Intensive Care Nursery POLICY

INTENSIVE CARE NURSERY

Resuscitation Policy Patient Care
Issued: March 2005
Last Approval: November 2021

I. PURPOSE
The Intensive Care Nursery (ICN) staff are the first responders to the deliveries of all
neonates requiring resuscitative efforts at UCSF Benioff Children’s Hospital. The ICN
works together with the UCSF Birth Center to ensure that all babies receive appropriate
resuscitative care at birth.
In accordance with the American Academy of Pediatrics (AAP)/American Heart
Association (AH) Neonatal Resuscitation Program (NRP), all labor rooms are equipped
for the resuscitation of newborns. Additionally, there exists a pass-through window from
the Operating Room (OR) directly into a resuscitation room. The resuscitation room is a
fully stocked ICN directly off the operating room for the sole purpose of providing
complete intensive care level services immediately upon birth if necessary.
II. REFERENCES
American Academy of Pediatrics and The American College of Obstetricians and
Gynecologists. (2016). Guidelines for Perinatal Care. Elk Grove Village, IL: American
Academy of Pediatrics; Washington DC: The American College of Obstetricians and
Gynecologists.
American Academy of Pediatrics. (2016). Textbook for Neonatal Resuscitation. Elk
Grove, IL: American Academy of Pediatrics.
Leone T. and Finer N. (2013). Resuscitation at Birth. In A. A. Klaus and J. M. Faranoff
(Eds). Care of the High-Risk Neonate. (pp 54-70). Philadelphia, PA: Elsevier Saunders.

Nuntnarumit P. (2010). Oxygen saturation trends in preterm infants during the first
15mins after birth. Journal of Perinatology. 30(6). 399-402.
Vermont Oxford Network NICQ Neonatal nutrition initiative 2009-2010
III. DEFINITIONS
None
IV. POLICY
This policy outlines the communication links between the Birth Center and the ICN staff.
It also defines which populations are delivered into the resuscitation room, procedure for
preparation of the resuscitation room, responsibilities of the staff during resuscitation in
the labor rooms and resuscitation room, transport of infants after resuscitation to the ICN,
and cleaning & stocking of the resuscitation room.
A. At least two people proficient in neonatal resuscitation will be present at
every high-risk delivery.
B. All standard resuscitations will occur with room air (21% oxygen) unless
otherwise specified by the neonatal fellow or attending. Specific situations
in which room air will not be used include pulmonary hypoplasia (CDH or
CCAM), severe hydrops fetalis, etc.
C. Respiratory therapists (RT) will attend high-risk deliveries at the discretion
of the Attending physician for infants.
D. Umbilical lines will be prepped and flushed using sterile technique for
imminent deliveries of neonates <28 weeks and any other patients at the

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 Intensive Care Nursery POLICY
INTENSIVE CARE NURSERY
Resuscitation Policy Patient Care
Issued: March 2005
Last Approval: November 2021

