Iowa Neonatology Handbook: General

Guidelines for Pediatric Attendance in the Delivery Room

Edward F. Bell, MD
Peer Review Status: Internally Peer Reviewed

1. Personnel in Attendance:
   1. A pediatric team should be present at ALL high-risk deliveries. All deliveries that are high-risk will be listed on the board in the NICU. In addition, the pediatric team will attend any other deliveries when requested to do so by the obstetric staff.
   2. The pediatric resident will be notified of a high-risk delivery ahead of time so that s/he may familiarize himself with the mother and her problem in order to prepare for the type of neonatal emergency care that might be required. The pediatric resident and the NICU should be given an approximate expected time of delivery.
   3. The most senior pediatric resident available will attend all high-risk deliveries (PL-3 assigned to the NICU during the day and PL-2 assigned to the NICU during the night). At night or on weekends the PL-2 in the NICU will notify the PL-3 covering the hospital prior to all high-risk deliveries. The attending neonatologist (or fellow) in the NICU will decide on a case-by-case basis which members of the pediatric team should attend each high-risk delivery. At least twice daily, the cases on the high-risk board in the NICU will be reviewed with the supervising resident: in the morning with the PL3, and in the evening with the PL2. The attending neonatologist will determine whether fellow or faculty attendance at the delivery is advisable. A neonatal intensive care nurse will accompany the resident, as well as an intern.
   4. The delivery of an infant equal to or less than 1500 grams is a special situation. The infant who is less than 1500 grams should be resuscitated by the most skilled person available. Time is critical. Therefore, intubation will generally be performed by the PL-3 or PL-2. There are many other opportunities for the intern, either pediatric or obstetric, or the family practice resident to gain skills in the intubation of larger infants. Free, frank communication should take place prior to the delivery so that each person understands his role. The senior pediatric resident will decide on the timing of transfer to the NICU.
   5. Pediatric personnel should be present in the delivery room to assist with effective resuscitation even in certain borderline situations when the obstetric staff have decided against fetal intervention. If the estimated gestational age on a "23 week er" is wrong, for example, and a depressed "26 weeker" is delivered, an immediate and full resuscitation effort is required.
   6. ALL pediatric personnel who attended a resuscitation should be listed on the Labor and Delivery Record (form B-13) placed in the infant's chart. In addition, if the resuscitation was attended by the staff neonatologist, a stamped procedure note entitled "Delivery Room Resuscitation" should be placed in the chart with the physician's admission notes; this procedure note should be signed by the neonatologist.
2. Equipment
   1. A resuscitation tray will be kept stocked and available in the NICU at all times. It will be the responsibility of the NICU nurse who is attending the delivery of a high-risk infant to take this tray with her. Items on the resuscitation tray should include:
      1. 2 each ET tubes: 2.5, 3.0, 3.5, 4.0
      2. 1 MEC ET tube pack
      3. 2 stylets
      4. 250 cc anesthesia bag and masks (1 preemie; 1 newborn)
      5. 1 oxygen connecting tubing
      6. 1 roll adhesive tape
      7. 1 roll 1/4" yellow tape
      8. 1 can adhesive spray
      9. 2 laryngoscope handles
      10. 2 Miller 0 blades
      11. 1 Miller 1 blade
      12. 2 scissors (sterile)
      13. 1 steri-drape
      14. 1 hemostat (sterile)
      15. Suction equipment
          • 1 bulb syringe
          • 2 DeLee traps
          • 2 8 fr suction catheters
          • 1 8 fr suction catheter with glove
          • 1 6 fr suction catheter with glove
          • 2 sterile gloves
          • 4 sterile sims connectors
          • 4 RT saline (5 ml)
      16. NG tubes
          • 2 8 fr
          • 2 5 fr
      17. Umbilical arterial catheters
          • 2 3 1/2 Fr
          • 2 5 Fr
      18. Needles and syringes
          • 2 25 gauge short butterflies
          • 2 23 gauge long butterflies
          • 2 25 gauge needles
          • 2 22 gauge needles
          • 2 20 gauge needles
          • 2 18 gauge needles
          • 2 20 gauge IV catheters
          • 2 22 gauge IV catheters
          • 2 24 gauge IV catheters
          • 1 20 cc syringe
          • 1 10 cc syringes
          • 2 3 cc syringes
          • 2 1 cc syringes
      19. Medications:
          • 2 NaHCO3
          • 1 Atropine Sulfate
          • 1 Epinephrine 1:10,000
          • 1 Plasmanate
          • 1 Calcium Gluconate 10%
          • 2 Narcan (Naloxone Hydrochloride) (0.4 mg/ml OR 1.0 mg/ml solution)
          • 1 Sterile Saline for injection
      20. Other
          • 1 razor
          • 4 #11 blades
          • 10 black caps
          • 2 4x4's
          • 1 needle aspiration pack
          • 2 Stopcocks
          • 10 Alcohol preps
   2. Each of the radiant heater beds is equipped with a portable oxygen tank. Following resuscitation and stabilization, the infant should be transferred to the NICU on the heater bed, not in the arms of the House Officer.

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