Care of the Extremely Preterm and Low Birth Weight …health.act.gov.au/sites/default/files/new_policy_and_plan... · Web viewBabies who require positive pressure ventilation require

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Canberra Hospital and Health ServicesClinical Guideline Care of the Extremely Preterm and Low Birth Weight Baby – The Golden HourContents

Contents....................................................................................................................................1

Guideline Statement.................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – Extremely Preterm Early Management (e-PREM) bundle – The Golden Hour........2

Section 2 – Resuscitation at Birth & Thermoregulation............................................................3

Section 3 – Skin Care and Humidification via an Isolette..........................................................7

Implementation........................................................................................................................ 9

Related Policies, Procedures, Guidelines and Legislation.........................................................9

References.............................................................................................................................. 10

Definition of Terms................................................................................................................. 11

Search Terms.......................................................................................................................... 12

Attachments............................................................................................................................12

Attachment 1 – ePREM Flow Chart – Extremely preterm early management Flow Chart. .13

Attachment 2 – Compliance Checklist for ePREM Flow Chart.............................................15

Doc Number Version Issued Review Date Area Responsible PageCHHS18/083 1 09/03/2018 01/03/2031 WY&C – Dept of

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

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Guideline Statement

The purpose of this document is to outline a care bundle for the admission and ongoing management of the extremely low birth weight (ELBW) baby less than 1000grams and /or babies born less than 28 weeks gestation.

BackgroundIn 2016 the Australian and New Zealand Committee on Resuscitation released recommendations which focused on: The golden hour, or initial first hour of neonatal life including neonatal resuscitation, post-resuscitation care, transportation to the neonatal intensive care unit, respiratory and cardiovascular support and the initial course in the nursery. Interventions in the first hour of life can have a significant impact on short and long term outcomes for very low birth weight babies.

Key ObjectiveThe key objective of this guideline is to ensure compliance with the requirements of the care bundle and provide consistency of practice.

Back to Table of Contents

Scope

This document pertains to the admission and care of ELBW babies and/or babies born less than 28 weeks gestation.

This document is applicable to clinicians who are working within their scope of practice, including: Medical Officers Registered Nurses (RN) and Registered Midwives (RM) Students under direct supervision.


Section 1 – Extremely Preterm Early Management (e-PREM) bundle – The Golden Hour

The components of the Golden Hour include; Counselling and team briefing, delayed cord clamping, prevention of hypothermia, respiratory system support, cardiovascular system support, early nutrition, prevention of infection, laboratory investigation and communication with the family.

Preparation in NICUEquipment


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Compliance Checklist for e-Prem pack (see Attachment 2) e-Prem pack Curosurf + administration pack Shuttle/ventilator/CPAP equipment Assemble team

Procedure1. Ensure the neonatologist, neonatology fellow, NICU team leader and retrieval nurse

have been informed of the pending delivery (see Attachment 1 e-PREM flow chart)2. Warm Curosurf in the isolette3. Prepare transport shuttle4. Prepare CPAP circuit/ventilator on shuttle5. Attach CPAP prongs to the CPAP circuit and leave in place6. Obtain compliance check list for e-Prem pack7. Prepare for INSURE (intubation/surfactant/extubation) if planned8. Prepare sterile preterm starter TPN (10%) and lipids at 2g/kg/day9. Prepare antibiotics and caffeine10. Set-up for umbilical line insertion

AlertThe registrar is to request to delay the caesarean if a neonatologist is not yet present and it is safe to do so.


Section 2 – Resuscitation at Birth & Thermoregulation

There are many interventions that need to be practiced in the golden hour to ensure that complications are minimised. The prime objective of the golden hour is to use evidence based interventions and treatment for better outcomes. In the golden hour, a standard approach is followed, derived from the best available evidence with the aim of practicing gentle but timely and effective interventions with non-invasive procedures. Prevention of hypothermia is an important consideration in this early management. Hypothermia is defined as a temperature <36.5°C. ELBW babies must maintain axillary temperature between 36.5-37.5°C.