discretion of the attending physician. This should be done no more than 2

hours before delivery to minimize contamination of the umbilical line tray.
E. While in the delivery room or resuscitation room identical bands that indicate
the mother's medical record number, the neonate's gender, and the date and
time of birth will be secured to the mother and infant. Upon transfer of the
neonate to the Newborn Nursery (NN) or the ICN, the Registered Nurse
(RN) will verify the neonate's identification and sign the neonate's record. If
the condition of the baby does not allow for placement of the bands, the
bands should accompany the baby to the site of admission.
F. All interventions, the neonate's response to these interventions, as well as the
neonate's status via objective data such as vital signs, oxygen saturation, and
blood gases will be recorded throughout the resuscitation by licensed personnel
on the resuscitation room record.
G. Communication Policy Between ICN and Perinatal Services:
For maternal-fetal procedures performed at more than 24 weeks
gestation: Obstetrics (OB) will notify the ICN triage nurse and the
Medical team covering deliveries about the time and type of procedure
being done (i.e., intrauterine transfusion, maternal surgery, etc.). In this
way the resuscitation team will be available if needed in an emergency.
For high-risk deliveries of infants <34 weeks gestation or with known
congenital anomaly: OB will call the ICN triage nurse and the Medical
team covering deliveries and describe the perinatal circumstances.
Information shall be provided with as much time as possible to ensure
that the ICN staff delivers appropriate antenatal counseling and neonatal
care. The team for attendance to these resuscitations will consist of
neonatal attending and/or neonatal fellow, pediatric resident and intern
(and/or Neonatal Nurse Practitioner) and two ICN nurses. Neonatal
attending physicians are required to be present for deliveries < 28 weeks
gestation.
For deliveries of infants >34 but <37 weeks gestation with no known
congenital anomaly: OB will call the ICN triage nurse and resident or
attending physician if necessary and describe any pertinent perinatal
circumstances and need for pediatric team presence. The team for
attendance to these deliveries will consist of pediatric resident and intern
(and/or NNP's) an ICN nurse, and, depending on circumstances, the ICN
fellow or attending.
The attending neonatologist and fellow on service will carry the
"Delivery Room Code" pager at all times and log into Voalte phones. OB
Perinatal Services use these pagers when there is a high-risk delivery or
emergency need of attending obstetrician, anesthesiologist and OB
resident. This will alert the attending neonatologist and neonatal fellow
that there is a potential emergency in the perinatal unit. The attending
and/or fellow will then check with the OB service to become informed of
the individual clinical situation. This pager will serve as a "back-up" in
case systems 1, 2 and 3 above have failed. This paging system does not
replace the need to alert the ICN team if they are needed in the
Delivery Room. This pager number must not be used by the ICN to call

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Resuscitation Policy Patient Care
Issued: March 2005
Last Approval: November 2021

the neonatal attending or fellow for an emergency in the ICN. Only the
perinatal unit will initiate this pager system.
In cases of an extreme or unexpected emergency, (when a neonatal team
is needed in the Delivery Room immediately) and there was no previous
communication as stated above the perinatal (or neonatal) staff should
use the emergency code buttons located in all patient care ,triage rooms
and surgical suites. With the activation of the code system, the ICN will
send a resident and/or a neonatal nurse practitioner, triage nurse, and
neonatal fellow and Attending physician.
I. Infants to be Delivered into the Resuscitation Room Include:
Any infant less than 34 weeks gestation or any other infant with a
prenatal history indicating a need for the resuscitation team set-up.
2. All infants with the following conditions diagnosed in utero:
a. Hydrops fetalis
b. Neural tube defects (spina bifida, myelomeningocele)
c. Severe bladder outlet obstruction
d. Gastroschisis
e. Omphalocele
f. Congenital diaphragmatic hernia
g. Antenatally diagnosed congenital heart block
h. All other infants so designated jointly by the attending and fellow of
the ICN and the OB attending.
3. All infants so designated jointly by the attending and/or fellow of the ICN
and the OB attending.
4. The decision to resuscitate infants < 24 weeks will be made jointly by the
attending and fellow of the ICN and the OB attending. See Periviability
Resuscitation Checklist- See Appendix A
5. All infants delivered into the resuscitation room are admitted into the
ICN. The appropriate staff needs to be informed of the impending
admission once that decision is made.
6. Respiratory therapists should be at the resuscitation of any infant < 28
weeks gestational age (at the discretion of the Attending Physician) and
should be on call for all other set up deliveries or per attending/fellow
request.
V. PROCEDURE
A. Preparation for Neonatal Resuscitation in the Resuscitation Room
1. Preparing resuscitation room “DRY” - Having the proper supplies and
equipment ready for use is paramount to a successful resuscitation.
To prepare resuscitation room "Dry" (no imminent deliveries) four areas
are to be set up:
a. Umbilical Line Insertion area
i. Umbilical Line Insertion Tray

