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CPS Position Statements Review > Newborn/NICU > Flashcards

Newborn/NICU Flashcards

Updated 01/04/2024

1
Q

What is MRSOPA during NRP ?

A

Differential for Crappy Air Entry/Response

  • Mask seal/position
  • Resposition Neck/Shoulders
  • Suction the airway and nairs
  • Oral air (sometimes open the mouth)
  • PIP increase (Pressure)
  • Alternative Airway (Intubate)
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2
Q

What are the contraindications to dexamethasone in prevention for Bronchopulmonary Dysplasia ?

Remeber this is community pediatrics, not neonatology, for the typical prem

A

We shouldn’t really be given them at all

  • No steroids before 7 days of life
  • No low dose dexamethasone after 7 days
  • No High dose dexamethasone ever

This used to be a routine thing, and with exception to some new experimental NICU stuff for extreme prems., the purpose of this statement is to say “don’t routinely do steroids”

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3
Q

What are the CPS’ Criteria for discharging a Premie from the NICU

A

Discharge Goals for Premies in the NICU
* Temperature control
* No apneas for 5-7 days post-caffeine cessation* (3-5 if they never had caffeine)*
* Medication, Physiotherapy, Wound care and Feeding regimens are established, tolerated and provided by the caregivers
* Follow-ups arranged for: ROP, BPD Hypertension, Developmental assessments,

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4
Q

Give me your Baby Checklist for discharging a TERM baby

(Checklist for the Baby)

A

Well Term Baby Discharge Checklist

  • Physical exam done - Abn findings F/U arranged
  • Normal vital signs
  • Passed urine and meconium
  • Weight loss < 10% - arranged follow-up if near or > 10 %
  • 2+ successful feeds
  • Sepsis, Jaundice, Abuse and Heart Disease risk factors have been evaluated
  • Maternal serologies - HBV, HCV, HIV, Coombs
  • If circumcized, check for bleeding
  • Routine screening tests completed
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5
Q

EPI BULLETS

A
  • 1st Trimester dating is actually +/- 8 days
  • Morbidity and Mortality decreases by 6 % with each week of gestation obtained
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6
Q

What are your temperature goals for Therapeutic Hypothermia?

A

Therapeutic Hypothermia Goals

The goals depend of the sensor being used

  • Head Sensor: 34.5 +/- 0.5 °C
  • Whole Body: 33 +/- 0.5 °C
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7
Q

Describe the 4 points of Shared Decision Making

A

Shared Decision Making

  1. Choice Discussion - identify what must be decided
  2. Options Discussion - what paths moving forward
  3. Identify Family’s Priorities/Desires for care
  4. How all that relates to the current Diagnoses & Prognoses* - why the options/choices are there

*Prognoses must also include psychosocial aspects unique to the patient and their family.

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8
Q

What are the top 5 reasons for readmission to hospital post-natally?

Highlighting the reason to have an outpatient follow-up for all babies within 72 h post-discharge

A

Post-Natal Readmission to Hospital

  1. Hyperbilirubinemia
  2. Weight loss/feeding difficulties
  3. Bowel Obstruction
  4. Congenital Heart Disease*
  5. First time parents / Psychosocial issues

*About 30 % of non-syndromic critical heart lesions are NOT diagnosed in the first 3 days of life, as per their physiology.

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9
Q

TRUE or FALSE

Natural BLES and Synthetic BLES are equivalent

A

FALSE

Synthetic is associated with higher mortality and pneumothoraces

Which sucks, because it’s less expensive to make and store

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10
Q

What are the MRI findings for HIE on DOL 3 - 5 ?

(remember that you’re cooling for the first 3 days)

A

HIE Findings on MRI

Days 3 - 5 of life

  • Normal T1 and T2 typically
  • Restricted Diffusion on DWI
  • MRSI will show lactate accumulation

Days 10 - 14 of life

  • The peak of the damage/affected areas
  • This scan is for planning more than anything

ALL FINDINGS MUST BE READ BY PEDIATRIC RADIOLOGY

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11
Q

Are SSRIs contraindicated in pregnancy?

