The transition to breathing for the hydropic infant after birth is a particularly tenuous situation. The delivery room management of hydrops can be a critical period of intervention and a highly intense event with a critically sick infant requiring extensive resuscitation and multiple procedures immediately following delivery.1 The basic principles for resuscitation of high-risk newborns still apply. However, because of the possibility of pleural effusions and ascites in hydrops, the team must be prepared to perform two additional procedures that are not commonly performed by delivery room personnel: thoracentesis and paracentesis. This chapter outlines the overall approach to delivery room management for hydrops and provides detailed descriptions of these two procedures.
Prior to delivery, appropriate counseling of the family may involve discussion of the etiology of hydrops, if known, and the prognosis.2 In some situations, hydrops may be an end-stage process, and comfort care after delivery may be a reasonable alternative to intensive resuscitation. This decision can be made prior to delivery with informed consent of the parents, allowing them to hold the infant soon after birth and to provide comfort. Prognosis in hydrops is dependent on the etiology, although the etiology may be indeterminate in about a quarter of cases. The prognosis can be discussed prior to delivery if time is available.
If resuscitation is planned, counseling of the parents should involve explaining the procedures that may be carried out in the delivery room. The delivery room will be a busy and intense environment; thus, preparation of the parents may help to relieve some degree of anxiety.
The makeup of the resuscitation team may vary by institution. Table 68-1 offers a potential delineation of roles that can be modified depending on availability of specific clinical personnel. The expected duties of clinicians may vary by institution, and this table can serve as a template for developing protocols that are more specific. However, it should be noted that the list of tasks is extensive, and a team consisting of at least 5, and possibly more, members is not an unreasonable expectation for this scenario.
Table 68-1Roles of Team Members in Delivery Room Management of Hydrops ||Download (.pdf) Table 68-1Roles of Team Members in Delivery Room Management of Hydrops
|Assess infant, manage airway and ventilation
|Continued assessment, perform thoracentesis and/or paracentesis as needed
|Assess heart rate, perform chest compressions
|Umbilical catheter placement to obtain labs and facilitate medication and volume infusion
|Dry infant, help with temperature control measures, apply monitors (pulse oximeter/ECG leads if available), assess breath sounds
|Draw up medications and fluids, prepare and assist with other equipment as needed
|Assist with airway management...