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Resuscitation Policy Patient Care
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Last Approval: November 2021

ii. (1) 3.5 single lumen & (1) 3.5 double lumen, (1) 5.0 single
lumen & (1) 5.0 double lumen umbilical catheter should be
easily accessible. Do not open until weight is known.
iii. 3- prefilled 10 mL 0.45 NS syringe
iv. 3-way stopcock
v. Blood gas syringe
vi. Umbilical tape (aka: Umbilical cord tie)
vii. 4.0 silk suture
b. Intubation area
i. Sterile drape
ii. Laryngoscope handle
iii. Laryngoscope blades: #0 blade, #1 blade #00 blade
iv. Endotracheal Tubes: 2.5 Fr., 3.0 Fr., 3.5 Fr.
v. Stylette
vi. Needle holder
vii. Scissors
viii. Measuring tape
ix. 8 Fr Orogastric Tube (OG) & 10 mL syringe
x. Meconium aspirator
xi. Endotracheal Tube (ETT) tape, Neo-fit, skin prep in
Respiratory Care Supply (RCS) cabinet door
xii. Capnograph CO2 detector (Pedi cap)

c. Radiant Warmer/Incubator area

i. Radiant warmer or incubator should be plugged into wall and
checked that it works correctly
ii. Bed linen should be complete and sides of bed down or top of
incubator raised
iii. Restraints should be tied to bed with limb leads and temp probe
taped to them
iv. Place sterile blue drape over linen under restraints
v. Neonatal and infant mask should be taped to bed
vi. Stethoscope
vii. Suction/bulb syringe/NeoSucker
viii. Polyethylene wrap for infants <29 weeks
ix. Thermal warming mattress (unopened)
x. PreSat monitor/cable for radiant warmer
xi. O2 Sat probe(s)
xii. Hat (thermal hat for <29wks)
xiii. Thermometer
xiv. Flow inflating bag
xv. Cord clamp

d. Documentation area
i. Flow sheet, blood gas slips, hematocrit (HCT) slips
ii. Accucheck strips, alcohol wipes, cotton ball, lancet, 2x2
iii. Capillary Blood Gas (CBG) tubes

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Resuscitation Policy Patient Care
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Last Approval: November 2021

iv. Sterile 2x2 and micropore tape

v. IV supplies located in container
vi. 24-G angiocath (x2), t-connector, tegaderm, saline, skin prep, arm
board, alcohol wipe, tourniquet (rubber band)
vii. Culture bottles, CBC vial and blood T/S vial (1) 3mL syringe, (1),
blood transfer device
viii. Blood pressure cuffs Sizes 1 to 5

e. Other Areas to Prepare

i. Connect suction tubing to canister. Set suction between 60-100
mmHg, place on bed:
10 French suction catheter on open warmer bed for term infants
8 French catheter in incubator
ii. Respiratory equipment should be set up by Patient Care Assistant
(PCA), but it is the nurse's responsibility to check it every shift. Set
FIO2 at 21% and check pop off of flow inflating bag, & nebulizer on
blender for transport. RT will check air and O2 tanks.
iii. It is the triage RN/charge nurse's responsibility to check the
resuscitation room each shift to make sure it is prepared correctly.
Material Service and the PCA will stock the room. It is the
responsibility of the triage nurse to ensure room is stocked
appropriately. Be sure to check expiration dates of each item and
replace those that have expired.