A

NOPE

If Mom was started on SSRIs in her 3rd Trimester, the baby needs to be monitored for 48 h clinically

Only paroxetine has some cardiac teratogenicity.

Breastfeeding on them is ok

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12
Q

What are the oxygen saturation goals for a Prem planning for discharge ?

A

Oxygen Goals of Ex-Prem

  • Saturations of 90 - 95 %
  • Must be maintained on a constant FiO2*
  • No apneae for 5 days

* 25 % of prems born < 1500 g require oxygen after 36 weeks, and at home. Don’t let chronic O2 needs prevent discharge.

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13
Q

What type of blood can be giving to prems ?

What are the thresholds

A

O Negative

When ABO Rh compatibility is determined, then you can match it

Transfuse if HgB is below

  • Week 1 : < 100 g/L (< 110 g/L Unstable)
  • Week 2 : < 80 g/L (< 100 Unstable
  • Week 3+ : < 75 g/L (< 80 Unstable)
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14
Q

What is your go-to premedication for intubation?

A

Intubation Pre-Medications

  • Fentanyl (3 μg/kg) or Morphine over 10 min*
  • Atropine 20 μg/kg or Glycopyrrolate**
  • Succinylcholine 2 mg/kg or Rocuronium***
  • Tube-em !

*Morphine binds more non-specific u-rec, so hypotension is a bigger issue than fentanyl. You give slowly to avoid rigid chest . **GlycoP dosing isn’t well understood for extreme prems.,***Roc takes longer effect, but better outcomes/risk if possible to use.

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15
Q

Give 2 intrinsic risk factors of the baby, for developing hyperbilirubinemia

A

Baby’s Intrinsic Hyperbilirubinemia Risk Factors

  • G6PD Deficiency (aka favism)
  • Pyruvate Kinase Deficiency
  • South or East Asian descent* / FHx Jaundice
  • Hereditary Spherocytosis/Eliptocytosis
  • Biliary atresia (duh)

​*This is because these population have delayed expression of the enzymes used for hepatic clearance.

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16
Q

Give me your Maternal checklist for discharging a TERM baby

(Checklist for the Mom’s status)

A

Maternal Readiness for Discharge Checklist

  • Mother provides routine infant care
  • Demonstrates knowledge of how to recognize illness and when to seek help
  • Psychosocial and environmental risk-factors have been assessed, with appropriate follow-up
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17
Q

Provide 2 contraindications to Therapeutic Hypothermia

A

Contraindications to Therapeutic Hypothermia

  • DNR as per other anomalies (prenatally done)
  • Suspected coagulopathy
  • Severe IUGR
  • Intracranial Bleed/Head Trauma (IVH is debatable)
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18
Q

If their schedules are kept, are IV, PO and IM Vitamin K in the newborn equivalent ?

A

NOPE

The best dosing method is IM for its ADME

IV isn’t great, and reserved for tiny babies where there is pretty much no M to IM

PO is terrible, requires a dose at birth, 2 weeks and 6 weeks but doesn’t meet serum goals

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19
Q

What team is ideal for NICU Transport ?

As per the CPS

A

NICU Transport Teams

  • 3 People in the vehicle
    • NICU RN
    • Respiratory Therapist / Extra RN / Paramedic
    • Driver
  • Single Neonatologist coordinates management prior and during transport. This can be the receiving, discharging or external care provider.
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20
Q

Describe an ex-prem that is ready to go home, from a feeding perspective

A

Feeding Checklist for Discharge of Ex-Prem

  • Tolerating required Caloric needs
  • 400 - 1000 units Vitamin D per day
  • Tolerating Iron supplementation
  • NG feeds are ok with home care services
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21
Q

Describe the sequence of actions when assessing a baby for HIE/Therapeutic Hypothermia

