WRITE-UPS

NEONATAL CASES

Read the pages on newborn physical examination in the assigned textbooks for the pediatric rotation (Nelson’s and Mosby’s). These are the textbooks for the nursery, also. Read the sections in Nelson’s which are pertinent to neonatal issues, both well and sick.  You are also responsible for the section on Group B Streptococcal Infections in the 2006 Red Book ( American Academy of Pediatrics 2006 Report of the Committee on Infectious Diseases).

You are expected to arrive in the nursery by 8:30 on days when you do not have morning subspecialty clinics to attend. On days you have morning clinics to attend, come in at 7:00 AM to see the moms and babies and write your notes before clinic. DO NOT BE LATE to either morning or afternoon clinics or noon conferences.

If you are going to be late or absent for any reason, you must follow the procedures outlined on the Absences page.

You may leave each day when all your work is finished.

You MUST wear street clothes and your white jacket – no scrub suits. Your jacket must be worn with the name tag visible on your POCKET OR LAPEL (not waistband).  You do not need to wear your jacket when you are in the nursery examining a baby or writing on charts but your badge needs to be visible on your shirt or blouse.

You MUST scrub to the elbows for 4 minutes when you first enter the nursery in the mornings. Wash your hands again immediately before touching a baby. Also wash your hands immediately if you pick up something from the floor, or touch your face, head, or hair. You cannot wear any jewelry or watches on your arms or hands when examining the babies.

You may not wear fingernail polish (NOT even clear polish), false nails, or have French manicures during the 2 weeks you are assigned to the nursery. Your nails must be trimmed to ~1/4 inch length or shorter.

Your hair, including bangs, must not touch the baby or the crib when you’re doing your exam, so you may need to use a barrette and/or wear it pulled back if it’s long.

Do not use the computer on the nurses’ desk.  You may use the computer next to the window. Sit at the counter along the side wall to work, not at the other two counters. Do not bring mothers’ charts into the nursery; stay out on the wing with the mothers’ charts.

Do full H&Ps on 4 babies - 2 the first week and 2 the second week as assigned in red ink on the student calendar on the bulletin board in the nursery. You must finish the write-up before you go home that day; place it on the chart when you’re done. As soon as you pick a baby, write the baby’s name on the yellow sheet on the bulletin board so there will be no doubling up of students on a single baby. Pick babies that are not going home until late that day or later so that you’ll have enough time to finish your write-ups (the nurses can help you determine when babies are likely to be going home).

Have all the mother’s visitors leave when you are getting the history. This includes having the baby’s father leave. You might want to take the phone off the hook to minimize interruptions.

DO THE PHYSICAL EXAMINATION IN THE INFANT’S CRIB, not on the warming tables. You must completely undress the child except for the diaper and lightly cover with the blanket those parts you’re not examining currently to avoid hypothermia. You are not allowed to move babies from one room to another so have nursery personnel bring the infant into the nursery to do your physical examination for the first write-up.  For the first write-up, bring the infant into the nursery to do your physical examination. For your 2^nd, 3^rd, and 4^th write-ups, if the infant is in the room with the mother, do the examination in the mother’s room. Be sure to introduce yourselves when you are speaking with the families.

For your write-ups and daily progress notes:

	Be sure to stamp EACH yellow progress page sheet you use with the baby’s blue or red hospital card.
	Sign each side of each page that you write on. If you are continuing on to another piece of paper, place “continued” by your signature. DATE and TIME each side of each write-up and progress note. When continuing on to another side or another piece of paper put at the top that this is a continuation of the junior med student initial H&P or daily progress note (example: MS III H & P cont; MS III Progress Note cont).
	Use front AND back of each yellow progress note page.

Xerox the 1^st newborn write-up  and put it in Dr. Bienvenu’s chair or under her office door if the door is locked.  Put original on chart. (Have Peds front office secretaries in med school on 5^th floor 5-303 make the Xerox copy for you. DO NOT HAVE OR ASK THE NURSERY PERSONNEL for help with this.  DO NOT use a fax machine to copy it.) Print your name at the top of the 1^st sheet and staple it before turning it in to Dr. Bienvenu.

