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This guideline is applicable to all medical, nursing and midwifery staff working in maternity units in the West of Scotland. Staff using this guideline are responsible for maintaining their skills in neonatal resuscitation and for seeking appropriate help where required. Staff should also refer to appropriate guidelines for the management of specific medical and surgical conditions which may require urgent intervention during the resuscitation of the infant.
The following are intended as guidance, judgement should be exercised in individual cases. Labour ward staff have primary responsibility for assessing the degree of risk anticipated and communicating their concerns effectively to the neonatal team. The earlier the neonatal team is given notice of a potential problem the better, allowing decisions to be made around the appropriate staffing and management at delivery.
If in doubt, call and discuss
In turn the neonatal team should make every effort to attend promptly and ensure that they have adequate information to make management decisions.
Training and competence:
Communication around an emerging situation where there may be both neonatal and maternal concerns is a challenge, however every effort should be made to ensure that adequate information is accurately passed to the neonatal team when they are called for resuscitation. Ideally the call should be made by a member of staff with a good working knowledge of the situation- if the midwife looking after the mother or midwife in charge is not able to make the call to the neonatal team, they should ensure that when delegating this adequate information is passed on.
When calling for neonatal assistance, the SBAR format should be used:
e.g. - I’ve got a baby about to deliver with meconium and a non reassuring CTG
e.g. - The baby is at term, mum has gestational diabetes, and there have been no other concerns in pregnancy. The obstetric registar is setting up for a vacuum extraction in the room
e.g. The CTG trace is concerning, with late dips
e.g. I need you to come to room 4 straight away- will you need the registrar too?
e.g. I’ll come straight down, my registrar is with me- I’ll bring them along
Deliveries not routinely requiring the presence of neonatal staff:
First Attender only (Doctor or ANNP carrying the first-on page)
All those marked with a * require assessment by labour ward staff of the degree of concern and whether middle grade staff should be requested to attend in addition to the first attender. This should be communicated using standard SBAR procedures
First Attender and Middle Grade (Doctor or ANNP carrying the second-on page)
First Attender, Middle grade and Consultant
(A sufficiently experienced neonatal trainee may act up in the role of the Consultant by agreement with the attending consultant)
It should be borne in mind that consultant staff are not resident out of hours in all units, and are not ordinarily part of the paediatric emergency team. It is the responsibility of the middle grade on call to have accurate contact information for the on call consultant. This may be in the form of a “baton” page or a list of contact numbers.
Local Contact Arrangements for Resuscitation team
Consultant Contact Arrangements
There are also a number of circumstances where a team including specialists other than neonatologists should attend delivery, e.g. ENT support for congenital upper airway anomalies. This should be clearly documented in the maternal notes, and the on call neonatal team should be informed as soon as a mother presents in labour.
Attendance by neonatal nursing staff
A number of fetal/neonatal issues require prompt review by a member of the neonatal team after delivery, but do not require them to be present at delivery. This is primarily to ensure that an investigation/treatment plan is put in place. The neonatal team should be informed of these situations before delivery, and should review the babies before they leave labour ward.
Requiring prompt review:
There are a number of situations outwith this that merit review by the neonatal team in the postnatal period, but where there is no need for any intervention immediately, e.g. an infant with antenatally diagnosed renal pelvis dilatation. In these circumstances it is most appropriate that the baby is reviewed on the postnatal ward, and many can wait for normal working hours. As before if there is any doubt about the timing of a review please contact the neonatal team to discuss.
Last reviewed: 01 August 2017
Next review: 01 August 2020
Author(s): Dr Alan Jackson, Neonatal Consultant PRM
Approved By: WoS Neonatal MCN