Sneha Sood, MD
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Definition: A neonatal resuscitation team can be
compared to an adult rapid response team or
“code” team. They should be in-house and
available 24/7.
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Safety-net at Community Hospitals that do not have in-house
Pediatric coverage by a physician or NNP/PA. Rapid response
of team could be life-saving to a neonate in the delivery room
or nursery. Can stand-by at emergency C-sections if
Pediatrician unable to arrive in time.
Trained team to manage newborn emergencies; other health
care professionals who do not routinely take care of babies
are usually not comfortable with neonatal intubations and
line placement so it is difficult to have an adult rapid response
team attend neonatal emergencies.
Team also valuable in assisting Pediatrician with neonatal
stabilization.
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NRP is used as the “gold standard” for Neonatal
Resuscitation. NRP states that “at every delivery there
should be at least one person who can be immediately
available to the baby as his or her only responsibility and who
is capable of initiating resuscitation. Either this person or
someone else who is immediately available should have the
skills required to perform a complete resuscitation, including
endotracheal intubation and administration of medications.
It is not sufficient to have someone “on call” (either at home
or in a remote area of the hospital) for newborn
resuscitations in the delivery room. When resuscitation is
needed, it must be initiated without delay. “
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Physicians, usually Pediatricians or Family
Practice Physicians, Emergency room physicians,
anesthesiologists
CRNA
Neonatal nurse practitioners
Resident physicians
Nurses
Respiratory therapists
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Nurse/Respiratory therapist team
Work as a two-member team
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Good general resuscitation skills (both nurses and respiratory therapists)
Airway management (both nurses and respiratory therapists)
Neonatal intubation (respiratory therapists or nurses)
Stabilization UVC, other access (Nurses)
Ability to administer emergency medications (nurses and respiratory
therapists)
Possible cross-over of skills based on the goals of the individual
community hospitals or as team gains experience
May take several years of ongoing experience and training for team
members to feel comfortable in their role
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Maternal diabetes
Pregnancy-induced hypertension
Chronic hypertension
Previous fetal or neonatal death
Maternal infection
Maternal cardiac, renal,
pulmonary, thyroid, or neurologic
disease
Polyhydramnios
Oligohydramnios
PROM
Fetal hydrops
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Post-term gestation
Multiple gestation
Size-dates discrepancy
Drug therapy, such as
Magnesium, adrenergic –
blocking drugs
Maternal substance abuse
Fetal malformations or anomalies
Diminished fetal activity
No prenatal care
Age < 16 or > 35 years
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Emergency C-section
Forceps or vacuum-assisted
delivery
Breech or other abnormal
presentation
Premature labor
Precipitous labor
Chorioamnionitis
Prolonged rupture of membranes
(> 18 hours before delivery)
Prolonged labor (> 24 hours)
Prolonged second stage of labor
Macrosomia
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Persistent fetal bradycardia
Non-reassuring fetal heart rate
patterns
Use of general anesthesia
Uterine hyperstimulation
Narcotics administered to
mother within 4 hours of delivery
Meconium-stained amniotic fluid
Prolapsed cord
Abruptio placentae
Placenta previa
Significant intrapartum bleeding
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Consider developing working committee to work with HI-CHI to
develop and maintain neonatal resuscitation teams.
Presentation of need and implementation plan and timelines to
appropriate hospital administration, staff, and physicians.
Identify composition of neonatal resuscitation team (e.g.
physician, NNP, nurse/respiratory therapist, etc.)
Advanced role and skills need to be endorsed by the hospital (e.g.
endotracheal intubation, placement of stabilization UVC) and
these skills written into the appropriate hospital bylaws and/or job
description, development of policies and procedures.
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Define team members (e.g. specifically identify those individuals to
receive training)
List of anticipated deliveries that need to be attended by the Neonatal
Resuscitation Team
How will the team be activated when they are needed for anticipated
high risk deliveries and unanticipated situations.
 Pager
 Phone
 Overhead
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How will team members be trained?
How will skills be maintained? Will there be regular drills to maintain
skills?
How will “certification” of team members be maintained (e.g. number
of intubations, stabilization UVCs, deliveries attended)
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Each hospital should design their own list of
indications; these can be based on guidelines
provided by training course and by other
hospitals, NRP.
Should include indications for calling:
 Neonatal Resuscitation team alone
 Both Neonatal Resuscitation team and Pediatrician
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Pediatric Resident/Neonatal Nurse Practitioner
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EFW < 2000 grams or > 4000 grams
< 36 weeks or 42 weeks and greater
Maternal eclampsia or AICU
Increased maternal/neonatal risk of bleeding
Meconium-stained fluid
Immature lung profile
C-section
Fetal distress/poor biophysical profile
Vaccum/forceps/breech vaginal deliveries
Major congenital malformation and/or chromosomal anomaly
Multiple gestation
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Neonatal Resuscitation team (includes
Neonatologist)
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< 33 weeks completed gestation
Maternal eclampsia or AICU
Increased maternal /neonatal risk for bleeding
Immature lung profile
Sustained fetal bradycardia or poor biophysical profile
Breech vaginal delivery
Major congenital malformation and/or non-lethal
Emergency C-sections
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Please remember that the training team can help
you establish guidelines and protocols and will
continue to work with you to maintain skills for
neonatal resuscitation!
We would recommend quarterly drills to keep up
skills; also consider regular on-site training at
Kapi’olani Medical Center for Women and Children.
However, the ability to do this training likely to be
determined by budget.
Consider working with other Community Hospitals
on neighbor islands to establish universal guidelines?
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Prerequisites: NRP and S.T.A.B.L.E.
Neonatal Resuscitation Course every two years (HI-CHI)
Advanced Neonatal Resuscitation Course every two years;
still in development (HI-CHI)
Hands-on training at Kapiolani Medical Center for Women
and Children
Quarterly reviews utilizing simulation (HI-CHI, core staff)
Ongoing mentoring at home institution by Pediatricians and
other experienced professionals
Each institution can mandate how skills are maintained
annually; can work with HI-CHI and other hospitals to
standardize.