1. (a) Immediate transport.

   1. (1) The following newborn conditions, when identified, require immediate transport of the newborn to the hospital by the most expedient method of transportation available to obtain treatment/evaluation.
   2. (2) LLMs who participate in the care of these newborns are required to submit additional incident reports (found in Appendix A or available on the Department of Health website).

   3. (3) The conditions are:

      1. (A) Respiratory distress;
      2. (B) Central cyanosis;
      3. (C) Seizures;
      4. (D)
2. (i) If a temperature outside the normal range of ninety-seven and seven tenths degrees Fahrenheit (97.7°F) or thirty-six and five tenths degrees Celsius (36.5°C), to ninety-nine and three tenths degrees Fahrenheit (99.3°F) or thirty-seven and four tenths degrees Celsius (37.4°C) per axilla is noted:
3. (a) (a) Appropriate corrective measures must be taken; and

4. (b) (b) Temperature must be taken hourly for the next two (2) hours.

   1. (ii) Three (3) persistently out-of-range temperatures warrant transfer;

      1. (E) Jaundice at zero (0) to twenty-four (24) hours;
      2. (F) Apgar score of less than five (<5) at one (1) minute or less than seven (<7) at five (5) minutes;
      3. (G) Apnea lasting more than ten (>10) seconds;
      4. (H) Heart rate greater than one hundred sixty beats per minute (>160 bpm) or fewer than one hundred beats per minute (<100 bpm);
      5. (I) Pallor and poor capillary refill;
      6. (J) Poor suck or refusal to feed;
      7. (K) High-pitched cry;
      8. (L) Any significant congenital anomaly including ambiguous genitalia;
      9. (M) Skin with petechiae or significant bruises;
      10. (N) Poor response to sound or touch; or
      11. (O) Poor tone (floppy).

5. (b) Physician consultation.

   1. (1) The newborn must be weighed weekly.
   2. (2) During the first two (2) weeks of life the newborn must be immediately referred to a pediatric or family medicine provider for any illness or abnormal physical finding.

   3. (3) The newborn must also be referred if there are any concerns about:

      1. (A) Weight gain;
      2. (B) Feeding;
      3. (C) Elimination;
      4. (D) Development; or
      5. (E) Abnormal screening results.
   4. (4) The following newborn conditions require immediate (unless otherwise indicated) consultation with a physician whose practice includes pediatrics.

   5. (5)

      1. (A) A plan of care must be established and execution documented.
      2. (B) Midwives caring for these newborns will be required to submit additional required incident reports to the department (found in Appendix A or available on the department website).

   6. (6)

      1. (A) If consultation is not available, the newborn must be transported to the hospital listed in the plan of care.

      2. (B) The LLM:

         1. (i) Is responsible for the coordination of the physician consultation with the child’s parents; and
         2. (ii) Must follow up on this consultation and document the outcome in the client’s record.

   7. (7) The conditions are:

      1. (A) Jaundice at twenty-four (24) to forty-eight (48) hours of life;
      2. (B) No urination at twelve (12) hours of life;
      3. (C) Birth weight of less than five and one-half pounds (5 1/2 lb) or more than ten pounds (10 lb);
      4. (D) Abnormal cry;
      5. (E) No stool after forty-eight (48) hours;
      6. (F) Vomiting after feedings;
      7. (G) Tachypnea of greater than sixty (60) breaths per minute after four (4) hours of life;
      8. (H) Mother’s membranes ruptured for more than eighteen (18) hours and unknown GBS status;
      9. (I) Infant born to mother with indications for GBS prophylaxis in labor that did not receive antibiotics more than or equal to four (≥4) hours prior to birth (per department-approved guidelines found on department website);
      10. (J) Jittery;
      11. (K) Floppy; or
      12. (L) Eye rolling.

Codification Notes: "GBS" means group B streptococcus. "LLM" means licensed lay midwife.