PowerChart training for more system. Please refer to your PowerChart training for more specific instructions.specific instructions.

You should notify the patient’s nurse of any new orders, You should notify the patient’s nurse of any new orders, especially if the order is written as STAT.especially if the order is written as STAT.

Tips and TricksTips and Tricks– Admission orders are found in the “pediatric” folder. The Admission orders are found in the “pediatric” folder. The

“Newborn Nursery Admission Power Plan” will have everything “Newborn Nursery Admission Power Plan” will have everything you need to admit a baby.you need to admit a baby.

– If HepB was given, it should be found under the baby’s MAR.If HepB was given, it should be found under the baby’s MAR.– To find out if the mom was given appropriate antibiotics, check To find out if the mom was given appropriate antibiotics, check

herher MAR. MAR.– If you have a withdrawal baby on morphine and it is time for a If you have a withdrawal baby on morphine and it is time for a

dose change, remember that the pharmacy sometimes takes dose change, remember that the pharmacy sometimes takes forever and a day to get drugs where they need to be. forever and a day to get drugs where they need to be.

If you are going from .12mg to .09mg Q4H, and the baby is due to If you are going from .12mg to .09mg Q4H, and the baby is due to receive a .12mg dose at 8am, let the baby get it.receive a .12mg dose at 8am, let the baby get it.

After the baby receives that dose, cancel the order in PowerChart and After the baby receives that dose, cancel the order in PowerChart and put in the new dose (.09mg), first dose to be given at 12pm.put in the new dose (.09mg), first dose to be given at 12pm.

Make sure to call the pharmacy and let them know you’ve made this Make sure to call the pharmacy and let them know you’ve made this change. You should get the new dose in time for the 12pm change. You should get the new dose in time for the 12pm administration, but no promises.administration, but no promises.

OrdersOrders

Attending RoundsAttending Rounds Attending rounds are generally bedside, Attending rounds are generally bedside,

incorporating presentations with teaching.incorporating presentations with teaching. Usually begin at around 9:30am, though Usually begin at around 9:30am, though

this is attending dependent.this is attending dependent. Each attending will let you know their Each attending will let you know their

rounding preferences and their rounding preferences and their expectations of you and your medical expectations of you and your medical students.students.

Length of rounds is obviously dependent Length of rounds is obviously dependent on the census. When the census ranges on the census. When the census ranges from 10-15, you will likely be done by from 10-15, you will likely be done by noon. This gives you plenty of time for noon. This gives you plenty of time for lunch, new admissions and afternoon lunch, new admissions and afternoon mommy rounds.mommy rounds.

Mommy roundsMommy rounds In the afternoon, you and your medical students In the afternoon, you and your medical students

should make rounds to see all of the families on the should make rounds to see all of the families on the floor.floor.

General questions to ask: General questions to ask: – Do they have any questions or concerns?Do they have any questions or concerns?– Breast/bottle feeding? Any problems with breastfeeding?Breast/bottle feeding? Any problems with breastfeeding?– Who will be the baby’s pediatrician? If they do not have Who will be the baby’s pediatrician? If they do not have

one, are they interested in one of our clinic pediatricians?one, are they interested in one of our clinic pediatricians?– Who is the insurance provider for the baby? (Make sure Who is the insurance provider for the baby? (Make sure

we take their insurance if they want one of our doctors!)we take their insurance if they want one of our doctors!) Note the patient’s PMD and insurance on your Note the patient’s PMD and insurance on your

admission flow sheet.admission flow sheet. Address any and all concerns the parents have. Address any and all concerns the parents have.

Reassure them that there is a pediatrician on at all Reassure them that there is a pediatrician on at all times and their baby will be looked at every day. times and their baby will be looked at every day.

Anticipatory GuidanceAnticipatory Guidance Rectal thermometers Rectal thermometers onlyonly in first 2 months of life. in first 2 months of life.

– Any temperature below 97 or above 100.4 is an Any temperature below 97 or above 100.4 is an emergency.emergency.

Back to Sleep (SIDS campaign). Back to Sleep (SIDS campaign). – Baby sleeps alone in the crib on his/her back, no pillows Baby sleeps alone in the crib on his/her back, no pillows

or stuffed animals, reducing the risk of SIDS.or stuffed animals, reducing the risk of SIDS. CarseatsCarseats

– Parents must have one before leaving the hospitalParents must have one before leaving the hospital– Current AAP recommendations as of April 2009 are to be Current AAP recommendations as of April 2009 are to be

rear-facing until age 2 or outgrows manufacturer’s limits rear-facing until age 2 or outgrows manufacturer’s limits for weight and height. for weight and height.

SmokingSmoking Address any other concerns the family may have, ie Address any other concerns the family may have, ie

immunizations, jaundice, etc.immunizations, jaundice, etc.

Note that you’ve given anticipatory guidance Note that you’ve given anticipatory guidance somewhere on your flow sheet.somewhere on your flow sheet.

Important PeopleImportant People Lisa Clark (beeper 4-5859)Lisa Clark (beeper 4-5859)

– Newborn Nurse PractitionerNewborn Nurse Practitioner– Lisa helps to “run” the nursery by assisting the Lisa helps to “run” the nursery by assisting the

team with any number of tasks. She spends team with any number of tasks. She spends considerable amount of time with the many considerable amount of time with the many psychosocial issues we have in the nursery. psychosocial issues we have in the nursery.

