King Fahad Armed

Forces Hospital

Neonatal Intensive Care
Unit Standing Orders
NUR07.041
Policy:
Standing orders for
medication or investigations are
carried out by the NICU nurses
to expedite treatment and
enhance recovery.

Procedures:

Complete Blood Count:
Capillary Blood sampling for CBC on all new
admissions.

Blood sample collection area
Vaccines
Hepatitis B vaccine
0.5ml intramuscularly
given prior to discharge, except for infants less than 1.7
kg

Bacillus CalmetteGurin (BCG) Vaccines
0.05 ml intradermally
prior to discharge, except for infants less than 1.7 kg

Respiratory Syncytial Virus (RSV) vaccine
15 mg/kg intramuscularly
All babies born at 32 weeks gestational age and below
All babies with Cardiac Conditions, Chronic lung
disease


Eye Drops for Dilatation:
Given prior to eye
examination by
opthalmologist:

Midriacyl 1%
- Apply one drop in
each eye for 3 doses
with 10 minutes
interval between each
dose. To be started
one hour before the
examination once the
opthalmologist called
to confirm his/her
arrival time in the unit.

Phenylephrine Hydrochloride 2.5%
1 drop to each eye 10 minutes
for 2 doses to start 1 hour
before the examination once the
opthalmologist to confirm
his/her arrival time.

Both drops are used alternatley for
a total of 5 doses collectively

Vitamin K:
1 mg intramuscularly for
all newborn babies (if not
given in labor ward or
operating room)


Intralipids:
If the order is 20% and the pharmacy issue 10%, then
double the rate of infusion
If the order is 10% and the pharmacy issue 20% , then
half of the hourly rate of infusion.
Intralipid infusion is not included on the total fluid intake
per day. It is givan as extra.

Metabolic Screening:
Blood test for
tandem metabolic
screen is done for all
babies 48-72 hours
of age and the baby
is on full feeds.

Serum Potassium Level:
Serum potassium level to be repaeted venously if
cappillary level is 6.0 mmol and above. If repeated
venous level is still 6.0 mmol and above, then the
physician must repeat potassim level arterially.

C02 for Electrolyte Result:
If the result from electrolyte is 18 mmol or less,
then blood gas must be done.

Hemoglobin Electrophoresis:
For all babies delivered from sickle cell positive mothers
should be samples for Hemoglobin electrophoresis within
24 hours of age if not done in labor ward or operating
room.
Pediatric Hematology appointment should be given when
the baby is discharged.

Serum Bilirubin level:
If the baby is having
coombs positive, Rh, or
ABO incompatibility and
G6pd deficient, monitor
serum bilirubin level
after 12 hours of age.

If serum bilirubin
level is whithin
photo therapy
zone, start
phototherapy light
according to the
result.

Babies with Diabetic mothers:
Gestational diabetic mothers taking insulin, their babies
must be admitted in NICU and monitor their blood glucose
levels.

Do initial dextrostics.
Then hourly x3, (if dextrostics is 2 mmol/L 6.8 mmol/L)
Then every 3 hours x3 (if dextrostics is 2 mmol/L 6.8
mmol/L)
Then every 6 hours x3 (if dextrostics is 2 mmol/L 6.8
mmol/L)
Every 12 hours

All dextrostics should be done before feeds.

Rule out Bacteremia:


GBS positive mothers,
Spontanous Rupture of
Membranes > 18 hours, with
single dose or no maternal
antibiotics received
Blood culture must be done by a physician

Complete Blood Count , C-Reactive Protein daily for 3
days
SBR done 24 hours of age. If the baby is having
coombs positive, Rh, or ABO incompatibility and G6pd
deficient, monitor serum bilirubin level after 12 hours of
age.

If baby is meconium stained, no need
to extract blood for CRP.


MRSA Screening

Babies requiring MRSA screen:
(swab for nose, axilla, groin)
Every 2 weeks for all babies delivered in
KFAFH Operating room and labor ward.
All Babies transferred from outside hospital
Babies delivered at home. (includes cord
swab)
All babies who stayed in Well Baby Nursery
for >12 hours then admitted to NICU.

Test for clearance:


Swabs of the nose,
axilla, groin and other
sites previously
positive should be
taken 3 days apart.
Three negative series
of screening tests are
required before the
patient is considered
to be clear.
Babies should not be
receiving antibiotic
therapy throughout
the screening
process.

Antibiotic BACTROBAN OINTMENT (mupirocin)
Ointment, 2% is given for 5 consecutive days, then a
swab from the previous positive site should be
taken.
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