Team Briefing - Lead by the Neonatologist or Senior Registrar/FellowEquipment Neonatal resuscitation checklist Delivery attendance sheet Neonatal code blue resuscitation sheet

Procedure1. All members of the team are to introduce themselves2. Discuss the plan, communication, expectations and assign roles to team members


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3. Discuss any special considerations4. Ask for additional personnel or equipment if required5. Use closed communication by confirming any orders from the Team leader

Pre-resuscitation equipment checksEquipment Ohmeda Giraffe Isolette with shuttle. Use NICU transport cot (Mansell cot) in addition if

twins are born Temperature probe Thermometer Thermometer cover Warm bedding: nest lined with abdominal sponge Mefix Humidifier reservoir Bottle of sterile water for irrigation 500 mL 1X Trans-warmer mattress (only to be used if the neopuff circuit is not available) 1X sheet for trans-warmer mattress 1X polyethylene wrap Micro beanie or Continuous Positive Airway Pressure (CPAP) hat 1X Fisher & Paykel (F&P) Humidified neopuff circuit- Resuscitation T-piece kit 1X F & P Humidifier base MR225 1X Water for injection 30mL 1X 30mL syringe 1X grey wire 1X 42mm face mask 1X 35mm face mask Ventilator/ CPAP circuit Transport shuttle

ProcedureBoth the medical and nursing staff are responsible for the following checks:1. Check temperature in birthing suite/ operating room is set to 25°C2. Check all equipment on the resuscitaire3. Intubation equipment:

a. Laryngoscopesb. Endotracheal tubesc. Maskd. Pedicape. Introducer

4. Curosurf and administration pack 5. Switch heating on resuscitaire to manual and increase to 100% output6. Place polyethylene wrap on top of warmed blankets onto resuscitaire with radiant

warmer until ready to use. Radiant heat should remain on but do not allow polyethylene to overheat. Do not use conventional plastic wrap as this will melt under the radiant heater


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7. Use the pre-activated trans-warmer mattress only if there has been insufficient time to warm the birthing room/theatre or resuscitaire or to set up the humidified neopuff system

8. Ensure cardiorespiratory monitor and pulse oximeter are ready for use9. Ensure emergency drugs-adrenaline and syringes are available & calculate approximate

dose10. Ensure equipment for emergency Umbilical Vein Catheter (UVC) insertion and normal

saline is available.

Humidification of the Neopuff CircuitResuscitation via Continuous Positive Airway Pressure (CPAP) or intubation using humidified gas in a closed Neopuff circuit assists in the prevention of hypothermia.

Procedure 1. Fill neo-puff humidifier base with 30mL sterile water2. Attach CPAP prongs (smallest size) to the CPAP circuit and leave in place 3. Turn neopuff settings to PIP 25, PEEP 54. Ensure the flow of gas through the neopuff is set at 10L/min5. Turn on humidifier base

Neopuff set up with humidified base attached

In Birthing Unit:1. At birth receive baby in warm blankets with polyethylene wrap on top. Immediately

wrap the baby’s entire body in polyethylene wrap, excluding the head and umbilical cord. Do not dry the baby

2. Dry the baby’s head and cover with a beanie or CPAP hat3. Delay cord clamping for 1 minute if possible. Keep baby securely wrapped until the cord

is cut4. Swaddle (wrap) the polyethylene wrapped baby with warmed blankets as soon as

possible after resuscitation5. Proceed with resuscitation as required6. Babies who require positive pressure ventilation require a 3 lead ECG to ensure accurate

monitoring of the baby’s heart rate during resuscitation


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7. Take the baby’s axillary temperature before leaving the birthing unit. If temperature > 37.2C remove chemically warmed mattress (if used) before placing baby into the isolette.

