Sickbaby Neonatal Section

Section Introduction:
The Sickbaby section of Valiasr Hospital is located on the second floor, adjacent to the Women and Maternity section. This unit has commenced its operations after completing equipment and personnel setup. There is a nursing station at the entrance of this section.

Direct Contact Number for the Section: 32122356-025 and 32122355-025

Section Head: Dr. Mohsen Sharifati

Section Supervisor: Mrs. Zahra Khan Ahmadi

Specialist Physicians in the Section:

• Dr. Mohsen Sharifati
• Dr. Farhad Mahjourian
• Dr. Abdulhossein Poshtiban
• Dr. Noushin Madani
• Dr. Elham Ramazani

This section includes two parts: Rooming In/Sickbaby (special care for neonates). This section is dedicated to the hospitalization of infants aged 1 to 20 days. In Sickbaby, infants in need of special care are placed under supervision. In the Healthy Neonates section, the following services are provided:

Admission of healthy infants, vaccination, screening of hospitalized infants, hearing tests, breastfeeding education to mothers by a lactation consultant, training in hygiene care for infants, 24-hour responsiveness to breastfeeding problems. Pediatric specialists are available on call. For the stay of mothers of hospitalized infants, a separate room has been provided, and the telephone number for the mothers’ room is 32122354-025.

Infant vaccination is carried out in accordance with the national vaccination program in this section.

After performing initial care and admitting infants, the Rooming In plan (mother and infant sharing a room) is implemented, and the infant is placed next to the mother in the mother’s room.

This section includes the following rooms: Neonatal Phototherapy Room with 7 circular phototherapy devices, Neonatal Bedridden Room with 1 resuscitation bed, 1 ventilator, 6 incubators, 1 electric breast pump, 4 catheters, 3 warmers, 1 scale, 3 pulse oximeters, 4 central suction devices, 1 portable suction device, 3 continuous monitoring devices, 1 TCB (neonatal jaundice) device, 1 bathroom, 2 T-piece devices, 1 syringe pump, 7 serum pumps, 1 refrigerator for storing breast milk, 1 medical refrigerator, pharmaceutical stock of the section, and a medication trolley. A breastfeeding room for mothers is located in the corridor next to the section. The vaccination room and hearing screening room are situated in an adjacent corridor to the section.

In this section, educational pamphlets on breastfeeding, as well as pamphlets on neonatal diseases such as jaundice, Fawism, premature infants, cleft palate, and hypoglycemia, are available. The televisions in the mothers’ rooms are equipped with flash and instructional breastfeeding videos. Regarding issues and problems related to infants, the importance of infant nutrition with breast milk, how to care for and maintain the umbilical cord, bathing, infant body temperature, room temperature between 26-24 degrees Celsius, suitable clothing for infants, jaundice, screening tests, post-discharge visits by a doctor, how to hold the baby by parents, how to feed the baby by hand, vaccination, storing breast milk in the refrigerator, and more are taught and explained. The doctor provides information and education to parents if there are specific examination cases, problems, or a need for follow-up after discharge. Finally, the midwife and nurse take signatures from parents in the parental registration book. In addition to breastfeeding education, there is a breastfeeding room in this area where parents feed infants who have started breastfeeding in the section. Alternatively, they use breast pumps to store breast milk. If a mother needs assistance or education, it is provided by nurses or midwives.

Admission Process:
In the Sickbaby section, patient admission takes place directly or indirectly, including infants hospitalized in incubators with respiratory problems and jaundice, monitored in the circular phototherapy room, and treated in the catheterization area.

Infants are directly transferred to the neonatal section from the operating room or maternity ward via the catheterization area, located adjacent to the neonatal section. The infant is handed over to one of the nurses or midwives in the section and immediately moved to the resuscitation bed under the warmer. Oral and nasal secretions are suctioned, and the infant is examined, followed by monitoring and vital signs control. Weight and height measurements are taken, and Vitamin K is injected. The infant is examined by the on-call doctor, then hospitalized in the service of one of the on-call physicians. Based on the clinical condition of the infant in the SICKBABY section, further medical orders are executed, including mandatory tests and lung X-rays for all hospitalized infants in Sickbaby. Serum therapy begins, and antibiotic treatment is initiated. In some cases, intubation may also be performed on unwell infants. All neonates receive visits from neonatology specialists. The admission order sheet is written by the on-call doctor, provided to one of the parents to complete admission tasks, and then the admission and hospitalization sheet is handed over to the section.

If the infant is in critical condition, they are transferred to a NICU-equipped hospital with a portable incubator, accompanied by a nurse and an anesthetic technician, following all necessary precautions.

