Edward F. Bell, MD
Peer Review Status:  Internally Peer Reviewed
Maria Lofgren, ARNP, NNP-BC
Denise Holiday, ARNP, NNP-BC

Personal in Attendance

A pediatric team should be present at ALL high-risk deliveries.  All deliveries that are high-risk will be listed on the board in Labor and Delivery.  In addition, the pediatric team will attend any other deliveries when requested to do so by the obstetric staff.

The pediatric team will be notified of a high-risk delivery ahead of time so that they may familiarize themselves with the mother and any complications of the pregnancy in order to prepare for any type of neonatal emergency care that might be required.  The pediatric team and the NICU should be given an approximate expected time of delivery.

The pediatric resident and/or neonatal nurse practitioner will attend all high-risk deliveries (PL-2/NNP assigned to the NICU during the day and PL-3/NNP assigned to the NICU during the night).  The attending neonatologist (or fellow) in the NICU will decide on a case-by-case basis which members of the pediatric team should attend each high-risk delivery.  At least twice daily, the cases on the high-risk board in the NICU will be reviewed with the NICU medical team:  in the morning with the PL-2 and NNP, and in the evening with the PL-3/NNP.  The attending neonatologist will determine whether fellow or faculty attendance at the delivery is advisable.  A neonatal intensive care nurse will accompany the team.

The delivery of an infant equal to or less than 1500 grams is a special situation.  The infant who is less than 1500 grams should be resuscitated by the most skilled person available.  Time and communication are critical.  Therefore, intubation will generally be performed by the NNP, PL-2, fellow, or PL-3.  There are many other opportunities for the intern, either pediatric or obstetric, or the family practice resident to gain skills in intubation.  Clear communication should take place prior to the delivery so that each person understands his role.  The resuscitation team will decide on the timing of transfer to the NICU.

Pediatric personnel should be present in the delivery room to assist with effective resuscitation even in certain borderline situations when the obstetric staff has decided against fetal intervention.  If the estimated gestational age on a “22-23 week infant” is wrong, for example, and a depressed “26 week infant” is delivered, an immediate and full resuscitation effort is required.

ALL pediatric personnel who attend resuscitation should be listed on the Labor and Delivery Record and placed in the infant’s electronic medical record.  A procedure note entitled “Delivery Room Resuscitation” will be completed by LIP running the resuscitation (“the head of bed”) and signed by the neonatologist.


A resuscitation bag will be kept stocked and available in the NICU at all times.  It will be the responsibility of the NICU nurse who is attending the delivery of a high-risk infant to take this bag with her.  Items in the resuscitation bag should include:

  • two each ET tubes: 2.5, 3.0, 3.5, 4.0
  • one MEC ET tube pack
  • two stylets
  • 250 cc anesthesia bag and masks (one preemie; one newborn)
  • one oxygen connecting tubing
  • one roll adhesive tape
  • one roll ¼” yellow tape
  • one can adhesive spray
  • two laryngoscope handles
  • two Miller 0 blades
  • one Miller 1 blade
  • two scissors (sterile)
  • one steri-drape
  • one hemostat (sterile)
  • Suction equipment
    • one bulb syringe
    • two 8 fr suction catheters
    • one 8 fr suction catheter with glove
    • one 6 fr suction catheter with glove
    • two sterile gloves
    • four sterile sims connectors
    • four RT saline (5 ml)
  • NG tubes
    • two 8 fr
    • two 5 fr
  • Needles and syringes
    • two 25 gauge short butterflies
    • two 23 gauge long butterflies
    • two 25 gauge needles
    • two 22 gauge needles
    • two 20 gauge needles
    • two 18 gauge needles
    • two 20 gauge IV catheters
    • two 22 gauge IV catheters
    • two 24 gauge IV catheters
    • one 20 cc syringe
    • one 10 cc syringe
    • two 3 cc syringes
    • two 1 cc syringes
  • Medications
    • two NaHCO3
    • one atropine sulfate
    • one epinephrine 1:10,000
    • normal saline 500 ml
    • one calcium gluconate 10%
    • two Narcan (naloxone hydrochloride) (0.4 mg/ml OR 1.0 mg/ml solution)
  • Other
    • one razor
    • four #11 blades
    • two 4x4’s
    • one needle aspiration pack
    • two stopcocks
    • twenty alcohol preps

Each of the radiant heater beds is equipped with a portable oxygen tank.  Following resuscitation and stabilization, the infant should be transferred to the NICU on the warmer bed.