Birth Requiring the Presence of a Neonatal Team Member

/ CHHS17/278

Canberra Hospital and Health Services

Clinical Guideline

Birth Requiring the Presence of a Neonatal Team Member

Contents

Contents 1

Guideline Statement 2

Scope 2

Section 1 – Process 2

Section 2 – Criteria 3

Section 3 – Contacting the Neonatal Team Member 3

Section 4 – Documentation 4

Implementation 5

Related Policies, Procedures, Guidelines and Legislation 5

References 5

Definition of Terms 6

Search Terms 6

Guideline Statement

Key Objective

·  To provide guidance on the situations that indicate a higher risk birth for a neonate, requiring a neonatal registrar or staff specialist to be present at a birth, and the processes involved in seeking their attendance at a birth.

Alert

For neonatal emergencies dial 8 and state Neonatal Code Blue and location.

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Scope

This document applies to the following Canberra Hospital Health Services (CHHS) staff working within their scope of practice:

·  Medical Officers

·  Nurses and Midwives

·  Students working under direct supervision.

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Section 1 – Process

An appropriately trained practitioner, skilled in neonatal resuscitation, should be present at all births. All staff attending births are required to complete the neonatal advanced life support e-learning accessed via Capabiliti and an annual assessment. This assessment is performed by a neonatal consultant, senior neonatal registrar, Clinical Development nurses or midwives or the Clinical Support Nurse/Midwives from Neonatology or Maternity.

1.  Where there is awareness in advance of a potential high risk birth, the attendance of a neonatal medical team member at the birth should be in consultation with the neonatal registrar or consultant and planned well in advance to enable the most appropriately skilled personnel to attend.

2.  The communication ideally should be from the person managing the birth (medical or midwifery) to the neonatal registrar and NOT through a third person.

3.  Where a third person is communicating the need for attendance of neonatal medical staff at the birth, the handover should be as inclusive and detailed as possible (i.e. following the ISBAR mnemonic) to give the neonatal team the opportunity to call for additional help if required.

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Section 2 – Criteria

Alert

A Neonatal Consultant should be present at any birth ≤28 weeks gestation or where resuscitation is required or planned (i.e. not in deliveries where a plan for comfort care only has been made) or where advanced resuscitation is anticipated (i.e. diaphragmatic hernia, etc). As much notice as possible should be given to enable the consultant to be present at the birth, i.e. after hours.

The Midwife or Obstetric Registrar should ask for the attendance of a Neonatal Registrar/SRMO under the following conditions:

·  Significant fetal compromise, e.g. Scalp ph ≤ 7.2, lactate > 4.8 or fetal bradycardia/tachycardia

·  Abnormal Cardiotocograph (CTG)

·  Maternal conditions causing concern e.g. antepartum haemorrhage, placenta praevia, severe preeclampsia, maternal pyrexia, unstable insulin dependent diabetes

·  Anticipated large for gestational age (LGA) baby

·  Multiple birth

·  Meconium liquor

·  Preterm birth or severe intrauterine growth restriction (IUGR)

·  Assisted vaginal birth

·  Emergency caesarean birth

·  Known fetal abnormality

·  Breech or compound presentation

·  Caesarean section requiring General anaesthesia

Note:

Neonatal Registrar attendance is not necessary for elective caesarean birth under regional anaesthesia or routine caesarean section for breech delivery unless any of the other above complications co-exist.

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Section 3 – Contacting the Neonatal Team Member

If the attendance of a neonatal team member is required at the birth, the midwife must:

·  Notify the Birthing Unit Team Leader

·  Check that the neonatal resuscitation equipment is in working order

·  Inform the woman and her partner of what is likely to happen

·  Notify the Neonatal Registrar/SRMO of the requirement to attend the birth outlining the history, gestational age and reason for concern about the birth as well as the location of birth (e.g. Theatre number (if available), Birthing or Birth Centre Room number)

Neonatal Registrar Attendance

Delivery Outreach SRMO/ Registrar

The Outreach Registrar is to be called for all low risk babies > or = to 35 weeks gestation who are not severely compromised. The Delivery Outreach SRMO/ Registrar can be contacted on 26335 allowing adequate time for him/her to attend the birth.

NICU Registrar

The NICU Registrar is to be called for all high risk babies who may be severely compromised. This includes-

·  Category A caesarean sections

·  Severe abnormalities on CTG

·  Life threatening congenital abnormalities

·  Babies < 35 weeks

The NICU Registrar can be contacted on 26365. If the NICU Registrar cannot be contacted the Midwife/Obstetric Registrar should contact the NICU team leader on 26353 or dial 8 and call a Neonatal code blue (and state location).

Where time allows and if a significant resuscitation is anticipated and if a senior Neonatology staff member is required (Fellow or Consultant) the most senior obstetric/midwifery clinician present should contact the neonatology fellow/ consultant to provide a clinical history.

Alert
If the Neonatal Registrar is notified they will require access to the baby until they are satisfied that normal adaptation to extra-uterine life has occurred. They will also be expected to perform a neonatal examination.

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Section 4 – Documentation

The following must be documented in the baby’s clinical record by the attending midwife or Obstetric registrar:

·  Time of notification to Neonatal Registrar

·  Response received from Neonatal Registrar

·  Time of arrival of neonatal team member

·  All care, treatment given and further management (in both maternal and clinical record and infant clinical record).

Midwife or Obstetric Registrar should also assist the Neonatal Registrar with relevant documentation regarding the resuscitation if required.

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Implementation

Education will be provided to medical and midwifery staff on this clinical procedure and its relevance to practice. The Clinical Guideline will be accessible online via the Policy Register.

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Related Policies, Procedures, Guidelines and Legislation

Policies

·  Nursing and Midwifery Continuing Competence

·  Consent and Treatment

·  Patient Identification and Procedure Matching

·  Care of the small baby

Procedures

·  Healthcare Associated Infections Clinical

·  Labour Care 1st, 2nd and 3rd Stage Care

·  Care of the Well Baby

Guidelines

·  Fasting Guidelines – Elective and Emergency Surgery Patients

·  Fetal Surveillance Practice Guideline

Legislation

·  Health Records (Privacy and Access) Act 1997

·  Human Rights Act 2004

·  Work Health and Safety Act 2011

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References

1.  International Liaison committee on Resuscitation (ILCOR) Guidelines: http://www.ilcor.org/home/

2.  The Royal Australian and New Zealand College of Obstetrics and Gynaecology, 2009 Responsibility for neonatal resuscitation at birth, C-OBS 32.

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Definition of Terms

Compound presentation: is a fetal presentation in which an extremity presents alongside the part of the fetus closest to the birth canal. The majority of compound presentations consist of a fetal hand or arm presenting with the vertex

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Search Terms

Neonatal, Resuscitation, newborn, attendance, birth

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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
18/10/2017 / Complete Revision / Penny Maher, A/g DON, WY&C / CHHS Policy Committee

This document supersedes the following:

Document Number / Document Name
CHHS12/085 / Birth Requiring Neonatal Medical Team Member
Doc Number / Version / Issued / Review Date / Area Responsible / Page
CHHS17/278 / 1 / 21/11/2017 / 01/11/2020 / WY&C - Maternity / 1 of 6
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