Deliveries not routinely requiring the presence of neonatal staff:
- Elective caesarean sections under regional anaesthesia with no concerns re fetal wellbeing
- Low/mid cavity instrumental deliveries with no concerns re fetal wellbeing
First Attender only (Doctor or ANNP carrying the first-on page)
- 33-36 weeks gestation
- Where a fetal blood sample (FBS) has been done with a pH <7.25
- Intrapartum haemorrhage prompting delivery*
- Fresh meconium in the amniotic fluid, with an abnormal CTG or FBS*
- Vaginal breech delivery*
- Instrumental deliveries in theatre
- Sustained Fetal tachycardia > 160
- Non-reassuring CTG *
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)
- Caesarean Section under general anaesthesia
- All criteria above marked * where labour ward staff have sufficient concerns
- All emergency calls (2222 calls)
- 29-32 weeks’ gestation
- Major concerns re intrapartum fetal wellbeing, e.:
- Significant abruption
- Any case of suspected fetal haemorrhage (specify this concern to neonatal team)
- Acute fetal bradycardia
- Cord prolapse
- Shoulder dystocia
- FBS with pH <7.2
- Multiple births <37 weeks
- Fetal anomalies with potential need for immediate resuscitation/stabilisation, e.g.
- Duct dependent cardiac anomalies
- Cleft lip/palate
- Abdominal wall defects
- Open Spinal defects
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A delivery plan should be agreed antenatally. This should include a decision about the staff required at delivery. This may include the need for the presence of a consultant or other specialist.
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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)
- <29 weeks’ gestation
- Diaphragmatic hernia
- Hydrops fetalis
- Fetal anomalies with potentially immediate life threatening consequences.
- CTG trace suggestive of fetal asystole or severe bradycardia
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 - PRM
SHO page 12201
Registrar page 12200
Neonatal Nurse page 12202
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Consultant Baton page 12210
NB – The baton page is carried by the Neonatal Nurse coordinator when the consultant is not resident. If required, they will contact the on-call consultant at home
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Local Contact Arrangements - QEH
SHO & Neonatal Nurse - use Red phone 62262
Registrar page 17690
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Consultant Baton page 16020
The Baton page is carried by the resident consultant who is on site 24/7
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Local Arrangements - RAH
Neonatal FY2 page 56018
Neonatal FY2 should be accompanied for all deliveries by either:
ANNP page 56547 (day time)
OR
Neonatal registrar page 56017
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Consultant contact – Contact via Switchboard
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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
- Attendance by neonatal nursing staff is determined in part by local arrangements for cover with labour ward.
- In all cases requiring a registrar or consultant a member of the neonatal nursing team should also attend as admission to the neonatal unit would be expected.
- Where nurses/midwives “taking the baby” at a caesarean section will be impinging upon the sterile field (e.g if baby going into a plastic bag, having delayed cord clamping etc), they should scrub and gown in the same way as those at the operating table.