I will provide a summary of the CPS’ Management

A

Management of Suspected HIE

  1. Meets Diagnosic Criteria of HIE/TH Qual.*
  2. A, B, C’s (Getting intubated, umb. lines)
  3. Monitor lytes, CO2, look for HCT drop
  4. Baseline aEEG (Brain-Z)
  5. Cool whole body to 33 +/- 0.5 °C x 72 h
  6. Sedate with 10 mcg/kg/h of morphine
  7. Thawing 0.5 °C/h over 12 h
  8. If neurologic status deteriorates; re-cool at a rate of 0.5 °C/h to goal x24 h
  9. Brain MRI #1 on Day 5 - 6
  10. Brain MRI #2 on Day 10 - 14

​*Discussed in a separate question. There are specific criteria that are described by the CPS

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22
Q

Give 2 extrinsic risk factors for a baby to have hyperbilirubinemia

A

Extrinsic Risk Factors for Hyperbilirubinemia

  • Sepsis
  • ABO / Rh incompatibility (also antiD/P etc.)
  • Dehydration (Resp. Distress, Exclusive Breastfeeding)
  • Breastmilk Jaundice
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23
Q

What teaching topics must be covered prior to discharging a baby from the hospital ?

A

Discharge Teaching for Well Newborn

  • Normal Feeding (signs of problems)
  • Normal newborn behaviours and care
  • Safe Sleep practices
  • Smoking hygiene (quit if possible)
  • Infection Control with bottle prep.
  • Sun exposure / Rehydration methods
  • Signs of infection and heart disease
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24
Q

Counselling Numbers

A

I’ve attached the big numbers from the CPS’ Statement on counselling for Extreme Prems

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25
Q

Who gets BLES ?

According to the CPS

A

Indications for BLES (Surfactant)

  • RDS and > 50 % FiO2
  • MAS and > 50 % FiO2
  • Respiratory Disease with O2 index > 15
  • Pulmonary Hemorrhage
  • < 29 weeks GA
  • Dose : 120 mg phospholipid/kg x 3 max via ETT and bag*
  • Can give again if FiO2 > 30 % after 2 h of previous*
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26
Q

What is the role of Head CT in the NICU?

A

Head CT in the NICU

CT strokes in acute settings when you can’t MRI.

Your goal is to assess for acute bleeds, ischemia or congenital anomalies whose identification will CHANGE management.

Birth Trauma evaluations need CT for bones

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27
Q

Besides Hypoxic Ischemic Encephalopathy (HIE), what NICU indications are there for Brain MRI?

Gimme 3 pathologies

A

Reasons to MRI in the NICU

  • Hypoxic Ischemic Encephalopathy (HIE)
  • Subacute bleeds / strokes
  • Congenital Infection
  • Meningitis with abscess forming species
  • Suspected anatomical anomalies
  • Inborn errors of metabolism

​DO NOT MRI FOR HYPERBILIRUBINEMIA OR TRAUMA

28
Q

What 3 antenatal treatments for threatened preterm labour are essential ?

A

Antenatal Care for the Possible Prem

  1. Antibiotics if query chorio/PPROM
  2. Steroids x 2 ASAP (48 h - 2 weeks before is best)
  3. MgSO4 (RR for CP is 0.88)
29
Q

What’s your dose and transfusion instructions for pRBCs in the NICU ?

What acute complications do you worry about

A

15 mL/kg pRBCS via Peripheral IV over 2 hours

We tend to worry about

  • Hyperkalemia
  • Transfusion reaction
  • Necrotising enterocolitis (but we don’t hold feeds anymore)
  • Volume overload
30
Q

What is the mechanism (and physiologic parameter) that iNO Therapy target ?

A

iNO vasodilates the pulmonary vasculature, decreasing pulmonary blood pressure preventing Right to Left Shunting.

It works well for critically ill patients with:

  • Persistent Pulmonary Hypertension
  • Significant Right to Left Shunting issues
31
Q

TRUE or FALSE

A history of Apnea of Prematurity is a risk factor for developing SIDS

A

FALSE

Apnea of prematurity is NOT associated with developing SIDS. Prems should be Apnea-free for 5 days prior to discharge. A study found that 96 % of babies whom had no apnea for 7 days did not develop any more episodes when watched for > 4 days.

