Postnatal handbook

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Hip examination and referrals

Hip examination

Barlow’s Test

  • Adduct the hip, then apply a downward pressure over the knee with your thumb.
  • If the hip is unstable, the femoral head will slip out of the acetabulum, producing the palpable sensation of the hip dislocating.
  • If the hip is dislocatable, then Barlow’s test is positive.

Ortolani’s Test

  • Used to confirm the hip dislocation.
  • Flex the hips and knees to 90 degree, then apply an anterior pressure over the greater trochanter and gently adduct the leg with your thumbs.
  • If the hip was dislocated, a distinctive clunk will be heard as the hip relocates. This would be Ortalani’s test positive.

Figure 1. Barlow’s and Ortolani’s test – Adapted from http://www.cssd.us/body.cfm?id=515


Youtube: How to test for newborn hip dysplasia

Hip Ultrasound Scan Referrals

 

BCG referrals

The BCG is no longer one of the vaccinations offered as part of the routine childhood vaccination schedule, due to the low prevalence of TB in the UK.

At the newborn examination, it is important to identify if the neonate is at an increased risk of TB.

The child will be referred to an outpatient Public Health Medicines clinic for BCG administration at either Govanhill Health Centre (Southside) or Woodside Health Centre (Westend). The vaccination is an intradermal injection, administered within the first 2 months of life.

Please ensure that referral proforma is completed. This must include indication for referral, parents telephone number, which centre they would prefer to attend for the vaccination, if an interpreter is required and if mum has been on any TNF alpha-antagonists or TB treatment. This proforma allows the neonatal secretaries to pass the baby’s details on to public health.

Full Guidelines: Immunisation Guidelines for Neonates

Postnatal Wards - Ward 47 & 50

Handover

Handover occurs in the classroom at NICU at 8:30 every morning. The night team will let the day team know of any babies on the postnatal ward that the team need to be aware off. This can commonly be for antibiotic administration, bilirubin levels and blood tests.

Jobs list

On each ward there is a diary that is updated throughout the day by the midwives. They will list the babies that require newborn examination that day and the babies that need to be reviewed.

  • Baby checks should only be done when the baby is over 6 hours old.
  • Preterm babies (babies < 37 weeks) should be reviewed by a registrar before they are discharged for assessment of temperature control, feeding and jaundice.

Antibiotic administration

This is carried out by the FY2 covering the postnatal wards during the day and by the NICU FY2 in the evenings. The night team are responsible for this overnight.

Collect the Kardex, a pre-made syringes of cefotaxime and a saline flush from the treatment room in NICU. Before administering the antibiotics, the medication and Kardex need to be checked by 2 people.

Ensure the cannula site is clean and dry, remove protective cap and clean end of cannula. Slowly administer saline flush, ensuring that it goes in easily with minimal resistance. If you are happy that the cannula is functioning, administer the cefotaxime slowly over a few minutes. Then flush the line again with saline and replace protective cap on the end of line.

Antibiotic times on the postnatal ward are routinely at 02:00 and 14:00 or 06:00 and 18:00. If asking colleagues to take blood on the postnatal ward overnight, please try and keep them to these times.

Documentation

All newborn babies should come from the labour suite to the postnatal wards with a newborn record proforma. The first page should be completed with details of the birth and examination immediately post delivery. The inside two pages should be completed at the time of the newborn examination.

The newborn examination should also be recorded on maternity badger. This allows the community midwives to access this post-discharge.

There is a proforma to be completed if a baby requires hip USS, the neonatal BCG or has required NEWS or antibiotics for GBS or PROM. The neonatal secretaries will automatically issue a letter to the GP if this is complete.

There is another proforma to be completed specifying whether or not a letter has been dictated for this baby.

Dictation

If any baby has a prolonged admission on the postnatal wards, requires any investigations or treatment or has any condition that will require follow up, a letter should be dictated to the GP outlining the events of their stay. This can be done using the Winscribe software on the computers in the postnatal wards. ID code is 2157 and password 2157.

If a letter is dictated, please complete the proforma detailing who did the dictation and the date that it was done. This then gets attached to the neonatal record, so the neonatal secretaries are aware that there is a letter to be dictated.

The neonatal secretaries will then type these letters and then they will be put on Tackcare to be verified. On Trackcare, expand the toolbar at the top and click CS review. Letters you have dictated should appear and can be edited. When you are happy with the letter, change letter status to clinician approved.

Editorial Information

Last reviewed: 10 June 2020

Next review: 27 July 2021

Author(s): Kirsteen McSween