N.J. Admin. Code § 8:43G-19.15

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:43G-19.15 - Newborn care policies and procedures

(a) A current roster of physicians, their specific pediatric privileges, and an on-call schedule shall be kept in each nursing unit in newborn care.

(b) A physician or an advanced practice nurse skilled in neonatal assessment shall perform a complete physical examination of the neonate within 24 hours of birth. This examination may serve as both the initial and discharge examination if the neonate is discharged within 24 hours. If the neonate remains in the hospital for more than 24 hours, a second examination shall be performed prior to discharge.

(c) Isolation practices for the newborn nursery shall follow the recommendations set forth in the following publication: Siegal, JD, Rhinehart, E, Jackson, M, et al., and the Healthcare Infection Control Practices Advisory Committee. "2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings." Last update: October 2017; 1-203, available at: http://www.cdc.gov/infectioncontrol/guidelines/index.html and is incorporated herein by reference, as amended and supplemented.

(d) The newborn nursery shall identify and report any outbreak of disease, or any single case of a disease as specified in N.J.A.C. 8:57-1.1 through 1.5.

(e) The hospital shall screen all newborns for high risk factors associated with hearing impairment pursuant to N.J.S.A. 26:2-103.4, biochemical disorders pursuant to N.J.S.A. 26:2-111, and congenital heart defects no sooner than 24 hours after birth by using pulse oximetry pursuant to N.J.S.A. 26:2-111.4.

1. The hospital shall report congenital defects pursuant to N.J.S.A. 26:8-40.21 and shall complete birth certificates and death certificates pursuant to N.J.S.A. 26:8-28 and 26:6-11.

(f) Policies and procedures for screening all newborns for hearing impairment, in accordance with N.J.S.A. 26:2-103.1 et seq., shall require that the hospital or birth center:

1. Screen all newborns for hearing impairment using electrophysiologic measures;

2. Screen all newborns for high-risk indicators associated with hearing loss, using criteria established at N.J.A.C. 8:19- 1.8, prior to discharge or no later than one month of age;

3. Complete and report to the Department all specified components of the Electronic Birth Certificate, including the hearing screening results within one week of discharge, in accordance with N.J.A.C. 8:19- 1.6;

4. Designate a licensed physician or licensed audiologist to oversee the administration of newborn electrophysiologic screening by licensed physicians, licensed audiologists and/or other qualified individuals receiving direction and training by the designated licensed physician or audiologist to administer the electrophysiologic screening; and

5. Establish policies and procedures, in accordance with 8:19-1.3 and 1.4 for the provision of follow-up services for newborns that do not pass or receive electrophysiologic screening in one or both ears and for those that are identified as being at-risk of developing a hearing loss.

(g) Policies and procedures for the early detection of biochemical disorders in newborn infants, including at least hypothyroidism, galactosemia, and phenylketonuria, pursuant to 26:2-110 and 111, shall include, but not be limited, to the following:

1. Collection of blood specimens from newborn infants on collection kits provided by the Department;

2. Collection of blood specimens 24 hours after the newborn infant's first feeding or 48 hours after the newborn infant's birth or upon the newborn infant's discharge from the facility, whichever comes first;

3. Development of a system within the facility for the submission of blood specimens to arrive at the Department's laboratory no later than 96 hours after the newborn infant's birth;

4. Designation of a staff member(s) to be responsible for receiving verbal and written positive screening test results and documenting the results in the newborn infant's medical record; and

5. Provision of written information, provided by the Department and/or the facility, to all parents and physicians regarding the testing of biochemical disorders and the possibility of incorrect screening test results if the blood specimen is not collected.

(h) The hospital shall require a newborn's medical record to contain documentation of the following:

1. A summary of the mother's obstetric and relevant medical history;

2. Anesthesia, analgesia, and medications given to the mother;

3. Reasons for induction of labor and operative procedures, if performed;

4. Date and time of birth and copies of all vital records;

5. Birth weight and length;

6. Condition of the newborn at birth, including the one- and five-minute Apgar scores, time of sustained respirations, details of any physical abnormalities, and any pathological states observed and treatment given before transfer to the nursery;

7. Any abnormalities of the placenta and cord vessels;

8. Length of gestation;

9. Procedures performed in the delivery room;

10. A record of the newborn assessment, performed by a physician or registered professional nurse upon the newborn's admission to the nursery;

11. A plan of care;

12. An initial physical examination performed by a physician, which bears the physician's signature and the date of the examination;

13. A physical examination that includes measurement of the newborn's head circumference, performed at discharge or upon transfer to another facility by a physician, and which bears the physician's signature and the date of the examination;

14. The administration of, and the newborn's response to, vitamin K, eye prophylaxis for ophthalmia neonatorum, and any other medication or treatment;

15. The results of the infant-feeding evaluation and any follow-up assessments;

16. An interdisciplinary comprehensive treatment plan that addresses the recommendations regarding either breastfeeding or formula-feeding based upon the assessments conducted pursuant to (h)15 above;

17. Formula supplementation of breast milk; and

18. Assessment of the risk for hyperbilirubinemia in every newborn born at 35 or more weeks of gestation, as performed by the newborn's physician in accordance with the Clinical Practice Guidelines for Hyperbilirubinemia.

i. The newborn's physician shall document in the medical record the newborn's pre-discharge serum or transcutaneous bilirubin measurement and parental counseling about hyperbilirubinemia, when applicable.

N.J. Admin. Code § 8:43G-19.15

Amended by 50 N.J.R. 552(b), effective 1/16/2018