The Prenatal Consult (part II)

This is part II of a series of posts which also currently includes part I, and part III
After discussing mortality and potential neurodevelopmental morbidities, I usually discuss delivery room resuscitation with parents. I start by explaining that should their baby deliver early, there will be a team of people led by myself or one of my partners that are there just for the baby. The team includes nurses and respiratory therapists with special training in neonatal resuscitation.


We place the baby in a radiant warmer and dry the baby off. We use a bulb suction device to suction the nose and mouth, and we stimulate the baby in an effort to initiate spontaneous breathing. There is good evidence that in babies less than 30 weeks gestation, the practice of placing a breathing tube into the airway and administering artificial surfactant (a substance necessary for breathing that preemies often don't make effectively) in the delivery room can positively influence the baby's overall respiratory course. So in our facility we do this for all babies that are born under 30 weeks gestation. I explain to parents of babies born after 30 weeks that their baby may still require this intervention, but that we will assess the baby's breathing and make that decision after delivery.


Lastly, I explain that in certain very rare situations, further interventions are necessary in the delivery room. If a baby's heart rate does not increase appropriately with placement of the breathing tube, then we sometimes have to initiate neonatal CPR in which we give the baby chest compressions and occasionally medications such as epinephrine to get the heart going. This only occurs in a very rare situation.


I then mention to the parents that following stabilization they will get to see their baby for a brief moment before admission to the NICU. NICU admission, procedures, and visitation are the next topics that I cover with parents. I will save this topic for the next installment. Tune in next time!