Care of the Extremely Preterm and Low Birth Weight Baby ...
Canberra Hospital and Health ServicesClinical Guideline Care of the Extremely Preterm and Low Birth Weight Baby – The Golden HourContents TOC \h \z \t "Heading 1,1,Heading 2,2" Contents PAGEREF _Toc508351790 \h 1Guideline Statement PAGEREF _Toc508351791 \h 2Scope PAGEREF _Toc508351792 \h 2Section 1 – Extremely Preterm Early Management (e-PREM) bundle – The Golden Hour PAGEREF _Toc508351793 \h 2Section 2 – Resuscitation at Birth & Thermoregulation PAGEREF _Toc508351794 \h 3Section 3 – Skin Care and Humidification via an Isolette PAGEREF _Toc508351795 \h 7Implementation PAGEREF _Toc508351796 \h 9Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc508351797 \h 9References PAGEREF _Toc508351798 \h 10Definition of Terms PAGEREF _Toc508351799 \h 11Search Terms PAGEREF _Toc508351800 \h 12Attachments PAGEREF _Toc508351801 \h 12Attachment 1 – ePREM Flow Chart – Extremely preterm early management Flow Chart PAGEREF _Toc508351802 \h 13Attachment 2 – Compliance Checklist for ePREM Flow Chart PAGEREF _Toc508351803 \h 15Guideline StatementThe 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 ContentsScopeThis 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.Back to Table of ContentsSection 1 – Extremely Preterm Early Management (e-PREM) bundle – The Golden HourThe 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 NICUEquipmentCompliance Checklist for e-Prem pack (see Attachment 2)e-Prem packCurosurf + administration packShuttle/ventilator/CPAP equipmentAssemble teamProcedureEnsure the neonatologist, neonatology fellow, NICU team leader and retrieval nurse have been informed of the pending delivery (see Attachment 1 e-PREM flow chart)Warm Curosurf in the isolettePrepare transport shuttlePrepare CPAP circuit/ventilator on shuttleAttach CPAP prongs to the CPAP circuit and leave in placeObtain compliance check list for e-Prem packPrepare for INSURE (intubation/surfactant/extubation) if plannedPrepare sterile preterm starter TPN (10%) and lipids at 2g/kg/dayPrepare antibiotics and caffeineSet-up for umbilical line insertionAlertThe registrar is to request to delay the caesarean if a neonatologist is not yet present and it is safe to do so.Back to Table of Contents Section 2 – Resuscitation at Birth & ThermoregulationThere 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/FellowEquipmentNeonatal resuscitation checklistDelivery attendance sheetNeonatal code blue resuscitation sheetProcedureAll members of the team are to introduce themselvesDiscuss the plan, communication, expectations and assign roles to team membersDiscuss any special considerationsAsk for additional personnel or equipment if requiredUse closed communication by confirming any orders from the Team leaderPre-resuscitation equipment checksEquipmentOhmeda Giraffe Isolette with shuttle. Use NICU transport cot (Mansell cot) in addition if twins are bornTemperature probeThermometerThermometer cover Warm bedding: nest lined with abdominal spongeMefixHumidifier reservoirBottle of sterile water for irrigation 500 mL1X Trans-warmer mattress (only to be used if the neopuff circuit is not available)1X sheet for trans-warmer mattress1X polyethylene wrap Micro beanie or Continuous Positive Airway Pressure (CPAP) hat1X Fisher & Paykel (F&P) Humidified neopuff circuit- Resuscitation T-piece kit1X F & P Humidifier base MR2251X Water for injection 30mL1X 30mL syringe1X grey wire1X 42mm face mask1X 35mm face maskVentilator/ CPAP circuit Transport shuttle ProcedureBoth the medical and nursing staff are responsible for the following checks:Check temperature in birthing suite/ operating room is set to 25°CCheck all equipment on the resuscitaireIntubation equipment:LaryngoscopesEndotracheal tubesMaskPedicapIntroducerCurosurf and administration pack Switch heating on resuscitaire to manual and increase to 100% outputPlace 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 heaterUse 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 systemEnsure cardiorespiratory monitor and pulse oximeter are ready for useEnsure emergency drugs-adrenaline and syringes are available & calculate approximate doseEnsure 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 Fill neo-puff humidifier base with 30mL sterile waterAttach CPAP prongs (smallest size) to the CPAP circuit and leave in place Turn neopuff settings to PIP 25, PEEP 5Ensure the flow of gas through the neopuff is set at 10L/minTurn on humidifier base Neopuff set up with humidified base attachedIn Birthing Unit: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 babyDry the baby’s head and cover with a beanie or CPAP hatDelay cord clamping for 1 minute if possible. Keep baby securely wrapped until the cord is cutSwaddle (wrap) the polyethylene wrapped baby with warmed blankets as soon as possible after resuscitationProceed with resuscitation as requiredBabies who require positive pressure ventilation require a 3 lead ECG to ensure accurate monitoring of the baby’s heart rate during resuscitationTake 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:If the baby is born by caesarean section the scrubbed nurse/midwife will receive the