22  Delivery Room Management

22.1 Delivery Room Attendance

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Level 0: Routine delivery

Attendance: L&D RN with or without RT

Level I: low risk for resuscitation

Attendance: NICU RN & RT

  • 35-36 weeks
  • < 2kg
  • Breech C/S
  • Maternal meds: opiates/ SSRI/ Mg/ etc.
  • Maternal exposure to illicit drugs (+U tox on admission)
  • Presence of meconium
  • No prenatal care
  • Multiples

Level II: high risk for resuscitation

Attendance: NICU RN, RT and MD

  • < 35 weeks GA
  • Category III FHR tracing
  • Vacuum / forceps delivery
  • Vaginal breech
  • Urgent or Emergent C/S
  • Hydrops with minimal fluid
  • Mother under general anesthesia
  • Placenta previa
  • Placental abruption
  • Placenta percreta/ increta/ accreta
  • Shoulder dystocia
  • Cardiac dysrhythmia (tachyarrhythmia, bradycardia, heart block, etc.)
  • Eclampsia

Level III: complex resuscitation

Attendance: 2 NICU RN, RT, and MD

  • 2 RNs & 2RTs required for <25 weeks GA unless staffing shortage
  • 2 RNs & 2 RTs recommended for 25 - 27 weeks GA
  • Hydrops with projected need for tapping
  • Multiple congenital defects
  • Projected severe/ compromised/ lethal outcome



22.2 Thermoregulation and Heat Loss Prevention

Labor & Delivery / OR

  • Maintain L&D/OR temperature at 70-74℉
  • Preheat the radiant warmer before birth and set on servo-control mode
  • Use prewarmed blanket to dry the newborn during delayed cord clamping
  • use prewarmed blanket to receive the newborn and dry under the warmer
  • Place temperature probe as soon as baby is under the warmer
  • Monitor temperature frequently (every 5-10 minutes) prior to transfer to the NICU
  • Maintain axillary temperature between 36.5℃ - 37.5℃
  • Place a thermal mattress under the blanket on the radiant warmer
  • Wrap the baby in a polyethylene plastic bag or wrap (<28 weeks and/or < 1,000 grams)
  • Place a prewarmed hat on the baby’s head (as soon as possible)
  • Keep the newborn fully covered during resuscitation and stabilization


Delayed Cord Clamping

  • All infants who emerged with active tone should receive delayed cord clamping for at least 30 sec unless:
    • Mono/di twins with TTTS or significant fetal wegith deiscrepency
    • Mono/mono twins
    • Need immediate evaluation and/or resuscitation (e.g., placenal abruption)