In Operating Theatres (OT) if born by Caesarean Section:1. If the baby is born by caesarean section the scrubbed nurse/midwife will receive the

baby onto a sterile receiver wrap2. NICU nurse receives baby in warm blankets with polyethylene wrap on top. Immediately

wrap the baby’s entire body in polyethylene wrap, excluding the head and umbilical cord. Do not dry the baby

3. Delay cord clamping for 1 minute if possible. Keep baby securely wrapped until the cord is cut

4. Swaddle (wrap) the polyethylene wrapped baby with warmed blankets as soon as possible after resuscitation

5. Dry the baby’s head and cover it with a beanie/CPAP hat6. Babies who require positive pressure ventilation require a 3 lead ECG to ensure accurate

monitoring of the baby’s heart rate during resuscitation7. Proceed with resuscitation as required8. Take the baby’s axillary temperature before leaving the theatre. If temperature > 37.2°C

remove chemically warmed mattress (if used) before placing baby into the isolette 9. Prior to leaving the OT remove all accountable items from resuscitaire, e.g. grey wire and

laryngoscope blade.

On arrival to the NICU:1. Add humidity to the isolette (if baby is <1000g and <28 weeks gestation) 2. Weigh the baby with polyethylene wrap insitu in the isolette if possible3. Check and record the baby’s axillary temperature (maintain between 36.5 – 37.5°C ) on

the observation chart and admission form 4. Once the baby is stabilized and umbilical lines/intravenous cannulas are secured, the

polyethylene wrap may be removed, the baby dried and humidity continued5. Commence preterm starter TPN (10%) and lipids at 2g/kg/day6. Aim to give caffeine and antibiotics (if required) within one hour of admission, as soon as

access is obtained7. Nest and settle baby and minimally handle the baby8. Inform the family of the baby’s progress and emphasise the need for early expressed

breastmilk (EBM)9. Start feeds with EBM 1ml 4th hourly as soon as EBM is available or use first expressed

breastmilk for mouth care10. Complete e-PREM compliance checklist, See Attachment 211. Determine ongoing respiratory requirements 12. Obtain a detailed obstetric history from the clinical record


Section 3 – Skin Care and Humidification via an Isolette


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The skin is the largest organ of the body, functioning as a protective and regulatory barrier between the body and external environment. The skin of the ELBW baby is fragile and transparent due to the thin non- existent stratum corneum. This subsequently increases trans-epidermal water loss (TEWL) causing fluid and electrolyte imbalances, ineffective thermoregulation, increased permeability and absorption of creams and/or cleaning agents and greater risk of epidermal stripping when using adhesives. These factors lead to an increased risk of infection and delayed healing. The ELBW baby may not have fully mature skin until 30-32 weeks postconceptional age.

Alerts The heat from Transcutaneous monitors (TCMs) can burn and TCM adhesive rings can cause epidermal stripping when removed. If a TCM is required, decrease the temperature settings to 43C and re-site 2-3 hourly.

Equipment Ohmeda Giraffe isolette Temperature probe Small chest leads for babies born < 1000g Warm bedding: nest lined with abdominal sponge Monitor for Arterial Blood Pressure (ABP) and Saturations Mefix ® Cotton wool ball Saturation wrap Sterile water for injection 10mL ampoule Tegaderm® Pulse oximeter probe for babies <1000g Chlorhexidine 0.2% Humidifier reservoir Bottle of sterile water for irrigation 500mL Antifungal Cream and oral drops Medication chart

Procedure 1. If the baby has not been transported via the shuttle with the isolette attached, ensure

the isolette has been warmed to an appropriate neutral thermal zone for the baby’s age and weight

2. Place the baby from the transport cot directly into the isolette whilst still wrapped in polyurethane wrap

3. Weigh the baby in the pre-warmed isolette.

Monitoring


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1. Apply mefix® to the baby’s feet before applying the pulse oximeter probe. Lightly press a cotton wool ball against the adhesive parts of the SaO2 probe and then attach to the baby’s foot with a saturation wrap

2. Continue to monitor the baby using the chest leads for ELBW babies. Do not use conventional chest leads on these babies as they may cause skin damage or tears

3. All adhesive tape for cannulas should have cotton wool pressed against it prior to applying to the baby to reduce the incidence of skin tears

4. It is not necessary for an ELBW baby to wear an identification label. These may be attached to the isolette. An identification sticker must be attached to the umbilical lines and feeding tube.

