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The Golden Hour
Focus on pre-planning, role definition, improving communication and increasing
efficiency of surfactant administrationRevised 8.5.13
Pre-planning for Deliveries <27 weeks
Transport RN• Tell team members of
impending delivery: NNP, RT, bedside RN, charge RN
• Bring surfactant and have it warmed and drawn up for babies <27 weeks
• Have suction ready• Have PIV out & ready• Have IV fluids ready• Have DR and transporter
ready• Review preplanning
checklist in DR with team (verbal)
NNP• Notify fellow/MD of
impending delivery and discuss specifics of care plan
• Determine estimated weight and tell transport RN and RT in order to have appropriate ETT size cut, surfactant drawn up & IV fluid ready based on estimated weight
• Have UAC/UVC out, flushed & ready
RT• Bring vent to DR• Bring Neopuff to DR. Starting
settings PIP=25, PEEP = 6• Have appropriate size face
mask out and ready, have ETCO2 detector & pulse oximetry ready
• Have sterile blade, appropriate size ETT based on estimated weight cut & ready in sterile fashion on Mayo stand in DR
• Have one ETT size bigger and one smaller than the ETT that is cut available in DR for use if needed (not cut prior to delivery)
• Have neobars available
Pre-planning for Deliveries ≥27 weeks
Transport RN• Tell team members of
impending delivery: NNP, RT, bedside RN, charge RN
• Bring surfactant for infants 27-34 weeks but do not warm or draw up.
• Do not routinely bring surfactant for infants >34 weeks unless stated by MD/NNP
• Have suction ready• Have PIV out & ready• Have DR and transporter
ready• Review preplanning
checklist in DR with team (verbal)
NNP• Notify fellow/MD of
impending delivery and discuss specifics of care plan
• Determine estimated weight and tell transport RN and RT in order to know appropriate meds, ETT size, and IV fluid rate based on estimated weight
RT• Bring Neopuff to
DR. Starting settings PIP=25, PEEP = 6
• Have appropriate size face mask out & pulse oximeter ready
Surfactant administration in DRGoal: Safely improve efficiency in surfactant administration to neonates warranting intubation in the delivery room
New Process: (if warrants intubation in DR)– Suction mouth then nose per NRP– Intubate– NNP/MD to hold ETT at appropriate insertion length
to roof of mouth– Confirm ETT placement by auscultation, condensation
in tube, and + yellow pediacap color change– Reconfirm appropriate length at lips– Administer surfactant WITHOUT TURNING the infant’s
position in 2 equally divided aliquots with PPV bagging for 1-2 minutes at approximate rate of 60bpm in between aliquots
– RT to temporarily stabilize ETT using silk tape and 1 wrap around ETT
– RT to stabilize ETT and vent tubing position so no torque on the baby/ETT/tubing
– NNP to work on access– RT to measure for Neobar and warm it– Once access complete and baby ready for transfer
back to NICU, Neobar to be applied by RT and RN under controlled environment to minimize extubation
– Final preparation and return to NICU
Guideline for ETTWeight ETT size
(mm)Cut
length (cm)
Insertion length at
the lip (cm)
500gm 2.5 13 5.5 - 6
750gm 2.5 13 6
1000gm 2.5 13 6
1500gm 3.0 14 7
2000gm 3.0 14 7
2500gm 3.5 14 8
3000gm 3.5 15 8
3500gm 3.5 15 9
4000gm 4.0 16 10
Quick Reference GuidesWeight ETT
size (mm)
Cut length (cm)
Insertion length at
the lip (cm)
500gm 2.5 13 5.5 - 6
750gm 2.5 13 6
1000gm 2.5 13 6
1500gm 3.0 14 7
2000gm 3.0 14 7
2500gm 3.5 14 8
3000gm 3.5 15 8
3500gm 3.5 15 9
4000gm 4.0 16 10
Approx. Gest. Age
~50% for weight estimate
24 weeks 500gm
26 weeks 750gm28 weeks 1000gm
30 weeks 1500gm33 weeks 2000gm
35 weeks 2500gm
40 weeks 3500gm
QUICK REFERENCE GUIDE
Delivery Room Quick-Check List