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As the number of high-risk and preterm births increases, delivery
centers are challenged to provide a consistently high standard of
care for an increasingly heterogeneous population of infants. Thus,
every nursery should regularly convene a multidisciplinary team
to develop policies and procedures that best suit the local population
of newborn infants. Routine care in any nursery should be considered
only one part of a complex system focused on safe transitions from
the hospital environs to the home.
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The first step is to promote a healthy transition from intrauterine
to extrauterine life. Routines vary from one nursery to another
in details, but all should follow the principles given in Guidelines
for Perinatal Care1 and may be further
adapted on the basis of clinical guidelines from the American Academy
of Pediatrics, the Centers for Disease Control and Prevention, or
other expert panels. Every nursery should have written criteria
for routine admission to well-baby nursery and for admission to
high-observation, special or intermediate care, and intensive care
nurseries.
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Communication and transfer of information are critical to providing
care for newborn infants. In a very short time period, the pregnant mother
is processed through a minimum of 3 different care settings: the
outpatient clinic, the delivery room, and the postpartum ward. Documentation
from each setting provides essential information for risk assessment
for each infant.
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Infant Identification and
Security
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Human error and human behavior continue to be the root causes
of infant switching and infant abduction. Movement of patients from one
care area to the next and discharge from the hospital are critical
times of increased risk. All mothers and newborn infants should
be assigned matching identification bands in the delivery room.
At minimum, the bands should include an identification number, the
mother’s medical record number, the birth date and time,
and the infant’s gender. The bands should be fastened securely
on both mother and infant. Extremely premature infants should have
their bands taped to the Isolette or warming bed and attached to
the infant as soon as possible. Any time an infant is moved from
or returned to the mother (eg, blood sampling, procedure, rest in
the nursery, or discharged home), the identification bands should
be verified for accuracy, and the care provider accepting or transferring
the infant should document both the verification and the infant’s
new location.
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All hospitals should develop a security system that best suits
their physical plant. Particular attention should be paid to emergency exits,
hallways, and stairwells, and partnership with local law enforcement
agencies is essential. The use of electronic card readers can limit
access to patient care areas such as intensive care units, and infants
may be equipped with sensors to track their location. Although technology
can improve infant security, more can be achieved through hospital
staff and parent education. In addition to equipment failure and
limitation of the physical environment, inadequate patient education,
insufficient staff training, ...