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Nurse/Provider Sign-out
- 3-day-old baby girl born at 39 weeks to 35 year-old G3, P3 mom on buprenorphine for history of opioid use disorder. Mom in recovery since birth of her first child 4 years ago. No concerns for illicit substance use in pregnancy.
- Mom on Paxil for depression and anxiety; mom has counselor she is well connected with through her PCP’s office. PCP is mom’s buprenorphine prescriber.
- Baby with tremors, hypertonia, and increased Moro on first day. On 2nd day, tone and Moro within normal limits and only mildly jittery when unswaddled or not skin-to-skin with mom. In past day, mom hasn’t noticed a difference in baby’s tone or jitteriness. Mom is holding baby skin-to-skin often and breastfeeding ad lib. Newborn team thinks baby slightly jitterier today with mildly increased tone noted.
• Baby had difficulties feeding on 1st day with spitting up colostrum. Spitting resolved by 24 hrs. Baby then feeding well at breast. In past day, breastfed 9 times, 4 voids/stools. Stools now yellow and seedy. Weight down 6%. - On last assessment approximately 3 hrs. ago: vital signs stable. Jaundiced to face. Baby fussy with slight increase in muscle tone and tremors on exam. Symptoms improve as soon as baby is picked up.
- Mom’s sister has been here helping (when father of baby is at work). Maternal grandmother is helping to care for mom’s 2 other children at home.
- Mom received prenatal education from her PCP’s office. Hospital staff stressing the importance of rooming-in, skin-to-skin contact, and breastfeeding and how these will help her baby go home sooner. Mom keeping baby with her all the time in a calm, quiet room, spending lots of time holding baby skin-to-skin when she is awake. Mom’s sister holds the baby when mom is sleeping (and takes naps herself when mom is awake and caring for baby).
In-room Assessment
- Mom asleep in bed, baby’s aunt is holding baby and helps wake mom up when the RN comes in.
- Baby slept for 2 hrs. after feeding with her aunt holding her. Mom able to nap during this time.
- Baby was fussy when woke up and cried through diaper change with tight muscle tone and tremors.
- Was able to calm down after a few minutes of skin-to-skin time with mom.
- After calming, baby breastfed well for 15 min on left and 10 min on right. Upon RN’s specific questioning, mom shares that baby latched within a few min.
- Last stool was watery and green, and baby just sneezed 4 times in a row. Vitals signs are stable.
- Baby gets fussy as soon as put in bassinet and breaks out of swaddle. Calms within a few minutes and stays consoled once picked up and held.