32
Q

What are side effects to anticipate, when initiating therapeutic hypothermia in the neonate?

A

Side-effects of Therapeutic Hypothermia

  • Hypotension
  • Arrhythmia
  • Pulmonary Hypertension
  • Bleeds (particularly of the diathesis)
33
Q

The brachial plexus includes which nerve roots?

A

Brachial Plexus includes C5 to T1

These present with abnormal Moro, and Erb’s Palsy

  • Extension of Arm
  • Pronation of Forearm
  • Flexion of wrist
  • “Goose facing” of fingers (QUACK!)
34
Q

After ABCs, what environmental and planning should surround initial care for an extreme prem?

A

Extreme Premature Infant Post-Resusciation

  1. Avoid Hypothermia (Brain injury risk)
  2. Do not permit hypotension (Pressors!)
  3. Maintain PCO2 between 45 - 55 mmHg**
  4. Volume Target Vent. > HFO if possible
  5. Do not give NSAIDs automatically
  6. Angle baby at 30 degrees head up*
  7. Keep the environment quiet
  8. Minimal Handling x 72 h
  9. Transport to tertiary center ASAP

*There is no evidence for this, it’s all theoretical. **There is permissible hypercapnea to optimize brain perfusion, physiologic is 35 - 45, but this has to be balanced with lung injury risk.

35
Q

Define Apnea of Prematurity

A

Apnea of Prematurity (cGA < 37 weeks)

  • Apnea for > 20 seconds (Hemodynamically well)
  • or*
  • Apnea for 10 -20 seconds & bradycardia
  • or*
  • Apnea for 10-20 seconds & desat < 80 %
36
Q

EPI BULLETS

A
  • 21 % of < 33 weekers have abn head imaging
  • 93 % of IVH are found by DOL 5
  • The Odds Ratio for IVH with PPROM is 2.33
  • PDAs of prems self-close 58 % of the time
37
Q

What role does Head US have in the NICU?

Gimme 3 pathologies

A

Head Ultrasound in the NICU

  1. Anterior brain masses (does not see posterior fossa)
  2. Early Hypoxic Ischemic Encephallopathy evidence can be seen by doppler
  3. IntraVentricular Hemorrhage Dx and F/U
  4. Diagnosis and follow-up of hydrocephalus
  5. Can identify some major anatomical anomalies, rarely an abscess/cyst
38
Q

What areas are typically affected by HIE on MRI?

A

Brain Regions affects by HIE

  • Basal ganglia (22 %)
  • Watershed injury (early PVL 52 %)
  • Generalized parenchymal edema can be seen within 72 h of the injury (usually the first scan)
39
Q

TRUE or FALSE

Caesarean Sections are safer than Vaginal Births for the premature infant

A

FALSE

The only situations where a C/S is better, is if the Mom’s condition is tanking or the baby is breech

(even then the evidence isn’t that impressive)

40
Q

What are the doses for intramuscular Vitamin K?

A

BW < 1500 g : 0.5 mg IM x 1

BW > 1500 g : 1.0 mg IM x 1

All doses must be given within 6 h of life

41
Q

What screening tests must be done before discharging any newborn from the hospital ?

A

Routine Newborn Screening Tests

  • Newborn Disease Screen at 24 h*
  • Hearing assessment - completed or arranged
  • Bilirubin screening – results reviewed and F/u arranged
  • Pulse oximetry cardiac screening

*If done before 24 h of life, it must be repeated within 7 days. This test includes several reversible metabolic, endocrine, hematologic and immunologic diseases.

42
Q

What are the benefits of deferred cord clamping?

(particularly in the prem)

A

Deferred Cord Clamping

  • Overall decreased mortality for all prems (30 % for extreme prems)
  • Decreased IVH (RR 0.83)
  • Decreased NEC (RR 0.59)
  • Higher Mean Arterial Pressures & HCT without increased risk for exchange transfusions
  • Less Blood Transfusions (RR 0.66)
  • Reduces CP development
43
Q

What 4 procedures does the CPS demand we manage pain for, in the NICU ?

