1. The Golden Hour
Focus on pre-planning, role definition, improving communication and increasing efficiency of surfactant administration
Revised

2. Pre-planning for Deliveries <27 weeks
Transport RN RT
NNP
Tell team members of impending delivery: NNP, RT, bedside RN, charge RN
Bring surfactant and have it warmed and drawn up for babies <27 weeks
Have suction ready
Have PIV out & ready
Have IV fluids ready
Have DR and transporter ready
Review preplanning checklist in DR with team (verbal)
Bring vent to DR
Bring Neopuff to DR. Starting settings PIP=25, PEEP = 6
Have appropriate size face mask out and ready, have ETCO2 detector & pulse oximetry ready
Have sterile blade, appropriate size ETT based on estimated weight cut & ready in sterile fashion on Mayo stand in DR
Have one ETT size bigger and one smaller than the ETT that is cut available in DR for use if needed (not cut prior to delivery)
Have neobars available
Notify fellow/MD of impending delivery and discuss specifics of care plan
Determine estimated weight and tell transport RN and RT in order to have appropriate ETT size cut, surfactant drawn up & IV fluid ready based on estimated weight
Have UAC/UVC out, flushed & ready

3. Pre-planning for Deliveries ≥27 weeks
Transport RN RT
NNP
Tell team members of impending delivery: NNP, RT, bedside RN, charge RN
Bring surfactant for infants weeks but do not warm or draw up.
Do not routinely bring surfactant for infants >34 weeks unless stated by MD/NNP
Have suction ready
Have PIV out & ready
Have DR and transporter ready
Review preplanning checklist in DR with team (verbal)
Bring Neopuff to DR. Starting settings PIP=25, PEEP = 6
Have appropriate size face mask out & pulse oximeter ready
Notify fellow/MD of impending delivery and discuss specifics of care plan
Determine estimated weight and tell transport RN and RT in order to know appropriate meds, ETT size, and IV fluid rate based on estimated weight

4. Insertion length at the lip (cm)
Surfactant administration in DR Goal: Safely improve efficiency in surfactant administration to neonates warranting intubation in the delivery room
New Process: (if warrants intubation in DR)
Suction mouth then nose per NRP
Intubate
NNP/MD to hold ETT at appropriate insertion length to roof of mouth
Confirm ETT placement by auscultation, condensation in tube, and + yellow pediacap color change
Reconfirm appropriate length at lips
Administer surfactant WITHOUT TURNING the infant’s position in 2 equally divided aliquots with PPV bagging for 1-2 minutes at approximate rate of 60bpm in between aliquots
RT to temporarily stabilize ETT using silk tape and 1 wrap around ETT
RT to stabilize ETT and vent tubing position so no torque on the baby/ETT/tubing
NNP to work on access
RT to measure for Neobar and warm it
Once access complete and baby ready for transfer back to NICU, Neobar to be applied by RT and RN under controlled environment to minimize extubation
Final preparation and return to NICU
Guideline for ETT
Weight
ETT size (mm)
Cut length (cm)
Insertion length at the lip (cm)
500gm
2.5 13
750gm 6
1000gm
1500gm
3.0 14 7
2000gm
2500gm
3.5 8
3000gm 15
3500gm 9
4000gm
4.0 16 10

5. Quick Reference Guides
Approx. Gest. Age
~50% for weight estimate
24 weeks
500gm
26 weeks
750gm
28 weeks
1000gm
30 weeks
1500gm
33 weeks
2000gm
35 weeks
2500gm
40 weeks
3500gm
Weight
ETT size (mm)
Cut length (cm)
Insertion length at the lip (cm)
500gm
2.5 13
750gm 6
1000gm
1500gm
3.0 14 7
2000gm
2500gm
3.5 8
3000gm 15
3500gm 9
4000gm
4.0 16 10

6. QUICK REFERENCE GUIDE

7. Delivery Room Quick-Check List