2. Preparing set-up room “WET” – Once delivery is expected the following steps
need to be taken. All supplies that have been “wet” down have a 2-hour
expiration.
a. Don mask and cap upon to entering resuscitation room
b. Make sure all areas from Section 1 are appropriately prepared
c. Alert RT to re-check respiratory equipment, set-up CPAP, manometer on bed,
tanks, etc., and to prepare surfactant if < 28 weeks or as necessary (surfactant
is located in the pyxis medication refrigerator in the set-up room)
d. Prepare for Intubation
i. Check laryngoscope light
ii. Choose appropriate size ETT and stylette
iii. Place stylette in E.T. tube when delivery is imminent
iv. Capnograph CO2 detector (pedi cap)
e. Prepare for Umbilical Vessel Catheterization for high risk deliveries
i. Obtain prefilled 10 mL O.45 NS syringes
ii. Open umbilical line insertion tray using sterile technique
iii. Using estimated size and age of infant, confirm size and lumen
(single or double) preference with Neonatal Fellow &/or Attending
and add to tray:
< 1500 gm = 3.5 Fr catheter
>1500 gm = 5.0 Fr catheter (Also usually used for UVC)

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Resuscitation Policy Patient Care
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Last Approval: November 2021

iv. Add extra 3mL and blood gas syringes to tray using sterile technique
v. Using sterile technique place prefilled 10 mL 0.45 NS syringes on
tray
vi. Add 6-inch connector (with sliding blue clamp) to catheter prior to
flushing
vii. Add luer lock stopcock to adaptor and flush catheter with 10 mL
prefilled syringe
viii. Turn stopcock off to the catheter

3. Imminent Delivery – Once delivery is imminent, make sure all steps above are
completed. Then follow the steps below. There are ideally two nurses for each
resuscitation room delivery, one for patient care and one for documentation.
a. Make sure all steps are completed in 1 & 2
b. Alert the fellow, attending, RT’s, blood gas lab, and house officers of
pending delivery
c. Don personal protective equipment including hat, gown, and mask if
necessary.
d. Adjust room temperature to 80 degrees F
e. Remove drapes and open trays
f. Turn on radiant warmer
g. Turn on CR monitor
h. Turn flow on to flow inflating bag
i. Turn on suction, attach appropriate NeoSucker, open bulb syringe
j. Assure team responsibilities have been assigned by team leader, i.e. ICN
Fellow (See below)
k. Assist physicians/NNP’s with gowning and gloving
l. Prepare neonatal resuscitation record for documentation and blood gas slips
m. Open and activate thermal mattress and place polyethylene wrap on bed for
all premature infants of < 29 weeks, thermal hat for <29wks
B. SPECIAL CIRCUMSTANCES REQUIRING ADDITIONAL CONSIDERATION
1. Premature infants < 28 weeks gestational age
a. ICN Attending &/or ICN Fellow, RT, two resident physicians or NNP and two
ICN nurses will make up team automatically attending these set-up deliveries
b. Intubation and umbilical vessel catheterization equipment should be “wet”
down
c. Polyethylene wrap should be placed on all beds and used as soon as possible
after birth prior to applying monitors

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INTENSIVE CARE NURSERY
Resuscitation Policy Patient Care
Issued: March 2005
Last Approval: November 2021

Preparation for delivery:

Airway:
1. Bulb syringe, NeoSucker attached to suction
2. Surfactant preparation (RT)
3. Correct size mask attached to HV system

Glucose Homeostasis:
1. PIV ready to insert
2. D10W infusion prepared, placed in syringe pump, rate set, on standby
3. 3.5Fr single and double-lumen catheters wet-down

Thermoregulation:
1. Chemical mattress on scale
2. NeoWrap open on mattress
3. Thermal hat