Securing Umbilical catheters1. 0.2% Chlorhexidine is used to the clean the baby’s abdomen prior to the insertion of

umbilical catheters2. Apply Tegaderm® to the abdomen around the umbilicus and use this as a base to secure

the catheters using the goal post strapping as outlined in the Clinical Procedure Venous and Arterial Access and Management in Neonatal Intensive Care

3. Tegaderm should be left in place when lines are removed until the baby is out of humidity

4. Commence fluids at 80mL/kg/day unless otherwise indicated

HumidificationBackgroundProvision of a high humidity environment limits transepidermal water loss, improves temperature control and reduces the risk of fluid and electrolyte imbalance.

Commence humidity at 85% from admission for preterm babies 28 weeks gestation or less, or less than 1000 grams. Reduce humidity by 5% daily from day 7 to14 as epidermal maturation occurs. Humidity is continually weaned until the humidity level reaches 40% when it is then turned off. This may take 7-10 days from the commencement of weaning. The reduction of humidity may alter the baby’s thermoregulation; therefore increase the cot temperature as indicated.

Equipment (humidification) Ohmeda Giraffe isolette Humidifier reservoir Bottle of sterile water for irrigation

Procedure (humidification)1. Ensure humidity reservoir is correctly inserted2. To fill the reservoir grasp it and push down: the reservoir will tilt open for filling3. Fill to the line on the heater cylinder with sterile water for irrigation and tilt the reservoir

back into place4. Do not fill the reservoir past the fill level as this will decrease the level of humidification

within the isoletteDoc Number Version Issued Review Date Area Responsible PageCHHS18/083 1 09/03/2018 01/03/2031 WY&C – Dept of

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5. Use the LED Humidifier Screen on the graphics display of the isolette to set the desired humidity level

6. Once umbilical lines have been inserted commence humidity at 85% 7. The reduction of humidity may alter the baby’s thermoregulation; therefore increase cot

temperature as needed to maintain baby’s temperature between 36.5 and 37.5 degrees8. Humidity reservoir should be changed weekly when the isolette is changed and sent for

pasteurisation to reduce the potential risk of colonisation of the reservoir water9. Clean all skin creases, neck, ears and underarms every 6-8 hourly or as required. 10. Apply antifungal creams to skin folds as per medication chart (antifungal creams should

not be visible after application, a light smear is all that is required)11. Baby should be nursed with abdominal sponge between skin and bed to absorb any

excess moisture. Linen should be changed with cares 6 – 8hrly as it becomes damp12. All babies born <1250g must be weighed daily for the first 7 postnatal days or until birth

weight has been regained or for a longer period as directed by the Neonatologist13. To maintain skin integrity, prevent epidermal stripping and infection use a hydrocolloid

dressing as a base between skin and tape when securing feeding tubes and nasal prongs14. Avoid the use of adhesives on the ELBW baby. Do not apply a urine bag to collect urine

for testing, place cotton wool balls in the nappy 15. Ensure that condensation within the isolette does not impair accurate observation of the

baby


Implementation

This Guideline will be: Discussed in existing education i.e. in-service, in orientation of new staff, displayed in

work rooms. Sent out via all staff email and available on the CHHS Policy register on SharePoint.


Related Policies, Procedures, Guidelines and Legislation

Legislation Health Records (Privacy and Access) Act 1997 Work Health and Safety Act 2011 Human Rights Act 2004

Procedures Non-Elective Caesarean Section (including classification of urgency) Venous and Arterial Access and Management in Neonatal Intensive Care Neonatal Routine Care Urine Collection in Neonates procedure Venepuncture Blood Specimen Collection procedure


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Guidelines Birth Requiring the Presence of a Neonatal Medical Team Member Neonatal hypoglycaemia Neonatal Intensive Care Drug Manual


References

1. Knoble, R. & Holditch –Davis, D. (2007) Thermoregulation and heat loss prevention after birth and during neonatal intensive care unit stabilization of extremely low birth weight babys. Journal of Obstetric, Gynaecologic and Neonatal Nursing, 36 (3) 280 - 287.