Do not Xerox write-ups numbers 2, 3 and 4. Put these on chart when you have finished writing them up.

Research and discuss the following  topics with each of your 4 mothers before the baby is discharged:

	Benefits of breast milk and breastfeeding for mother and infant (be certain first that breastfeeding would be appropriate for this particular mother and infant pair before discussing it with the mother; breastfeeding is contraindicated in some of our patients.)
	The particulars of adequate breastfeeding for a full term infant by the end of the first week of life: average number of nursing sessions per day, using both breasts each time, recommended maximum length of time on each breast at each feeding, recommended minimum length of time between feedings (start of one feeding to start of next feeding)
	The particulars of adequate formula feeding for a formula-fed full term infant by the end of the first week of life: average number of feedings each day; average volume of each feeding; how purchased concentrated formula is prepared for use by the infant
	Minimum recommended age that infants be introduced to bovine (cow’s) milk
	Recommendations for age of introduction of solid foods and in what order.
	Age by which first stool should have occurred and subsequent usual frequency of stools
	Age by which umbilical cord should fall off
	“Back to Sleep” to reduce incidence of SIDS.
	LA car seat laws; current recommended location and position (forward-facing or rear-facing) of car seats in a car based on a child’s age AND weight. Car Safety Seats Infant Passenger Safety
	LA law banning smoking in cars with children (revised statute 32:300.4)
	The effects of cigarette smoking on the fetus, infant and child from cigarette smoking by the mother or anyone else around her; and recommendations for decreasing an infant’s exposure to passive smoke inhalation in the home and vehicle environment.

Speak with each mother daily, examine each infant daily, and write daily progress notes on each of the 4 babies except on Saturdays, Sundays, and holidays.

Orally present your first or second write-up to Ms. Julian or Dr. Bienvenu on the day it is written.  Do this after clinic on those days you are assigned to subspecialty clinic.  

Unless told otherwise, you must take and have finished the online nursery quiz by Tuesday of the second week. This test is graded. DO NOT DISCUSS the test questions or answers with anyone outside of attending rounds with Dr. Bienvenu or Ms. Julian.

Attending rounds will usually be at 11:00am on Thursday mornings in the classroom on 4J wing.

	On Wednesday of Week 1 prepare for Thursday’s attending rounds by working on the Neonatal Case sheet  cases  # 1-6.
	Complete assigned Case Files assignments. You will be tested on these required assignments.
	The online nursery quiz will be discussed during attending rounds the 2nd Thursday.

I suggest that sometime during the first week you ask the nursery intern to demonstrate the physical examination for you and/or watch you do a physical examination. This is to help prepare you for the observed physical exam that Dr. Bienvenu or Ms. Julian will watch you perform the second week.

The observed physical exam will usually be performed on Monday or Tuesday of the second week that you are assigned to the nursery. The expected date will be posted on the nursery wall but this is subject to change. Dr. Diana Bienvenu or Kathy Julian, CPNP will be the examiner. These will be done individually and will be performed on a baby you have probably not previously examined. This observed exam lasts ~ 1 hour.

Your Nursery grade will be a single Pass/Fail grade from Dr. Bienvenu and Ms. Julian together.  In addition you will receive numerical grades for the online quiz and the observed physical exam.

You may answer the phone or the door but do not give out any information on ANY baby or mother to ANYONE who is not a nursery staff person (don’t even acknowledge that a mother or baby exists).  Find someone from the nursery to answer questions that the caller or visitor may have.  

You will change wet and/or dirty diapers yourselves.  Be certain to let the nursing staff know about it, though, so the information can be put into the log book.  Be certain to dress the baby and wrap the baby back up in the blanket when you are finished. Always place the baby in the crib on his or her back.

Wipe your stethoscope with alcohol before using it each and every time. You may want to bring your own ophthalmoscope, but if not, there is one in the nursery which you can use.

DO NOT TAKE ITEMS OFF ONE BABY’s CRIB TO USE ON ANOTHER BABY.

NO FOOD, DRINK, OR GUM in the nursery or in Mothers' rooms

Use only hospital-approved abbreviations for all terminology

See the footnote in the write-up guidelines for the hospital-approved abbreviations for ethnicity.