Preparation for resuscitation – Term and Preterm babies

Preparation for babies where there are maternal and fetal risk factors:

 

  1.  In a high-risk situation ensure there are at least two doctors present (SHO and Registrar or Consultant). Ideally if possible, a consultant should be present at births under 28 weeks gestation.
  2. Introduce yourself to the parents.  Check the maternal notes and take the relevant history.  Explain what is likely to happen e.g. in the case of a pre-term birth it is likely that the baby will require resuscitation and will be admitted to the neonatal intensive care unit etc.
  3. Check that the radiant heater is on maximum power. In theatres, a ‘Cosycot’ mattress is already in place and must be switched on. It goes to a preset of 370C. You can feel that it is warm only if you press your hands on the mattress and it offers controlled warmth to reduce conductive heat loss. Ensure that the towels and blankets are warmed. For premature babies < 32 weeks weeks gestation, ensure you have a large food grade  plastic bag available. Ensure a proper size hat along with a range of sizes on either side is available. Delivery room temperature should be at least 26 0C for the most immature babies. In theatres, you can achieve this temperature by adjusting the control panel is on the wall behind the anaesthetics machine. (For full instruction See Home Neonatology/ Early care of very premature babies/Thermal care guidelines).You need 15-20 minutes to achieve this. So act early and liaise with theatre sister. Aim to maintain temperature of the baby following birth between 36.5 and 37.50 C.
  4. Check that the oxygen supply, connections, the pressure control valves, the Laerdal bag (or neopuff ventilator) and the face masks are handy and working satisfactorily.  Preset the pressures to 20/5 in a preterm infant and 30/5 in a term infant. Step up / down pressure and FiO2 according to response to resuscitation (Heart rate, chest expansion and oxygen saturation).
  5. Check that an oxygen saturation monitor is available with appropriate probes and fixation material.
  6. In the case of preterm birth, check that transfer and ventilation facilities en route to NNU after stabilisation are in order. In Singleton hospital, check that the incubator transporting the baby to Special Care is ready in the room, warmed to 37oC for extreme preterms and 350C for all other babies, and that the oxygen supply is working. Check that the ventilator on the transport incubator is working and a new CPAP circuit is available. For premature babies less than 29 weeks make sure the surfactant is out of the fridge and warming to room temperature.
  7. Check the suction equipment and set the vacuum control to 10 cms of water
  8. Check the laryngoscope is working, that the light is bright and the bulb (if present) is tightened. For a large baby use a large blade and for a preterm baby make sure that there is a small blade available.
  9. Check the availability and sizes of the endotracheal tube and that the ETT fixation system is available. Most average sized term babies need a size 3.5 tube to ensure effective ventilation.  Use a size 3 tube for any baby > 1 kg, and a 2.5 tube for smaller babies.
  10.  If the clinical situation indicates for e.g. severe prolonged fetal bradycardia, hydrops etc.), draw up emergency drugs e.g. Adrenaline, concentration 1:10,000 and prepare catheters
  11. Check that a stethoscope is present and working. Lay out a measuring tape at the head end of the resuscitaire in order to be able to measure the head circumference straight away if condition permits.
  12. Close the door to eliminate drafts and try and keep the room as warm as possible.

 

Preparation for birth of a healthy baby where the midwife is the lead professional

  1. Prepare an area for newborn resuscitation with all necessary equipment checked and to hand.
  2. Check bag/valve/mask is in good working order with appropriate size mask
  3. Pre warm towels.
  4. If any problems with resuscitation are anticipated during labour and birth consider calling a 999 ambulance and inform the receiving hospital or inform labour ward co-ordinator if the birth is in a consultant led unit.
  5. If available and necessary, check the resuscitaire and all equipment is in good working order.
  6. If appropriate take resuscitaire into the birthing room.
  7. If baby needs to be transferred to hospital, prepare pod / transfer blanket.