2. Twins/Triplets
a. The room is set up for 3 neonates with three radiant warmers or incubators
b. If possible, there should 2 nurses per infant and 2-3 physicians/NNP’s.
Resuscitation will follow standard procedure depending on gestational age.
The gestational age and condition of twins/triplets will determine the number
of RTs needed at the resuscitation. An RT will assess the need for more than 1
RT at the time of the resuscitation.
3. Hydrops Fetalis
a. Equipment needed:
i. Centesis (thoracentesis, pericentesis, etc.) set-ups (30mL syringe,
stopcock, 23g butterfly)
ii. Large bore angiocaths (16, 18 and 20 gauge)
iii. Chest Tube equipment available in supply area if requested
iv. Prefilled 10 mL 0.45 NS
b. Prepare an additional Umbilical Arterial Catheter (UAC)
c. Make sure there is fresh (less than 5 days old) emergency released blood
products available upon request by Neonatal attending (OB nurses will order
from mother's type and screen when ICN nurse notifies them). Send
messenger for pick-up when set-up is imminent.
4. Diaphragmatic Hernia Preparation
a. Notify ExtraCorporeal Membrane Qxygenation (ECMO) Team (ECMO
Director, Attending, Coordinator) and Pediatric Surgery team for pending
delivery; ECMO algorithm may be initiated by team.
b. Prepare bed space in a double room in Orange Zone (bed 3and 4 or 9 and 10)
for the admission; have 4 functional suction set-ups ready.
c. Assess with Attending the need to order blood "on call" in case baby needs
transfusion. (Type and cross from maternal blood.) The maternal antibody

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Resuscitation Policy Patient Care
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screen must be completed. 0 negative CMV negative blood may be given after
screening for maternal antibodies.
d. Obtain estimated fetal weight from L and D staff.
e. Have Birth Center HUSC “pend” the admission in electronic medical records
system so that medications can be ordered by the ICN Fellow or Attending
prior to delivery.
f. Prepare a radiant warmer bed in set-up room with pre and post O2 sat monitors
and probes.
g. Have the following available:
i. Surfactant (prepared by RT)
ii. Paralytic agent
iii. Morphine sulfate
(Paralytic agent and morphine signed out from Pyxis, drawn up and
labeled, at bedside)
h. Set up 2 suction regulators
i. 1 for ET/oral suction
ii. 1 for replogle at low continuous suction. Have #10 replogle set up with
bubble trap, ready to insert
i. Intubate and obtain access. Administer paralytic and pain medication as soon
as possible after delivery
j. Insert replogle and place to suction as soon after delivery as possible
k. Send Type & Cross for ECMO blood as soon as possible.
CBC Differential & Platelets, blood culture and other labs per Attending. If
blood is needed emergently, make sure maternal screen for antibodies is
complete. O negative CMV negative blood may be used after screening for
maternal antibodies.
5. Omphalocele and Gastroschisis
http://manuals.ucsfmedicalcenter.org/NursingDept/NeoPedsProcedures/NPProcsPDF
/_PDFsafter12-29-2003/AbdominalWallDefectGastroschisis-
OmphaloceleNeonatal.pdf
a. Equipment needed:
i. Sterile Isolation Bag (Turkey Bag) (for the gastroschisis)
ii. Warm Sterile normal saline
iii. Replogle for gastric decompression
b. Notify surgeons of impending delivery
c. Check with Fellow/Attending for additional equipment needed
d. See also, UC Fetal Consortium Gastroschisis Pathway

e. Prior to delivery, request that obstetricians leave an extended length of

umbilical cord segment at delivery (to be used for sutureless closure later)
1. Gastroschisis

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Resuscitation Policy Patient Care
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Last Approval: November 2021

i. Place babe in turkey bag to shoulders

ii. Fill with warm sterile saline
iii. Position infant right side down to minimize tension on mesenteric
vessels
iv. Place blanket roll under intestines to support abdominal organs

2. Omphalocele
i. No bag
ii. Cover sac with warm saline-soaked gauze to keep moist
6. Myelomeningocele
http://manuals.ucsfmedicalcenter.org/NursingDept/NeoPedsProcedures/NPProcsPDF/_
PDFsafter12-29-2003/MyelomeningoceleLesionInfantSpinaBifidaNeonatal.pdf

a. Have Sterile Bacitracin solution (50,000 units/1000 mL normal saline)

without preservatives - prepared by Pharmacy
b. Non-adherent dressing
c. Large tegaderm

