Obstetrical & Neonate Protocols

Question 1

Neonate with skin maceration (softening and peeling of the skin) and/or eyelids fused.

Answer 1

Assess for vital signs. If vital signs present, proceed with neonate resuscitation. If absent, no resuscitation.

Question 2

Criteria for beginning neonate resuscitation protocol.

Answer 2

Birth or age < 48 hours
Preterm
Apneic, gasping or no crying
Poor tone

Question 3

First steps of neonate resuscitation

Answer 3

Warm, open airway, clear secretions, dry, stimulate, assess heart rate, observe for gasping or apnea.

Question 4

Neonate resuscitation: after initial steps HR is < 100 or baby is gasping/apneic.

Answer 4

Initiate PPV (40-60 bpm)
Initiate SpO2 and ECG monitoring

Question 5

Neonate resuscitation: unable to achieve chest rise after first 15 seconds of PPV.

Answer 5

Take ventilation corrective steps until able to achieve chest rise (MRSOPA)

Mask adjustment
Realign Airway
- (15 seconds) -
Suction
Open Mouth
- (15 seconds) -
Peak Inspiratory Pressure increase
- (15 seconds) -
Alternative airway

Question 6

Neonate resuscitation: 30s of PPV with chest rise, HR remains < 60

Answer 6

Insert advanced airway*
Initiate chest compressions (3:1, 120 events/min)

• Do not delay chest compressions if not ready for advanced airway

Question 7

Neonate resuscitation: After 60s of chest compressions HR remains < 60

Answer 7

EPINEPHRINE
IV/IO 0.01mg/kg (1:10,000 0.1ml/kg) q4m
ET 0.1mg/kg (1:10,000 1ml/kg to a max of 3mL) q4m

Question 8

Steps for maintaining warmth of neonate

Answer 8

• Increase temperature of patient compartment to 27C
• Promote skin to skin contact
• Place baby on Transwarmer mattress
• Cover baby in dry blankets and toque
• Prepare BabyPod for transport of stable neonate and place neonate in BabyPod at earliest opportunity

Question 9

When to use bulb syringe on neonate.

Answer 9

Clearing the airway with a bulb syringe or suction catheter is reserved for babies who have obvious obstruction to spontaneous breathing or require PPV.

Question 10

The most effective method of monitoring heart rate on a neonate

Answer 10

ECG monitoring

Question 11

Oxygen flow rate for PPV of a neonate.

Answer 11

Room Air unless resuscitation continues for longer than 90 seconds, at which time oxygen concentration should be increased to 100% until recovery of a normal heart rate.

Question 12

Treatment for pregnant patient with heavy vaginal bleeding or severe abdominal pain with signs of shock.

Answer 12

IV fluid bolus per non-traumatic shock protocol.

Question 13

Oxytocin dosing

Answer 13

If baby(ies) delivered uneventfully, give mother 5 units OXYTOCIN IM / IV after all babies delivered.

Add 10 units OXYTOCIN to 1 L N/S running wide open, if significant postpartum hemorrhage

Question 14

Part presentation (during labour) requiring emergent transport.

Answer 14

Limb or prolapsed cord.

Question 15

Neonate triage

Answer 15

Ask for closest obstetrical hospital.
* If closest is St Boniface, confirm that there is a NICU bed available by contacting Neonatal Triage Nurse. If no NICU bed available go to Women’s.