APPENDIX.

Standards Document, Project 27/28: Standards for Neonatal Care

Resuscitation
    Personnel present for resuscitation: Intermediate-grade pediatric staff and/or a consultant neonatal pediatrician, in addition to a junior pediatrician from the neonatal unit, should be present for the delivery.31C
    In the first minute after birth: If there are absent or ineffective respirations or persistent heart rate of <100 beats/min, then IPPV should be administered via a bag and mask or tracheal intubation without delay.32C
    5 minutes after birth: If there are absent or ineffective respirations or persistent heart rate of <100 beats/min, then IPPV should be administered via a tracheal tube.33C
    At any time during resuscitation: After effective IPPV has been established, if at any age the heart rate is <60 beats/min, then external chest compression should be performed.32C
    On admission to the neonatal unit: If there are absent or ineffective respirations or persistent heart rate of <100 beats/min, then mechanical ventilation should be administered via a tracheal tube.32C
Early thermal care
    The infant's temperature on admission to the neonatal unit should be above 36°C.34C
Surfactant therapy
    Surfactant should be administered to all intubated infants.35
    Surfactant should be administered as soon as practical after birth.36A
Ventilatory support
    Regular blood gas analysis should be performed while the infant remains ventilated, on CPAP, or in supplementary oxygen.34C
    Ventilation should be adjusted with the aim of maintaining a pH >7.25 and PaO2 6–10 kPa.34C
    The response to therapy should be clearly recorded along with the remedial action taken.33C
Cardiovascular support
    Blood pressure should be monitored regularly while the infant remains unwell.34C
    The mean blood pressure (mm Hg) should be managed with the aim of maintaining it at or above the infant's gestation in weeks.34C
    The response to therapy should be clearly recorded along with any remedial action taken.33C
  • CPAP indicates continuous positive airway pressure. Standards are classified according to the scheme endorsed by the NHS Executive to show the level of evidence on which they are based: A, evidence from randomized, controlled trials; B, evidence from other robust experimental or observational studies; C, more limited evidence, but the standard relies on expert opinion and has the endorsement of respected authorities.