7. Ductal-dependent CHD
a.Prostaglandin
b. On pump, to bifuse, D5W syringe for carrier
c. PIV supplies prepared

C. TRANSPORT OF INFANT FROM SET-UP ROOM TO ICN AFTER STABILIZATION

1. RN to prepare infant for transport
a. Transfer Patient Data Module (PDM or “Brain”) to transport monitor.
b. Turn on tanks and transfer corrugated tubing to bed when preparing to transport
infant to unit (Notify person hand ventilating of temporary loss of flow)
c. If the shuttle is available, connect the shuttle to the bed prior to transfer.
d. Report current ventilator settings to RT in unit
e. Cover baby with warm blankets and hat from set up room or close incubator
f. If baby is stable enough, make brief stop for mother to see baby
g. Ensure that bands from Labor and Delivery are on patient or bed prior to the
transfer
h. Have Attending or Fellow sign set-up room record
i. File set up room charges in electronic medical record
D. CLEAN UP AND RESTOCKING THE RESUSCITATION ROOM
1. The PCA/Patient Support Assistant (PSA) will clean and stock the rooms.

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Resuscitation Policy Patient Care
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Last Approval: November 2021

a. Notify environmental services that room needs to be clean. Their responsibility is

to clean the floor and empty garbage cans.
b. Properly dispose of instruments from Umbilical Catheter tray
c. Dispose of all other used material from previous set-up
d. Clean all counters and wall unit with disinfectant
e. Replace radiant warmer/incubator
f. Set up room as described in (A1) prepare room "dry"
g. Attach Continuous Positive Airway Pressure (CPAP) to wall and place
transducer on CPAP on the bed
E. SUPPLY MANAGEMENT
1. The Set-up room includes 3 distinct areas for supply management:
a. Counters and Mayo stands
b. Supply drawers and shelves
c. Delivery room/admit cart
2. Stocking procedures are as follows:
a. The ICN Patient care assistants (PCA’s) will be responsible for stocking of the
counters and mayo stands, and delivery room/admit cart
b. The Department of Materials Services is responsible for the daily management of
all supplies in the set-up room. Call Materials Services if items are low in stock
or missing.

F. SPECIFIC GUIDELINES FOR NEONATAL RESUSCITATION TEAM

RESPONSIBILITIES
1. An Attending will be present in the following circumstances:
a. All infants ≤ 28 6/7 weeks Gestational Age (GA)
b. Infants 29 0/7 - 32 6/7 weeks GA with < 24 hours exposure to antenatal
glucocorticoids or other concerns regarding fetal well-being (e.g., abnormal fetal
heart rate tracing, chorioamnionitis, abruption)
c. Multiple gestation pregnancies ≤ 32 6/7 weeks gestation: these deliveries are
often complicated and may result in neonatal distress and attending presence
assures there are an adequate number of experienced medical providers present.
d. Infants with congenital anomalies requiring immediate care after birth (e.g.,
abnormal airway, CDH, abdominal wall defects, sacrococcygeal teratoma,
hydrops fetalis or large single compartment fluid collection, fetal arrhythmias,
urinary tract obstruction with decreased amniotic fluid volume)
e. Emergency Cesarean section due to loss of fetal heart tones, prolonged or
ongoing fetal bradycardia, suspected fetal blood loss, prolapsed cord or other
concern for severe fetal compromise

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f. If the Obstetrics Attending requests her/his presence