A

Always Provide Pain Control for:

  • Chest Tube Insertion
  • Intubation
  • Circumcision
  • Retinal Examinations
44
Q

EPI BULLETS

A
  • Brachial Plexus injuries occur 5.1/1000 births
  • 75 % of them recover completely
  • If there’s no change/improvement by 3 - 4 weeks of life, they’ll have persistent issues
45
Q

What are indications for controlled hypothermia to protect against Hypoxic Ischemic Encephalopathy?

A

Indications for Therapeutic Hypothermia for HIE

  • ≥ 36 weeks GA
  • ≤ 6 h of life
  • Evidence of neurologic injury, as seen by either seizures or 3/6 of the following
    • Decreased level of conciousness
    • Decrease baseline activity
    • Posturing
    • Poor tone
    • Weak/Incomplete primitive reflexes
    • Abnormal HR, RR or pupils​

Cord Gas Criteria

  • Cord pH < 7.0 with a Base Excess ≥16
  • Cord pH 7 - 7.15 with a Base Excess 10-15.9 and a strong history for ischemic injury, PPV > 10 min or 10 min APGAR < 6
46
Q

What are the ABSOLUTE contraindications to Deferred Cord Clamping ?

STRONG RECOMMENDATION

A

Absolute Contraindications to Deferred Cord Clamping

  • Fetal Hydrops
  • Need for immediate resuscitation of Mom/Baby
  • Placental and/or Uterine bleeds
  • Twin-Twin transfusion syndrome
  • Twin Anemia Polycthemia Sequence
47
Q

When should Uterotonics be given to the mother, Intrapartum, as per the CPS ?

A

After Deferred Cord Clamping has been performed

48
Q

What are RELATIVE contraindications to Deferred Cord Clamping ?

Conditional low Recommendation

A

Relative Contraindications to Deferred Cord Clamping

  • Risk for Hyperbilirubinemia in TERM
  • High Maternal Anti-body titres
  • First born Monochorionic Twin
49
Q

When is Umbilical Cord Milking indicated ?

MODERATE - STRONG RECOMMENDATION

A

Umbilical Cord Milking

  • NEVER in < 32 weeks extreme prems
  • We should be using Deferred Cord clamping in > 32 weeks instead.
50
Q

Describe a perfect Deferred Cord Clamp scenario

A

Proper Deferred Cord Clamping

  • Baby placed below or at the level of the vagina (or C/S opening)
  • 60 - 120 seconds for < 37 weeks
  • 60 seconds for Term
  • 30 - 60 seconds for Twins
  • 30 seconds of DCC is > immediate clamp when DCC has to be stopped for hemodynamic reasons.
51
Q

Premie Clerical Discharge Checklist

(Run through what needs to be organized before they go home)

A

CPS’ Premie Discharge Checklist

  • Physical Examination and Growth Parameters
  • Metabolic screenings and follow-ups
  • Hearing screen done/planned
  • ROP evaluation dates confirmed
  • Vaccines booked, educate on access to RSV ppx
  • Confirm accessibility to prescribed feeding plan (formula, tubing, pump rental)
  • Confirm accessibility of medications at patient’s local pharmacy
  • Confirm accessibility of follow-up appointments (e.g. means of travel, clinic fees, time-off work)

Confirm Date and Time for follow-up with Pediatrics, Special Infant Clinic (Neonatalogists) or Family Doctor to assess weight and management follow-through

52
Q

What is ordered when initiating iNO
for acute pulmonary hypertension
in the NICU

(Describe the orders you would write after you’ve decided to start iNO)

A

Starting iNO for PPHN

  1. Confirm indication for iNO
  2. Obtain Echocardiogram ASAP
  3. Have both venous and arterial blood access to determine OI (or have OSI set-up if you can’t get an art line)
  4. Start iNO at 20 ppm
  5. Increase in increments of 5 - 10 ppm with OI/OSI re-assessment every 30 minutes
  6. If you reach 40 ppm with no change in OI/OSI, stop iNO therapy and re-assess
53
Q

