Fetus and Newborn CPS

Question 1

How long should skin to skin post birth last

Answer 1

At least an hour uninterrupted
WHO recommends 8 hours per day

Question 2

Benefits of skin to skin care

Answer 2

Improved duration and volume of breastfeeding
Lower mortality, hypothermia, suspected sepsis
Cardiopulmonary stability
Colonization of infant microbiome
Pain management in infants
Stress regulation
Neurodevelopmental benefits
Improved parent infant interaction and parental mental health

Question 3

Which infants may need delay of skin to skin care?

Answer 3

Extremely preterm infants
May be warranted for concerns regarding handling and neuroprotection

Question 4

3 relative contraindications for skin to skin care

Answer 4

Abdominal wall or neural tube defects
Postoperative instability
Significant instability associated with clinical handling, or prolonged recovery

Question 5

Definition of
1. Preterm
2. Very preterm
3. Extremely preterm
Infants

Answer 5

1. 37 weeks or less
2. < 32 weeks
3. < 28 weeks

Question 6

Duration of DCC for
1. Preterm and extremely preterm
2. Term
singleton infants

Answer 6

1. 60 to 120 s
2. 60 s

Question 7

Benefits of DCC in preterm and extremely preterm singletons

Answer 7

Decreases newborn mortality and morbidity
Improves hemotological outcomes (slightly increased hematocrit and ferritin)
Reduced risk of death or adverse neurodevelopmental outcomes at 2 years

Question 8

Risk with DCC longer than 60s in term infant

Answer 8

Increases risk of hyperbilirubinemia requiring phototherapy

Question 9

Is DCC recommended in twins?

Answer 9

Yes, unless contraindications
Presumed 30 to 60 s duration

Question 10

When do you give uterotonic medications in
1. Preterm
2. Term
infants

Answer 10

1. After clamping cord (avoid bolus of blood)
2. With delivery of anterior shoulder (higher risk for maternal PPH)

Question 11

6 absolute contraindications for DCC

Answer 11

Fetal hydrops
Certain fetal anomalies (diaphragmatic hernia)
Need for immediate resus of mom or babe
Disrupted utero-placental circulation (bleeding vasa previa or placenta previa, placental transection or abruption)
Twin to twin transfusion syndrome
Twin anemia polycythemia sequence

Question 12

3 relative contraindications to DCC

Answer 12

Risk factors for severe hyperbilirubinemia in term infants
High maternal antibody titers
First infant in a pair of monochorionic twins

Question 13

Is umbilical cord milking recommended

Answer 13

No
Increased risk for severe IVH in very preterm infants