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Special ConsidersationsChapter 22
Delivery Room Management
Delivery Room Attendance
Section titled “Delivery Room Attendance”Level 0: Routine delivery
Section titled “Level 0: Routine delivery”Attendance: L&D RN with or without RT
Level I: low risk for resuscitation
Section titled “Level I: low risk for resuscitation”Attendance: NICU RN & RT
- 35-36 weeks
- < 2kg
- Breech C/S
- Maternal meds: opiates/ SSRI/ Mg/ etc.
- Maternal exposure to illicit drugs (+U tox on admission)
- Presence of meconium
- No prenatal care
- Multiples
Level II: high risk for resuscitation
Section titled “Level II: high risk for resuscitation”Attendance: NICU RN, RT and MD
- < 35 weeks GA
- Category III FHR tracing
- Vacuum / forceps delivery
- Vaginal breech
- Urgent or Emergent C/S
- Hydrops with minimal fluid
- Mother under general anesthesia
- Placenta previa
- Placental abruption
- Placenta percreta/ increta/ accreta
- Shoulder dystocia
- Cardiac dysrhythmia (tachyarrhythmia, bradycardia, heart block, etc.)
- Eclampsia
Level III: complex resuscitation
Section titled “Level III: complex resuscitation”Attendance: 2 NICU RN, RT, and MD
- 2 RNs & 2RTs required for <25 weeks GA unless staffing shortage
- 2 RNs & 2 RTs recommended for 25 - 27 weeks GA
- Hydrops with projected need for tapping
- Multiple congenital defects
- Projected severe/ compromised/ lethal outcome
Thermoregulation and Heat Loss Prevention
Section titled “Thermoregulation and Heat Loss Prevention”Labor & Delivery / OR
Section titled “Labor & Delivery / OR”- Maintain L&D/OR temperature at 70-74℉
- Preheat the radiant warmer before birth and set on servo-control mode
- Use prewarmed blanket to dry the newborn during delayed cord clamping
- use prewarmed blanket to receive the newborn and dry under the warmer
- Place temperature probe as soon as baby is under the warmer
- Monitor temperature frequently (every 5-10 minutes) prior to transfer to the NICU
- Maintain axillary temperature between 36.5℃ - 37.5℃
- Place a thermal mattress under the blanket on the radiant warmer
- Wrap the baby in a polyethylene plastic bag or wrap (<28 weeks and/or < 1,000 grams)
- Place a prewarmed hat on the baby’s head (as soon as possible)
- Keep the newborn fully covered during resuscitation and stabilization
Delayed Cord Clamping
Section titled “Delayed Cord Clamping”- All infants who emerged with active tone should receive delayed cord clamping for at least 30 sec unless:
- Mono/di twins with TTTS or significant fetal wegith deiscrepency
- Mono/mono twins
- Need immediate evaluation and/or resuscitation (e.g., placenal abruption)