All infants born in this hospital are received by the neonatal section nurses from the operating room or maternity ward. In the same section, all the following are evaluated by a nurse or midwife in the presence of the section staff, and the admission log is signed in the Admit Office of the section:

• The infant’s identification bracelet is thoroughly checked against the infant’s admission form. The mother’s and father’s names, as well as the mother’s obstetrician’s name, are verified.
• The infant’s gender is matched with the admission form.
• The umbilical cord is checked for clamping and bleeding.
• The overall appearance of the infant is thoroughly examined. If any abnormality is observed, it must be communicated to the maternity ward, documented in the admission form, and the necessary actions taken.
• A blood sample from the umbilical cord is collected for BG-RH testing.
• The back of the admission form must be fully completed by the person delivering the infant.
• Finally, if there are no issues, the neonatal section nurse leaves the operating room and maternity ward.
• The infant is transferred to the neonatal section with a catheter, placed under the warmer, and then undergoes an initial assessment. Before starting the admission process, a wet towel is removed, and the infant is dried.

Stable Infants Admission Process:

• Internal oral and nasal secretions are suctioned.
• Then, the rectal feeding tube is checked for the infant’s patency. If the tube does not pass through the nasal and rectal openings, the on-call doctor inside the section and the nurse in charge of the shift are quickly notified.
• Passing the NGT (Nasogastric Tube) for esophageal atresia assessment.
• The nurse, along with the midwife, starts the infant’s admission, measuring height, weight, and head circumference.
• Injection of Vitamin K ampoule in the left leg.
• VS (Vital Signs) control of the infant in the first hour after birth and every 6 hours, including K – HR – Rate – Sat O₂.
• The infant is visited by the on-call doctor.
• If the infant has respiratory problems, they are quickly transferred to the incubator based on the doctor’s diagnosis.

• All the infant’s details are recorded in the identification card.
• The infant is dressed according to gender and then placed inside the crib. The neonatal section nurse hands the infant over to the mother in the maternity room (located in the women’s section). The infant’s wristband is checked against the mother’s wristband. It is then given to the father or a female relative present in the room for training.
• After bringing the mother, the nurse or midwife responsible for breastfeeding goes to the maternity room, and breastfeeding is initiated. Parents or relatives present are taught how to hold the infant. If the infant shows signs of distress or crying, the neonatal section should be informed promptly.
• If the mother does not enter the women’s section for any reason within the first hour after birth, for initial breastfeeding, the neonatal section personnel must follow up. If necessary, the infant is taken back to the recovery room or the operating room. The decision on initial breastfeeding will be made by the on-call doctor or the attending physician.
• All vaccination procedures immediately after birth in the vaccination room, located near the neonatal section, are performed by the vaccination expert according to the protocol.
• Hearing screening of the infant, located near the neonatal section, is carried out by the relevant specialist according to the protocol.

Discharge of Patients:

The discharge of hospitalized patients in the section includes the following teachings. Infants who have completed their stay in the ward, undergone the treatment period, achieved complete recovery, and have successfully breastfed are ready for discharge.

Education at the Time of Discharge Includes:

• Dressing the infant
• Bathing the infant
• Changing the infant’s clothes
• Umbilical cord care
• Holding the infant
• Administering oral medications, including vitamins and prescribed drugs
• Follow-up after discharge, such as necessary ultrasounds based on the doctor’s order
• Vision screening and ABR (Auditory Brainstem Response) at three months
• Ultrasound at one month
• Visit by the doctor within 48 hours
• Continuation of vaccination
• Education on warning signs and risks, including lethargy, jaundice, fever, vomiting, respiratory problems, twitching, and shaking
• Performance of screening tests
• Provision of educational pamphlets to parents
• Collection of the summary file
• Signing and fingerprinting in the educational registration book of parents
• When one of the parents, preferably the father, delivers the discharge sheet to the section, the infant is given oral polio drops and then leaves the section and the hospital.

Healthy Infant Discharge:

After the visit by the pediatric specialist, if there is a discharge order, the infant is discharged after 24 hours.

1. Oral polio drops are administered to the infant.
2. Recommendation for a follow-up visit in the next 48 hours.
3. Educational pamphlets on screening are provided.
4. Recommendation for screening tests between days 4-7 after birth, and information on screening centers in the neonatal section is provided to parents.
5. Vaccine card is given to parents with recommendations for vaccination.
6. Advice on signs of insufficient breastfeeding and additional jaundice.
7. Rechecking the infant’s wristband, and the infant is handed over to the father. Signing and fingerprinting are done in the handover book.
8. Educational warnings about signs of jaundice, lethargy, respiratory problems, twitching, fever, seizures, difficulty breastfeeding, vomiting, etc.
9. Recommendation for establishing a file in nearby health centers within the next 48 hours.