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Considerations for the Neonate Delivered at Home. Susan J Dulkerian, MD Director of Nurseries, Mercy Medical Center Fetus and Newborn Subcommitee Chair AAP, Maryland Chapter. State of Maryland Infant Mortality. Several years ago, rate was significantly higher than the national average.

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considerations for the neonate delivered at home

Considerations for the Neonate Delivered at Home

Susan J Dulkerian, MD

Director of Nurseries, Mercy Medical Center

Fetus and Newborn Subcommitee Chair

AAP, Maryland Chapter

state of maryland infant mortality
State of Maryland Infant Mortality
  • Several years ago, rate was significantly higher than the national average.
  • Many state-wide initiatives have been made-> with resultant significant decrease in mortality and improved safety and quality of care is delivered to neonates throughout the state
  • Mortality rate at 6.7/1000 in 2010 & 2011 – lowest in recorded history of stats in MD
neonatal care in the peripartum period
Neonatal Care in the Peripartum period
  • Care as outlined in the Guidelines of Perinatal Care, Sixth Edition
  • NRP expertise and equipment
  • Transition of Care of the acute infant
  • Newborn Screening
  • Bilirubin screening and follow-up
  • Follow up care
neonatal care
Neonatal Care
  • Care delivered to a neonate should be the same, independent of the delivery site.
  • Care should be as outlined in guidelines, and should take into consideration: mother’s history, the labor and delivery history, and the neonatal exam and course
neonatal transition and resuscitation
Neonatal Transition and Resuscitation
  • Birth is usually a benign and natural event
  • 10% of all deliveries will require some assistance of the normal transition to exteruterine life
  • Neonatal Resuscitation Program (NRP) Guidelines
slide6
NRP
  • One person present at the delivery whose sole responsibility is to care for the infant, and who can perform neonatal resuscitation, including intubation
  • Appropriate neonatal equipment should be immediately available for all deliveries
neonatal transition and resuscitation1
Neonatal Transition and Resuscitation
  • Prior arrangements should be made between the midwife provider and the accepting facility/providers, in the event that transfer is necessary
  • Assure complete and accurate transition of care to accepting pediatric provider
  • Prior arrangements for transport, if needed
immediate neonatal care
Immediate Neonatal Care
  • Assess for risk factors for hypoglycemia, screen if indicated. If persistent, transport should be arranged for ongoing monitoring and treatment
  • Cord blood type and Coombs should be sent in all RH negative moms, bilirubin level as clinically indicated
  • Consider evaluation of infants born to O+ moms
  • Intramuscular Vit K- studies show that oral vitamin K is not well absorbed
newborn screening
Newborn Screening
  • Metabolic screening- done at 24 hours after initiation of feeds- screens for inborn errors of metabolism which are life-threatening if missed; hypothyroidism, sickle cell disease
  • Hearing screening- every neonate should be screened for congenital hearing loss (intervention works!)
  • Congenital Cyanotic Heart Disease Screening (CCHD)
congenital cyanotic heart disease screening cchd
Congenital Cyanotic Heart Disease Screening (CCHD)
  • As of September 1, 2012 all neonates should be screened for CCHD at 24-48 hours
  • Those who do not pass screen will need further evaluation and an echocardiogram as soon as possible
transition of care
Transition of Care
  • Follow up pediatric provider should receive a summary of infant’s history and neonatal course
  • Arrange for reevaluation within 24-48 hours by a pediatric provider
  • Follow up assessment for hyperbilirubinemia and level if clinically indicated