– It should not be assumed by any member of the It should not be assumed by any member of the newborn team that Lisa will be available to assist newborn team that Lisa will be available to assist with morning rounds or pre-rounding work.with morning rounds or pre-rounding work.

– Lisa has 25 years of newborn experience and is Lisa has 25 years of newborn experience and is also our resident neonatal withdrawal expert. If also our resident neonatal withdrawal expert. If you don’t know something, chances are, Lisa does. you don’t know something, chances are, Lisa does. She is an invaluable resource.She is an invaluable resource.

Kathy Vanderventer – lactation consultantKathy Vanderventer – lactation consultant Darlene/Stephanie – social workersDarlene/Stephanie – social workers

Medical StudentsMedical Students All students assigned are to collect All students assigned are to collect

information, examine and chart on infants.information, examine and chart on infants. Depending on the ability to complete tasks, Depending on the ability to complete tasks,

the average assignment is 3-5 patients.the average assignment is 3-5 patients. Medical students should also assist with new Medical students should also assist with new

afternoon admissions.afternoon admissions. All assigned patients are under the supervision All assigned patients are under the supervision

of the residents and nursery attending. All of the residents and nursery attending. All findings admission/ discharge chart notes must findings admission/ discharge chart notes must be completed in time to attend AM rounds. be completed in time to attend AM rounds.

It can get busy, but try to make the time that It can get busy, but try to make the time that the students spend in the nursery worthwhile. the students spend in the nursery worthwhile. Teach as much as you can, even if it’s only Teach as much as you can, even if it’s only pearls of wisdom here and there. They’ll pearls of wisdom here and there. They’ll appreciate it.appreciate it.

AssignmentsAssignments www.Breastfeedingbasics.org

– Click “Register”, then click “Students enroll in your course”. Then type in Click “Register”, then click “Students enroll in your course”. Then type in Stony BrookStony Brook and click “Find”. Then register and complete the course. (You and click “Find”. Then register and complete the course. (You may skip the International Section.) may skip the International Section.)

– The scores of this course will be sent to Dr. Guralnick.The scores of this course will be sent to Dr. Guralnick. Newborn Nursery ExamNewborn Nursery Exam

– https://ezexam.som.sunysb.edu/q4/perception.dll – As part of your newborn nursery rotation, As part of your newborn nursery rotation, all interns all interns must take and pass must take and pass

the online exam that is now available.  All the questions are based on the the online exam that is now available.  All the questions are based on the required readings required readings on pedsportal.   on pedsportal.  

– The test will contain approximately 13 random questions from a large bank The test will contain approximately 13 random questions from a large bank of board style questions.  If you do not achieve 85% or better, you will need of board style questions.  If you do not achieve 85% or better, you will need to retake the exam until you pass.  You will not pass the rotation if you do to retake the exam until you pass.  You will not pass the rotation if you do not pass the exam.   not pass the exam.  

– You will need an access code that will only work for a limited period of time You will need an access code that will only work for a limited period of time after your rotation ends, therefore it is critical that you take the exam in a after your rotation ends, therefore it is critical that you take the exam in a timely fashion during the last week of your rotation.  timely fashion during the last week of your rotation. 

– Please e-mail or see Elaine for your individual access code.  Please e-mail or see Elaine for your individual access code.  Schedule time to observe a Lactation Consultant interact with a Schedule time to observe a Lactation Consultant interact with a

mother/baby.mother/baby. Observe one hearing evaluation.Observe one hearing evaluation. Perform an observed physical exam.Perform an observed physical exam.

Required ReadingsRequired Readings Week 1:Week 1:

– Hypoglycemia protocolHypoglycemia protocol– Clinical Practice Clinical Practice

Guideline Management Guideline Management of GBS in the Neonatesof GBS in the Neonates

– Summary sheet on Summary sheet on Hepatitis B, Hepatitis Hepatitis B, Hepatitis C, HIV, Syphillis, and C, HIV, Syphillis, and TBTB

Week 2:Week 2:– Neonatal JaundiceNeonatal Jaundice– Respiratory Disorders Respiratory Disorders

of the Newbornof the Newborn– TORCH infectionsTORCH infections– Hepatitis BHepatitis B

Week 3:Week 3:– Presentation of Presentation of

Congenital Heart Congenital Heart Disease in the Disease in the Neonate and Young Neonate and Young InfantInfant

– Fetal HydronephrosisFetal Hydronephrosis– Development Hip Development Hip

DysplasiaDysplasia Week 4:Week 4:

– Brachial Plexus InjuryBrachial Plexus Injury– Sudden Infant Death Sudden Infant Death

SyndromeSyndrome– Newborn Hearing Newborn Hearing

ScreenScreen

Weekend CallWeekend Call

Weekends are structured exactly like weekdays. Weekends are structured exactly like weekdays. Time your arrival depending on the census, and Time your arrival depending on the census, and take into consideration that neither Lisa nor the take into consideration that neither Lisa nor the medical students are available over the weekend.medical students are available over the weekend.

Most attendings will get in early, see babies by Most attendings will get in early, see babies by themselves, then sit down to round. (However, themselves, then sit down to round. (However, this is extremely attending-dependent, so stay this is extremely attending-dependent, so stay flexible!) Make sure that you have all your flexible!) Make sure that you have all your paperwork done.paperwork done.

Try to get all clinic appointments scheduled on Try to get all clinic appointments scheduled on Friday and Saturday. Clinics are closed on Friday and Saturday. Clinics are closed on Sundays. Sundays.

Appendix 1 How you organize yourself is up to you, but most interns will

use their census as a to-do list.