Describe weaning iNO in the NICU

A

CPS’ iNO Weaning Guidelines

Weaning iNO for confirmed PPHN can start if Oxygenation Index (OI) ≤ 10 and** FiO2 < 60 %**

  • Decrease iNO by 50 % per wean Q 30 min
  • At 5 ppm, decrease by 1 ppm Q 30 min

A wean is considered tolerated if:
* OI Remains ≤ 10
* FiO2 does not increase ≥ 10 %
* Pre-ductal SpO2 does not decrease ≥ 5 %

54
Q

Explain Oxygenation Index (OI)

(What is the formula ? what is normal ?)

A

Oxygenation Index (OI)
Describes the presence of a V/Q mismatch; where a larger number represents a massive dependance on ventillatory support, or a very small result of arterial oxygenation

OI= (FiO2 x Mean Airway Pressure)/ PaO2

< 10 is our typical goal, but this should be measured dynamically with your clinical management

55
Q

Explain the Oxygen Saturation Index (OSI)

(What is the formula ? what is normal ?)

A

Oxygen Saturation Index (OSI)
A postulated surrogate for OI when arterial lines aren’t possible. Describes the presence of a V/Q mismatch; where a larger number represents a massive dependance on ventillatory support, or a very small result of arterial oxygenation

OSI= (FiO2 x Mean Airway Pressure)/ SpO2

< 10 is our typical goal, but this should be measured dynamically with your clinical management

56
Q

What are the indications for starting iNO for refractory hypoxic respiratory failure

A

Indications for starting iNO

  • OI > 15
  • PaO2 < 100 mmHg on 100 % O2
  • Low suspicion or confirmed absence of Cyanotic Congenital Heart Disease
  • Right ventricular insufficiency secondary to PPHN

iNO should be considered in patients with refractory Hypoxic Respiratory Failure, not immediately in the NRP setting. It can be considered in the emergency setting with PROM or Oligohydramnios.

ECHO ASAP to rule out cyanotic heart disease and see vent. function

57
Q

COVID BULLETS

A
  • Vertical transmission risk of COVID19 is 0.01 %. Risk factors are Maternal viral load/disease severity and immunodedeciency.
  • Breastfeeding transmission of COVID19 is not a thing.
  • Isolated Maternal COVID19 is NOT an indication for NICU to be present at the birth.
  • Do not restrict delayed cord clamping because of maternal COVID19
  • N95 with all aerosol generating manipulations of suspected COVID19 in the NICU… which means everything except isolated line placement
58
Q

What infections are screened for, in the Mother, prenatally ?

A

Canadian standard Prenatal Infection screening

  • HBV (sAB, cAB, sAG)
  • HIV
  • Group B Streptococcus
  • Chlamydia trachomatis
  • Neisseria gonnorrhoeae
  • Rubella Immunity assay

Syphilis, HCV, Toxoplasmosis, Cytomegalovirus, HSV are ** for across Canada.

59
Q

A child is born to an HBsAg+ mother, what is your management of the baby ?

A

Management of Child born to HBV+ Mother
(1) Clean the baby immediately post-partum to remove any possible body fluid vectors
(2) Administer a HBV Vaccine within 12 h
(3) Administer HBV Immunoglobulin within 12 h
(4) If Mother has a high viral load, consult Infectious Disease to possibly administer antivirals.
(5) Arrange F/U as per CPS Guidelines

Transmission risk is substantially higher if the Mother is also HBeAg+, but all scenarios reduce transmission to the child up to 95 % if vaccine and immunoglobulin is given.

60
Q

A child is born to an HIV+ Mother, what is your management of the baby ?

A

Management of Infant born to an HIV+ Mother
The risk of transfer is dependent on the Maternal time of diagnosis, compliance with treatments and subsequent viral load.

(1) Clean the baby immediately post-partum to remove any possible body fluid vectors
(2) Baseline infant HIV serologies
(3) Oral zidovudine within 6 h of life
(4) Exclusive formula feeding
(5) Refer to Infectious Disease/Infant HIV specialists

61
Q

What are the symptoms of congenital CMV infection in the neonate ?

