Quick guide to taking community calls

NHS Lothian neonatal guidelines (in development)
NHS Lothian

(refer to Badger guidance if in any doubt) 

If baby requires review/bloods and they will have to attend after 5pm, or the weekend, or there is COVID risk (mother/baby have symptoms of COVID or are self-isolating due to actual/suspected COVD) à they should be referred to the ARU Reg on 9424 and be seen in RHSC A&E 

Prolonged jaundice (babies who are jaundiced at or beyond 14 days (term) or 21 days (preterm))

Advise same day attendance at RHSC A&E any baby who is/has: 

  • unwell, rash/bruising, feeding poorly, low tone, other neurological signs or lethargic 

Advise next working day attendance to RHSC A&E (attend by 10am) any baby who: 

  • has pale (or ‘suspect’) stools at any time –THIS IS THE MOST IMPORTANT SIGN TO OBSERVE and EMPHASISE ONGOING DAILY ASSESSMENT BY PARENTS 
  • has a FHx of recurrent jaundice or blood disorder, or parents are consanguineous 
  • has been formula feeding exclusively without any breastmilk in the last 7 days 
  • has not regained birthweight by 14d and where there is evidence that weight gain is not reassuring; or, where weight gain has become poor since regaining birthweight 
  • has had previous NNU admission for intensive PTX due to suspected haemolysis  

All other babies: 

  • do not need to be referred to hospital or seen at this stage 
  • MW should give parents worsening advice and the new PJ information leaflet 
  • MW should ensure parents know to assess stool colour daily using the PiL stool chart (if in colour) or online link. THIS IS THE MOST IMPORTANT SIGN TO OBSERVE and EMPHASISE ONGOING DAILY ASSESSMENT BY PARENTS 
  • MW or HV should review babies weekly until no longer jaundiced and refer back as pathway above 

NB: all babies who remain jaundiced at 28 days (term or preterm) should be booked in ward attendee clinic for next working day attendance (RIE GynaeOPD) 

Early jaundice

Jaundice <24h:  baby requires to be assessed in clinic urgently (RIE GynaeOPD) and have an SBR measured.  

Minolta reading      
Any gestation any time point      Baby requires to come urgently to NNU for assessment, SBR and phototherapy. Alert SC TL to prepare a space and do not delay seeing the baby. 
Gestation 35+0-36+6w  ≥37w  
24-48h  ≥120  ≥170

Baby requires SBR 

  • Check if CommNT can do and if so book for virtual appt (Contact: bleep 22587 or 07720508696) 
  • If CommNT cannot then, book for actual ward attendee appointment (RIE GynaeOPD)  

Note: guidance is that SBR result should be available within 6 hours of noting jaundice. If CommNT cannot do SBR until late in the day then it may be appropriate to book baby into clinic 

Note: it is useful to also do a DCT for jaundiced babies coming to clinic to facilitate assessment for home PTX. Remember babies should be managed on home PTX where possible if they meet criteria. 
>48h  ≥200  ≥270

Weight loss

Any baby with weight loss ≥13% should be seen same day for medical assessment and bloods as per guideline (ward attendee RIE GynaeOPD).  A baby with weight loss <13% does not require to be referred or to be seen unless there are other concerning features. Any plan to see these babies should be discussed with consultant beforehand. 

Other

Get full information and give advice as you feel able, but state you will discuss plan with your consultant and that they or you may contact midwife if plan changes. Take a note of midwife mobile number. 

A baby with any signs suggestive of infection should be referred directly to ARU Reg on 9424. 

All referrals should be documented in the baby Trak record; all clinic visits should have a discharge letter recorded on Trak 

Your point of contact for CMW Referrals is the PNW Consultant on bleep 4133 

Editorial Information

Last reviewed: 28/10/2020

Author(s): Julie-Claire Becher.