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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.

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.

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.

Infant Identification and Security

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.

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, ...

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