A

Congenital CMV Infection

  • IUGR
  • Hepatitis (indirect hyperbilirubinemia)
  • Thrombocytopenia
  • Microcephaly
  • Hearing test failure

You can screen for CMV with a PCR test of the saliva and/or urine

62
Q

What are indications for testing the Mother for infectious aetiologies ante/postnatally ?

A

Test the Mother for Infections if :
(1) Pre-natal testing was not adequately completed or available
(2) Mother has on-going risk factors for STIs, IV Drug Use or non-compliance with anti-viral therapies.
(3) When epidemiologic risk factors support screening for certain diseases (e. g. immigrants from SE asia for Hep C, maternal lesions suspicious of HSV)

63
Q

What is the management of an infant with suspected systemic HSV ?

A

Management of Infant HSV Infection
(0) Contact precautions
(1) PCR Swab oronasopharynx, eyes and include HSV PCR in the CSF fluid assays. Consider wound swabs as well (e.x. scalp electrode, forceps abrasions) @ 24 h of life minimum.
(2) Acyclovir 20 mg/kg Q8H (60 mg/kg/day) x 14 days for SEM (21+ for CSF involvement)
(3) Arrange follow-up with Pediatrics for neurologic assessment
(4) If CSF is positive at 21 days, continue acyclovir with weekly LP.
(5) Once CSF is cleared; prescribe 300 mg/m^2 PO x 6 months

If C/S without ROM : Swab at 24 HOL - no treatment
If SVD with 1st Herpes episode : Treat with acyclovir for 10 days
If SVD with chronic Herpes : Monitor and swab at 24 HOL. Educate parents and note in chart should they return with sepsis-like symptoms to start acyclovir.

64
Q

What is the protocol to establish Skin-to-Skin optimally ?

A

Skin-to-Skin Care

  1. Confirm a back-up SSC person if birthing parent is unstable
  2. Routine NRP for the child if baby is flat/anomalous
  3. Immediate SSC (baby prone on parent, face exposed, body blanketed, exremities flexed without rotation of trunk)
  4. Do NOT interrupt for 1 h or after first feed (give meds then and resume SSC)
  5. Goal SSC Time is 8 h per day (going above is ideal)
  6. Reinforce the importance and evidence based benefits as it gets harder to maintain* (in the NICU or at home)*
  7. Have safety plans to avoid the parent passing out from exhaustion* (at home / in hospital)*

*This is independant of the location of the delivery. This can be done intraoperatively, and if the Anasthesiologist is ok with it - you can delivery SSC whilst the mother is intubated with you nearby. *

https://cps.ca/en/documents/position/skin-to-skin-care

65
Q

What outcomes does Skin-to-Skin Care provide ?

A

Outcomes from Skin-to-Skin Care

  • Improved breastfeeding rates (both partial and exclusive Breastfeeding)
  • Reduced mortality for 1000 g+ BW babies (+25 % survival)
  • Improved Cardiorespiratory transition rates
  • Improved microbiome development (suspected reduced infection)
  • Improved pain-management for procedures/treatments
  • Reduced cortisol, heart rate variability and increased oxytocin$ - improved parent stress/bonding as well
  • Stabilized EEG findings and developmental outcomes (early evidence)
  • **Reduced rescue opioid **needed in Neonatal Abstinence Syndrome

$They actually did this study measuring these hormone levels.

https://cps.ca/en/documents/position/skin-to-skin-care

66
Q

What are contraindications to Skin-to-skin Care ?

A

Contraindications to Skin-to-skin Care
There aren’t many
* Major abdominal wall anomaly
* Major neural tube defects
* Active resusciation (an intubated bb on pressors can be held)
* Therapeutic hypothermia **if ** contact causes too much temp variability

The take-home point is that the baby will stabilize better with skin-to-skin care, but it becomes a nursing headache that MUST be overcome. You can do it.

https://cps.ca/en/documents/position/skin-to-skin-care

67
Q
A

CPS Position Statements Review (8 decks)

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