2. Allwood, M.(2011) Skin Care Guidelines for Babys Aged 23-30 Weeks' Gestation: A Review of the Literature. Neonatal, Paediatric & Child Health Nursing, 14 (1) 20-27

3. Bredemeyer, S. Reid, S. & Wallace, M. (2005) Thermal management for premature births Journal of Advanced Nursing 52(5) 482-489

4. Telofski, L.S. Morello, P. Mak-Correa,C and Stamata, G.N (2011) The Baby Skin Barrier: CanWe Preserve, Protect, and Enhance the Barrier? Journal of Perinatology 31, S49–S56;

5. A Singh, J Duckett, T Newton1 and M Watkinson, Improving neonatal unit admission temperatures in preterm babies: exothermic mattresses, polythene bags or a traditional approach? Journal of Perinatology (2010) 30, 45–49;

6. Neonatal Resusitation: Specific Treatment Recommendations (ILCOR 2015)7. Robin B Knobel RNC, MSN, NNP, John E Wimmer Jr MD and Don Holbert PhD, Heat Loss

Prevention for Preterm Babys in the Delivery Room, Journal of Perinatology (2005) 25, 304–308

8. Sunita Vohra, MD, MSc, Robin S. Roberts, MSc, Bo Zhang, MPH, Marianne Janes, MHSc, Barbara Schmidt, MD, MSc: Heat Loss Prevention (HeLP) in the delivery room: A randomized controlled trial of polyethylene occlusive skin wrapping in very preterm babys, The Journal of Pediatrics, Volume 145, Issue 6, December 2004, Pages 750–753

9. Williams, J. (2004). An investigation into the effect of a polyethylene wrap on the temperature regulation of the very low birth weight and premature baby during transfer to the neonatal intensive care unit: a systematic review. Health Care Reports, 2:(3): 53-78.

10. Ashmeade, T. L., Haubner, L., Collins, S., Miladinovic, B., & Fugate, K. (2016). Outcomes of a neonatal golden hour implementation project. American Journal of Medical Quality, 31(1), 73-80.

11. Australian Resuscitation Council. (2016, January 1). Guidelines - Australian Resuscitation Council. Retrieved March 15 2017

12. Chawla, S., Amaram, A., Gopal, S., & Natarajan, G. (2011). Safety and efficacy of Trans-warmer mattress for preterm neonates: results of a randomized controlled trial. Journal of Perinatology, 31(12), 780-788.

13. Doctor, T. N., Foster, J. P., Stewart, A., Tan, K., Todd, D. A., & McGrory, L. (2017). Heated and humidified inspired gas through heated humidifiers in comparison to non-heated


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and non-humidified gas in hospitalised neonates receiving respiratory support. Cochrane Library.

14. Gardner, S. L., & Hernandez, J. A. (2016). Initial nursery care. In S. L. Gardner, B. S. Carter, M. Enzman Hines, & J. A. Hernandez, Merenstein & Gardner's Handbook of neonatal intensive care (8th ed., pp. 71-80). St Louis: Elsevier.

15. Kai-Hsiang, H., Ming-Chou, C., Shu-Wen, L., Jainn-Jim, L., Yu-Cheng, W., & Reyin, L. (2015). Thermal blanket to improve thermoregulation in preterm infants: A randomized controlled trial. Pediatric Critical Care Medicine, 16(7), 637-643.

16. Kalia, Y.N., Nonato, L.B., Lund, C.H. & Guy, R.H. (1998). Development of skin barrier function in premature infants. Journal of Investigative Dermatology, 111, 320-326.