2. An Attending will be available for the following:
a. Infants 29 0/7 – 32 6/7 weeks’ GA with ≥ 24 hours exposure to antenatal
glucocorticoids and no other concerns regarding fetal well-being
b. Infants with congenital anomalies that may require immediate care after birth (e.g.,
complex congenital heart disease, CCAM without hydrops, pulmonary
sequestration, GI obstruction, cleft palate, urinary tract obstruction with normal
amniotic fluid volume)
3. An Attending will be present if the Fellow requests her/his attendance:
a. Infants ≥ 33 0/7 weeks’ GA with no known congenital anomalies or other
concerns regarding fetal well-being
b. Infants with congenital anomalies that are unlikely to require immediate care after
birth (e.g., myelomeningocoele, encephalocoele, small abdominal mass)
4. The Attending will attend any delivery with the Pediatric resuscitation team at the
request of the RN attending delivery, senior Pediatrics Resident, the Obstetrics
Attending or the Neonatal Attending. In addition, the Bridge Attending will be present
at any delivery to provide backup for the Pediatrics resident resuscitation team in any
circumstance where the team is concerned that the senior resident is not comfortable
with the circumstances of the delivery.
a. In any case of maternal gas anesthesia or significant therapeutic narcotic exposure
the Attending should be notified and be available in ICN if needed. If there is
concern regarding fetal well-being, use of the set-up room for these resuscitations
should be considered.
b. If the Attending is not present, she/he should be called immediately if:
i. chest compressions are initiated
ii. any newborn is requiring significantly more resuscitation than anticipated
iii. a newborn fails to respond to resuscitative measures
iv. the Pediatrics team is alerted to any condition that might represent significant
fetal/neonatal compromise (as above, e.g., loss of fetal heart tones, prolonged
or ongoing fetal bradycardia, suspected fetal blood loss, prolapsed cord or
other concern for severe fetal compromise).
G. Team roles during set-up resuscitations
1. Triage Nurses
a. Notify Charge Nurse, MD & RT if unaware
b. Check delivery room resuscitation equipment
c. Check admit bed for readiness
d. Assist with “wet down” preparation
e. Start Apgar timer when infant born

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f. Dry baby and apply limb leads and sat probe

g. Temperature and glucose; glucose can be taken from Umbilical Arterial Catheter
(UAC)/Umbilical Venous Catheter (UVC) (see Premie Project protocols for
temp/glucose guidelines)
h. If emergency medications are needed, drug sheets with average weights are
provided in a binder on the code care, and they can be given at the discretion of
the attending physician
2. Recording Nurse
a. Record all events and vital signs
b. Request one- and five-minute Apgar scores from the physicians
c. On first draw from the UAC/UVC line, obtain blood culture, blood gas,
hematocrit, CBC, diff, platelets, type and screen, cross match (approximately 3mL
of blood), blood glucose
d. Record name of staff attending resuscitation (MD, RN, RT)
e. Complete the “Charge Capture” on electronic medical record.
f. Review resuscitation record for completeness of documentation
g. Have Fellow or Attending sign resuscitation record
2. Fellow/Attending
a. Assign roles to team members
b. Will run the resuscitation
3. Provider or NNP
a. A provider will be assigned to receive the baby and pass the baby through the
window
b. Should then assist with resuscitation
c. Review the maternal chart and other antenatal information to determine what level
of resuscitation might be required
d. Check resuscitation equipment
e. Manage the airway providing respiratory support as needed
f. Place umbilical line if necessary
g. Transport baby with CPAP or Positive Pressure Ventilation (PPV) to the ICN
4. Respiratory Therapist Responsibilities
a. Be present at all deliveries < 28 weeks gestation, and notified for others < 34
weeks
b. Check blender and PPV set-up
c. Prepare/warm exogenous surfactant if indicated by provider

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d. Assist with intubation and securing of Endotracheal Tube (ETT) after confirmation
of intubation
e. Prepare gas tanks for transport to ICN
VI. RESPONSIBILITY
These guidelines were established and reviewed by the Intensive Care Nursery Joint
Practice Committee.
VII. HISTORY OF POLICY
Author: Intensive Care Nursery Joint Practice Committee
Issue Date: March 2015
Reviewed and Revised: March 2012, L. Nathan, RNC, Y. Sun, MD; S. Sehring, MD
T. Shimotake, MD; M. Thompson, RN, M.K. Stratigos RN-NIC. October 2014 M.K. Stratigos, RN-
NIC; K. Johnston, RN-NIC; Y. Sun, MD, PhD; R. Keller, MD;4/2016 S. Mazely RNC-NIC; 6/2017
S. Mazely RNC-NIC and A. Estrada-Yost RN.
Last Revision/Review: 112021 M. Merino, RN; L. Bellingham, RN; T. Shimotake MD

