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Neonatal emergencies in the delivery room require immediate treatment, effective teamwork, and clear communication to optimize outcomes. Neonatal resuscitation teams need to be prepared for anticipated and unanticipated delivery room emergencies, highlighting the importance of having available team members trained in basic neonatal resuscitation skills, including airway management and circulatory support. Healthcare providers who attend deliveries should be up to date with the American Academy of Pediatrics Neonatal Resuscitation Program® training and be familiar with neonatal resuscitation concepts and basic skills related to cardiopulmonary resuscitation and emergency cardiovascular care. In order to maintain and enhance team member performance, regular simulation programs can promote training opportunities to help familiarize team members with clinical situations requiring expertise to navigate a myriad of neonatal emergency scenarios.
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To facilitate effective teamwork when neonatal emergencies arise, clearly defined roles and ongoing team communication are essential. Initial information gathering should include obtaining critical maternal and fetal information from the obstetrical team to clarify a diagnosis and potential problem, involving family members in resuscitation-related discussions, and pre-briefings with resuscitation team members to formulate a shared mental model of the anticipated situation and plan. Before any delivery, basic information should be obtained from the obstetrical team, including the “4 As”: (1) Age—What is the gestational age? (2) Amniotic Fluid—Is the amniotic fluid clear? (3) Amount—How many babies? and (4) Additional Risk Factors? Discussion should include providing delayed umbilical cord clamping (minimum 60 seconds recommended) to promote placental transfusion to neonates unless contraindicated, such as in the setting of maternal hemodynamic instability, interrupted placental circulation (eg, abruption, bleeding placenta previa, known true umbilical cord knot, cord avulsion), or with non-vigorous newborns who are thought to require immediate resuscitation. If feasible, discussion prior to the delivery with parents, partners, and supporting family members is recommended to provide important information about the expected resuscitation, potential interventions, and postdelivery plan.
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In conjunction with gathering and communicating essential information, standard neonatal resuscitation equipment or any other specialized equipment should be identified and configured for use. In any neonatal emergency, airway stabilization may be needed to ensure adequate ventilation. For all potential neonatal emergencies, prenatally detected fetal malformations and anomalies should prompt multidisciplinary counseling and delivery planning, ideally in a center equipped with high-risk pregnancy assistance, relevant pediatric subspecialists (eg, pediatric surgery), and neonatology.
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RESPIRATORY EMERGENCIES
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The rapid fetal-to-newborn transition at birth is considered the most complex physiologic adaptation in human life. After birth, failure to transition to effective air-breathing may lead to morbidities and death. While respiratory emergencies may occur unexpectedly, advances in prenatal ultrasound and magnetic resonance imaging (MRI) have enabled the identification of fetuses at risk for postnatal airway obstruction, which allows for coordinated multidisciplinary planning to address potential treatment options for anticipated airway emergencies at the time of delivery. In pre-identified airway obstruction, elective cesarean delivery allows a planned response with the proper personnel and equipment to ...