17. Kevat, A. C., Bullen, D. V., Davis, P. G., Omar, C., & Kamlin, F. (2017). A systematic review of novel technology for monitoring infant and newbornheart rate. ACTA PAEDIATRICA: Nurturing the Child, 106(5), 710-720.

18. Lambeth, T. M., Rojas, M. A., Holmes, A. P., & Dail, R. B. (2016). First golden hour of life. Clinical Issues in Neonatal Care, 16(4), 264-272.

19. Niermeyer, S., Clarke, S. B., & Hernandez, J. A. (2016). Delivery room care. In S. L. Gardner, B. S. Carter, M. Enzman Hines, & J. A. Hernandez, Merenstein & Gardner's handbook of neonatal intensive care (pp. 47-70). St Louis: Elsevier.

20. Omar, C., Kamlin, F., Dawson, J. A., O'Donnell, C. P., Morley, C. J., Donath, S. M., & Sekhon, J. (2008). Accuracy of pulse oximetry measurement of hearth rate of newborn infants in the delivery room. The Journal of Pediatrics, 152(6), 756-769.

21. Reynolds, R. D., Pilcher, J., Ring, A., Johnson, R., & McKinley, P. (2009). The golden hour: Care of the LBW infant during the first hour of life one unit's experience . Neonatal Network, 28(4), 211-219.

22. van Vonderen, J. J., Hooper, S. B., Kroese, J. K., Roest, A. A., Narayen, I. C., van Zwet, E. W., & te Pas, A. B. (2015). Pulse Oximetry Measures a Lower Heart Rate at Birth Compared with Electrocardiography. The Houral of Pediatrics, 166(1), 49-53.


Definition of Terms

ABG: Arterial blood gasCPAP: Continuous Positive Airway PressureCRP: C-reactive proteinCXR: Chest X-rayFBC: Full blood countHydrogel products: Gel formed dressingINSURE: Intubation, surfactant, resuscitation, extubationOhmeda Giraffe Incubator: An apparatus used to maintain environmental conditions suitable for a babyStratum corneum: the outer part of the epidermis consisting chiefly of layers of dead flattened nonnucleated cells filled with keratin

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Search Terms

Less than 28 weeks gestation, Premature infant, Premature, Preterm, Extremely low birth weight baby, ELBW, E-PREM, Less than 1000grams, Neonatal Intensive Care, Retrieval, Newborn Emergency Transport Service (NETS), Temperature maintenance, Humidification, Isolette, Golden hour, Cardiovascular monitoring


Attachments

Attachment 1 – ePREM Flow Chart – Extremely preterm early management Flow ChartAttachment 2 – Compliance Checklist for ePREM Flow Chart

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Policy Team ONLY to complete the following:Date Amended Section Amended Divisional Approval Final Approval 21/02/2018 Complete Review and

ConsolidationKay Thomas, A/g DON, WY&C

CHHS Policy Committee

This document supersedes the following: Document Number Document NameCHHS13/651 Department of Neonatology - Humidification by the ohmeda Giraffe isolette

CHHS13/627 Department of Neonatology - Skin care of the extremely low birth weight less than 28 weeks gestation

CHHS16/138 Polyethylene Wrap for temperature regulation at Preterm Births


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Attachment 1 – ePREM Flow Chart – Extremely preterm early management Flow Chart

The first 72 hours for infants <28 weeks of gestation and/or ELBW <1000g Resuscitation team staff members, duties as below as per colour coding:

o Retrieval nurse (nurse attending delivery)o Admission Nurse/Team Leadero Junior doctor attending the deliveryo Consultant attending the delivery

Preparation Inform consultant of impending delivery, set Neopuff 25/5 in 30% oxygen, Flow

10L/minute. Request that the caesarean be delayed if the consultant is not yet present and it is reasonable to do so.

Travel to hospital (if after hours) Warm curosurf in isolette and leave this vial of Curosurf in the isolette. Fill the

humidifier base of CPAP circuit on transport shuttle with 30 mL of sterile water and switch on. Attach CPAP prongs (smallest size) to the CPAP circuit and leave in place. Prepare and take transport shuttle.