baby onto a sterile receiver wrapNICU 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 babyDelay cord clamping for 1 minute if possible. Keep baby securely wrapped until the cord is cutSwaddle (wrap) the polyethylene wrapped baby with warmed blankets as soon as possible after resuscitationDry the baby’s head and cover it with a beanie/CPAP hatBabies who require positive pressure ventilation require a 3 lead ECG to ensure accurate monitoring of the baby’s heart rate during resuscitationProceed with resuscitation as requiredTake 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 Prior to leaving the OT remove all accountable items from resuscitaire, e.g. grey wire and laryngoscope blade.On arrival to the NICU:Add humidity to the isolette (if baby is <1000g and <28 weeks gestation) Weigh the baby with polyethylene wrap insitu in the isolette if possibleCheck and record the baby’s axillary temperature (maintain between 36.5 – 37.5°C ) on the observation chart and admission form Once the baby is stabilized and umbilical lines/intravenous cannulas are secured, the polyethylene wrap may be removed, the baby dried and humidity continuedCommence preterm starter TPN (10%) and lipids at 2g/kg/dayAim to give caffeine and antibiotics (if required) within one hour of admission, as soon as access is obtainedNest and settle baby and minimally handle the babyInform the family of the baby’s progress and emphasise the need for early expressed breastmilk (EBM)Start feeds with EBM 1ml 4th hourly as soon as EBM is available or use first expressed breastmilk for mouth careComplete e-PREM compliance checklist, See Attachment 2Determine ongoing respiratory requirements Obtain a detailed obstetric history from the clinical recordBack to Table of Contents Section 3 – Skin Care and Humidification via an IsoletteThe 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.EquipmentOhmeda Giraffe isoletteTemperature probeSmall chest leads for babies born < 1000gWarm bedding: nest lined with abdominal sponge Monitor for Arterial Blood Pressure (ABP) and Saturations Mefix ? Cotton wool ballSaturation wrapSterile water for injection 10mL ampouleTegaderm?Pulse oximeter probe for babies <1000gChlorhexidine 0.2% Humidifier reservoirBottle of sterile water for irrigation 500mLAntifungal Cream and oral dropsMedication chartProcedure 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 weightPlace the baby from the transport cot directly into the isolette whilst still wrapped in polyurethane wrapWeigh the baby in the pre-warmed isolette.MonitoringApply 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 wrapContinue 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 tearsAll adhesive tape for cannulas should have cotton wool pressed against it prior to applying to the baby to reduce the incidence of skin tearsIt 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 catheters0.2% Chlorhexidine is used to the clean the baby’s abdomen prior to the insertion of umbilical cathetersApply 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 CareTegaderm should be left in place when lines are removed until the baby is out of humidityCommence 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 isoletteHumidifier reservoirBottle of sterile water for irrigationProcedure (humidification)Ensure humidity reservoir is correctly insertedTo fill the reservoir grasp it and push down: the reservoir will tilt open for fillingFill to the line on the heater cylinder with sterile water for irrigation and tilt the reservoir back into placeDo not fill the reservoir past the fill level as this will decrease the level of humidification within the isoletteUse the LED Humidifier Screen on the graphics display of the isolette to set the desired humidity levelOnce umbilical lines have been inserted commence humidity at 85% 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 degreesHumidity reservoir should be changed weekly when the isolette is changed and sent for pasteurisation to reduce the potential risk of colonisation of the reservoir waterClean all skin creases, neck, ears and underarms every 6-8 hourly or as required. 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)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 dampAll 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 NeonatologistTo 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 prongsAvoid 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 Ensure that condensation within the isolette does not impair accurate observation of the babyBack to Table of Contents 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.Back to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationLegislationHealth Records (Privacy and Access) Act 1997Work Health and Safety Act 2011Human Rights Act 2004ProceduresNon-Elective Caesarean Section (including classification of urgency)Venous and Arterial Access and Management in Neonatal Intensive CareNeonatal Routine CareUrine Collection in Neonates procedureVenepuncture Blood Specimen Collection procedureGuidelinesBirth Requiring the Presence of a Neonatal Medical Team MemberNeonatal hypoglycaemiaNeonatal Intensive Care Drug ManualBack to Table of ContentsReferencesKnoble, 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.