Iowa Neonatology Handbook: General

Nonviable Infant Admission Protocol

Edward F. Bell, MD and Lou Ann Montgomery, PhD, RN, CCNS, CCRN
Peer Review Status: Internally Peer Reviewed

1. The following protocol will be followed by NICU and Ob-Gyn/Labor & Delivery:
   1. An infant of 20 weeks gestation or more with an Apgar score of one or more at any time after delivery is considered liveborn, regardless of whether the patient dies in the Delivery Room or NICU and regardless of whether the pediatric team was in attendance.
   2. An infant with an Apgar score of zero at all times after delivery is considered stillborn and will be entered into Labor & Delivery statistics, but not admitted to the NICU.
2. For liveborn but nonviable infants:
   1. If the infant is physically admitted to the NICU:
      1. The NICU unit clerk will:
         1. Notify UIHC Registration of the infant's birth and obtain a hospital number.
         2. Admit the patient to the NICU by entering the hospital number and patient data into the UIHC computer system and the census book. Discharge the infant as a death on the computer and census book.
         3. Enter the appropriate data into the Neonatal Registry field on the UIHC computer system (using gestational age by dates).
         4. Assemble a chart which will include a record of labor and delivery, white identification card, doctor's notes, including Delivery Room resuscitation if required, and other pertinent information.
      2. Nursing personnel will:
         1. Complete the admission assessment form.
         2. Notify Central Nursing Office and the pediatric nursing supervisor of the infant's death.
      3. The pediatricians will complete the physician's note.
   2. If the infant is not physically admitted to the NICU (regardless of whether pediatrics physicians or nurses ever attended the infant):
      1. The nursing unit clerk from Labor & Delivery will:
         1. Notify UIHC Registration of the infant's birth and attain a hospital number.
         2. Admit the infant to Labor & Delivery on the UIHC computer system and discharge by computer when infant dies.
         3. Enter the appropriate data into the Neonatal Registry field on the UIHC computer system (using gestational age by dates).
         4. Assemble a chart for the infant.
         5. Notify Central Nursing Office of the infant’s death.
      2. If a pediatric physician provides any assessment or treatment, a note will be written for inclusion in the infant’s medical chart.
      3. The physician in attendance at the time of death, regardless of department, will be responsible for completing the chart.
      4. Labor & Delivery personnel will be responsible for notifying Central Nursing Office of the infant's death.

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