APPENDIX A

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Antenatal Counseling and Management

Eligibility and Relative Contraindications to resuscitation at 23-23 6/7 weeks
****In 2014-15, the UCSF Maternal Fetal Medicine and Neonatology faculty
departments reviewed the evidence on outcomes at periviable gestations and developed
the following eligibility and relative contraindications to active management at periviable
gestation. Re-reviewed guidelines September, 2020. 1–7

CRITERIA MANDATORY TO BE OFFERED RESUSCITATION AT 23 0/7-23 6/7

[ ] No major congenital anomalies
 Anomalies that require surgical care for survival- e.g. TEF, single ventricle,
CDH
 Anomalies that are incompatible with life: e.g. bilateral renal agenesis
 Known chromosomal anomalies with known significant impairment: e.g. T13,
T18
 All fetal treatment patients to be discussed on an individual basis with MFM,
neonatology, and fetal surgery teams prior to providing options to the family,
as these will differ with different cases.
[ ] No chorioamnionitis on presentation, clinical diagnosis made by obstetrics
team
 It is understood that chorioamnionitis is an evolving picture, and if develops
prior to 24+0, would remove a candidate from resuscitation
[ ] Greater than 24 hours from first dose of BMZ
[ ] Category 1 or 2 Fetal Heart Rate Tracing; no evidence of category III tracing on
presentation
[ ] No prior or current laminaria placement

RELATIVE CONTRAINDICATIONS TO RESUSCITATION AT 23 0/7 – 23 6/7,

unless otherwise specified, to be taken into account in counseling
[ ] within 24 hours s/p select fetal treatment procedure (i.e. Twin to twin), though
all fetal treatment cases need to be discussed an on individual basis with MFM,
Neonatology, and the fetal treatment team prior to fetal intervention
[ ] multiple gestation pregnancy
[ ] IUGR (<10%)
[ ] Unexplained or prolonged oligohydramnios

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 Intensive Care Nursery POLICY
INTENSIVE CARE NURSERY
Resuscitation Policy Patient Care
Issued: March 2005
Last Approval: November 2021

Resuscitation at limits of viability

VIII. >26 WEEKS – STANDARD RESUSCITATION

IX. 25 0/7 - 25 6/7 – RESUSCITATION IS STANDARD OF CARE, WITH PARENTAL
CHOICE FOR COMFORT CARE OR RESUSCITATION AFTER COUNSELING
AND SHARED DECISION-MAKING
X. 24 0/7 - 24 6/7 – RESUSCITATION IS OPTIONAL. PARENTAL CHOICE FOR
COMFORT CARE OR RESUSCITATION, BASED ON INDIVIDUAL RISK
FACTORS, E.G. CHORIO, IUGR, ETC. AFTER COUNSELING AND SHARED
DECISION-MAKING

XI. 23 0/7 – 23 6/7 – THERE IS LIMITED EVIDENCE TO RECOMMEND

RESUSCITATION IN THIS GROUP BASED ON COHORT STUDIES THAT
SHOW HIGH RATES OF MORBIDITY AND MORTALITY. PARENTAL
CHOICE FOR COMFORT CARE OR RESUSCITATION AFTER COUNSELING
AND SHARED DECISION-MAKING IF MEETS CRITERIA TO BE
CONSIDERED.

This guideline is intended for use by UCSF Medical Center staff and personnel and no representations or
warranties are made for outside use. Not for outside production or publication without permission. Direct
inquiries to the Office of Origin or Medical Center Administration at (415) 353-2733

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