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) 20-27Bredemeyer, S. Reid, S. & Wallace, M. (2005) Thermal management for premature births Journal of Advanced Nursing 52(5) 482-489Telofski, 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;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;Neonatal Resusitation: Specific Treatment Recommendations (ILCOR 2015)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, 304–308Sunita 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 750–753Williams, 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.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.Australian Resuscitation Council. (2016, January 1). Guidelines - Australian Resuscitation Council. Retrieved March 15 2017Chawla, 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.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 and non-humidified gas in hospitalised neonates receiving respiratory support. Cochrane Library.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.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.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.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.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.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.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.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.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.Back to Table of ContentsDefinition of TermsABG: 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 keratinBack to Table of ContentsSearch 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 monitoringBack to Table of ContentsAttachmentsAttachment 1 – ePREM Flow Chart – Extremely preterm early management Flow ChartAttachment 2 – Compliance Checklist for ePREM Flow ChartDisclaimer: 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 AmendedSection AmendedDivisional ApprovalFinal Approval 21/02/2018Complete Review and ConsolidationKay Thomas, A/g DON, WY&CCHHS Policy CommitteeThis document supersedes the following: Document NumberDocument NameCHHS13/651Department of Neonatology - Humidification by the ohmeda Giraffe isoletteCHHS13/627Department of Neonatology - Skin care of the extremely low birth weight less than 28 weeks gestationCHHS16/138Polyethylene Wrap for temperature regulation at Preterm BirthsAttachment 1 – ePREM Flow Chart – Extremely preterm early management Flow ChartThe first 72 hours for infants <28 weeks of gestation and/or ELBW <1000gResuscitation team staff members, duties as below as per colour coding:Retrieval nurse (nurse attending delivery)Admission Nurse/Team LeaderJunior doctor attending the deliveryConsultant attending the deliveryPreparationInform 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.DeliveryCheck temperature in OT-request to set it at 25 degrees CEncourage 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. 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:: PreparationYNConsultant on call informed and present FORMCHECKBOX FORMCHECKBOX Curosurf present in incubator FORMCHECKBOX FORMCHECKBOX Neopuff equipment checked, pressures & flow set FORMCHECKBOX FORMCHECKBOX Humidifier Base of the isollette filled and switched on FORMCHECKBOX FORMCHECKBOX Transport shuttle prepared FORMCHECKBOX FORMCHECKBOX Plastic wrap, hat, mattress available FORMCHECKBOX FORMCHECKBOX Admission nurse prepared TPN, caffeine, antibiotics FORMCHECKBOX FORMCHECKBOX DeliveryYNTemperature in OT/BS set to 25?C FORMCHECKBOX FORMCHECKBOX Delayed cord clamping done FORMCHECKBOX FORMCHECKBOX Plastic wrap placed FORMCHECKBOX FORMCHECKBOX Hat placed FORMCHECKBOX FORMCHECKBOX Baby placed on heated mattress wrapped with blanket FORMCHECKBOX FORMCHECKBOX Appropriate IPPV / CPAP commenced FORMCHECKBOX FORMCHECKBOX Required intubation FORMCHECKBOX FORMCHECKBOX Humidifier base of the resuscitaire filled and switched on FORMCHECKBOX FORMCHECKBOX Saturation at 5 min >80% FORMCHECKBOX FORMCHECKBOX Saturation at 10mins 90-94% FORMCHECKBOX FORMCHECKBOX Vitamin K given FORMCHECKBOX FORMCHECKBOX Transferred to NICU within 30 minutesTemperature prior to transferOn arrival to NICUYNWeighed FORMCHECKBOX FORMCHECKBOX Surfactant required FORMCHECKBOX FORMCHECKBOX Settling In (First Hour)YNUmbilical lines placed within 1 hour FORMCHECKBOX FORMCHECKBOX Antibiotics given within 1 hour FORMCHECKBOX FORMCHECKBOX Caffeine given within 1hour FORMCHECKBOX FORMCHECKBOX TPN and lipids commenced within 1 hour FORMCHECKBOX FORMCHECKBOX Blood taken for Group & screen, CRP, FBC, blood culture FORMCHECKBOX FORMCHECKBOX First Blood gas – Time::pH:PaCO2:PaO2:HCO3:BE:Lactate:BGL:Hours 1-72YNDetailed obstetric history documented FORMCHECKBOX FORMCHECKBOX At 12hours - NICP and SBR taken FORMCHECKBOX FORMCHECKBOX Second dose of surfactant given (up to 12hours) FORMCHECKBOX FORMCHECKBOX EBM commenced at 1mL/4hrly:Vaginal birth within 2 hrsCaesarean Section within 4 hrs FORMCHECKBOX FORMCHECKBOX Contributory factors for goals not met: ................
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