Switch heating to manual and increase to 100% output on resuscitaire, prepare plastic wrap, hat and heated mattress. Prepare and connect Heated Humidified Circuit.

Collect equipment for INSURE (if planned). Prepare sterile preterm starter TPN (10%) and lipids 2g/kg/day. Prepare antibiotics and caffeine. Prepare umbilical lines.

Delivery Check temperature in OT-request to set it at 25 degrees C Encourage delayed cord clamping. Consider ECG monitoring for heart rate. Intermittent positive pressure ventilation or CPAP as indicated. ETT as per consultant.

Maintain saturations at 80% by 5 minutes and 90-95% by 10 minutes. Maintain infant well wrapped in plastic. Place infant on heated mattress wrapped with

blanket and place hat on head. Pulse oximeter on right hand or wrist. Apply ECG leads (if considered necessary). Listen to heart rate for 6 seconds (tap the heart beat), multiply by 10 and inform medical staff (if ECG not used). Ensure Vitamin K is given and labels are put on infant or attached to isolette if baby is too small to wear identification labels. Take temperature prior to transfer.

If the baby is ventilated as advised by retrieval nurse, fill humidifier base with water and wet the circuit of ventilator. Order for sticker.

ETT SURFACTANT AS PER CONSULTANT TEAM TO DEPART RAPIDLY WITHIN 30 MINUTES TO NICU PROVIDED CLINICALLY STABLE. Call ahead to nursery with respiratory support settings.


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Attachment 2 – Compliance Checklist for ePREM Flow Chart(Place the compliance sheet in the progress notes)Date of Review:

Medical staff and Nurses present in Resuscitation:

Apgar: ______________________________________________________________________

Time of Birth: : Time of Admission: :

Preparation Y N

1. Consultant on call informed and present

2. Curosurf present in incubator

3. Neopuff equipment checked, pressures & flow set

4. Humidifier Base of the isollette filled and switched on

5. Transport shuttle prepared

6. Plastic wrap, hat, mattress available

7. Admission nurse prepared TPN, caffeine, antibiotics

Delivery Y N

1. Temperature in OT/BS set to 25ᵒC

2. Delayed cord clamping done

3. Plastic wrap placed

4. Hat placed

5. Baby placed on heated mattress wrapped with blanket

6. Appropriate IPPV / CPAP commenced

7. Required intubation

8. Humidifier base of the resuscitaire filled and switched on

9. Saturation at 5 min >80%

Saturation at 10mins 90-94%

10. Vitamin K given

11. Transferred to NICU within 30 minutes

12. Temperature prior to transfer


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Delivery Y N

On arrival to NICU Y N

1. Weighed

2. Surfactant required

Settling In (First Hour) Y N

1. Umbilical lines placed within 1 hour

2. Antibiotics given within 1 hour

3. Caffeine given within 1hour

4. TPN and lipids commenced within 1 hour

5. Blood taken for Group & screen, CRP, FBC, blood culture

6. First Blood gas – Time: :

pH: PaCO2:

PaO2: HCO3:

BE: Lactate:

BGL:

Hours 1-72 Y N

1. Detailed obstetric history documented

2. At 12hours - NICP and SBR taken

3. Second dose of surfactant given (up to 12hours)4. EBM commenced at 1mL/4hrly: Vaginal birth within 2 hrs

Caesarean Section within 4 hrs

Contributory factors for goals not met:1. _________________________________________________________________________

__________________________________________________________________________________________________________________________________________________

2. ___________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. ___________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. ___________________________________________________________________________________________________________________________________________________________________________________________________________________________


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5. ___________________________________________________________________________________________________________________________________________________________________________________________________________________________


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Documents

Care of the Extremely Preterm and Low Birth Weight …health.act.gov.au/sites/default/files/new_policy_and_plan... · Web viewBabies who require positive pressure ventilation require