Happy New Year! I hope that you had a wonderful Holiday Season. Please enjoy this newsletter and know that our next one will be posted electronically on our new website! The BCH Outreach Team, specifically Cynthia Jensen, has been working hard to get this up and running. The goals for this website are for it to be easy and useful for you and your teams. We will be looking to you for feedback and ways to expand this resource. I want to thank the BCH Outreach Team for all their hard work this year. They are a great team! I look forward to 2016.

JANUARY 2016 VOLUME 7, ISSUE 1

Outreach Program Winter Newsletter

Inside this Issue

Greetings!! 1-2

Welcome Tanya 3

Preemie Project 3

Levels of Maternity

Care

4

Periviability

Counsleing

5-6

AIM Conference 40th Anniversary

6

Maternal Early

Obstetric Warning

Signs (MEOWS)

7

An Outreach Story 8

Magnesium for

Neuroprotection

9

UCSF Safe Sleep

Program

10

NRP 2017 Updates 10 -11

Outreach Website Registration

12

Access/Contact Info 12

Greetings from the Outreach Program! Cynthia Jensen RN, MS, CCNS

Happy New Year!

I cannot believe that I have been in the role as Outreach Program Manager for 6

months now, time is flying. Thank you for your patience and support as I try to fill the

big shoes that Jill Thornton left behind when she retired last June. February 1st will be

the anniversary of our move to Mission Bay. This has been a blessing and a huge learn-

ing experience for everyone here. Hoping to see more of you come by for a tour and

visit if you haven’t already. We have great meeting facilities and will be hosting more

conferences here on campus in addition to those we provide in the community.

Change is in the air...

An astute professor once told me that the only person who likes change is a baby with

a dirty diaper and I have to agree! Although difficult, we all know that change can be

good, and helps us continually improve ourselves and our services. Outlined below are

some upcoming changes to the Outreach Program. I sincerely hope that these changes

will help us to better serve you.

Meet the newest member of the Outreach team: our new website!

Starting with phase one this month, we will be improving your access by launching the

new Outreach website at: bchsfoutreach.ucsf.edu.

This phase will allow you to learn about the program, see a calendar of upcoming clas-

ses, and access UCSF policies, procedures and resources. The policies and procedures

will be in a password protected area of the site so users will have to set up an account.

Once we verify that the applicants are outreach affiliates, we will send a link with a log

on and password. We want all of your staff to have access, any time of the day or night

so please encourage them to create accounts! The plan for the second phase is in pro-

cess. We are hoping to build in a system for online payment for classes, stay tuned for

details. Continued on page 2

Welcome from Diane VonBehren RNC-OB, MS Perinatal Services Director

PAGE 2 VOLUME 7, ISSUE 1

It’s not easy going green

Outreach is committed to environmental responsibility and one of the ways we hope to decrease waste and use of natural

resources (in our case trees) will be to have more web based materials for our classes. We get several complaints each

year about the size of the slides on our class handouts being too small. We already use a tremendous amount of paper

and if we were to increase size of the slides we would need a lot more of it. Our solution will be to email handouts a few

days before the class in pdf format so the attendees can view them in larger size, and keep a copy on their computer. You

will notice that nearly all of the larger conferences you attend use this system with the same goal in mind. While we will

miss the hard copy handouts, going green is the right thing to do.

In the near future, registration, evaluations and CEUs will all become electronically based. We will also be moving to

more electronic submissions for case conferences instead of faxing or mailing. The benefit of this is to decrease the risk

of losing protected health information, as well as reduce the large amounts of paper used for printing charts that may be

hundreds of pages long. We will work with your hospital information systems to transition this new process over time.

We love feedback!

We are always looking for ways to improve our services and would love to hear from you. We now have a dedicated email address for Outreach which is: bchsfoutreach@ucsf.edu or call us at (415) 353-1574. Wising you and yours an amazing 2016,

Cynthia Jensen RN, MS, CNS, Outreach Program Manager cynthia.jensen@ucsf.edu (415) 353-1401

Greetings from the Outreach Program! (cont’d from page 1)

CONTACT US:

Diane VonBehren RNC-OB, MS

Director Perinatal Services

diane.vonbehren@ucsf.edu

Cynthia Jensen RN, MS, CNS

Program Manager

cynthia.jensen@ucsf.edu

(415) 353-1401

Valerie Huwe, RNC-OB, MS, CNS

Perinatal Outreach Educator

valerie.huwe@ucsf.edu

(415) 353-1449

Tanya Kamka, RNC-NIC, MSN

Neonatal Outreach Educator

tanya.kamka@ucsf.edu

(415) 353-3912

Sharlene Johnson, MPA

Program Analyst

sharlene.johnson@ucsf.edu

(415) 502-6930

Our Team

Front: Sharlene Johnson, Valerie Huwe, Tanya Kamka

Back: Diane VonBehren, Cynthia Jensen

PAGE 3 VOLUME 7, ISSUE 1

Tanya Kamka Joins UCSF BCH Perinatal Outreach Team

Preemie Project at UCSF Medical Center by Tanya Kamka, RNC-NIC, MSN

Delivering care to Extremely Low Birth Weight (ELBW) Infants (<28 weeks gestation or <1000 gram birth weight) presents many complex and unique medical, social and ethical issues. The UCSF Benioff Children’s ICN is dedicated to providing this population with not only the best chance of survival, but survival without morbidities. The Preemie Project is a collaborative effort across multiple disciplines that will provide a best practice guideline for the less than 28 week infant. These guidelines are a compilation of sound evidence, and practices that have been successful in other centers. These will be implemented in March 2016, and will be followed up with a quality improvement bundle for IVH reduction. This has been such a comprehensive effort critically focused on standardizing care for our ELBW infants. We look forward to keeping you abreast of our challenges and successes implementing the Preemie Project!

Tanya has been in the UCSF Benioff Children’s Intensive Care Nursery just over a year and has recently

joined our Outreach team as the Neonatal Outreach Educator. Prior to joining UCSF Tanya worked at a lev-

el IV NICU in Southern California for seven years where she gained extensive experience in caring for cardi-

ac, surgical, and extremely low birth weight (ELBW) infants. Tanya was a core nurse in the development of

the Small Baby Unit, dedicated to optimizing outcomes for ELBWs. After caring for multiple patients with a

rare skin disorder Epidermolysis Bullosa, and developing a care guideline for all patients with fragile skin,

Tanya obtained her Master’s degree in nursing education in 2013 from Walden University. She is thrilled to

join our team and looks forward to working with each of you in supporting your units!

Please join us in welcoming Tanya to our BCH Family!

UCSF Benioff Children’s Hospital

celebrated World Prematurity

Day on November 17th, 2015

with a conference on the Pre-

term Birth Initiative (PTBI).

A team of experts including

parents of preterm babies pre-

sented stories , projects and

research aimed at reducing the

leading cause of neonatal mor-

tality worldwide.

Tanya’s Contact Info:

Tanya.Kamka@ucsf.edu 415-353-3912 Direct line

415-353-1574 Outreach line

PAGE 4 VOLUME 7, ISSUE 1

A consensus document recently published jointly by the Society for Maternal Fetal Medicine Specialists (SMFM) and the Ameri-

can College of Obstetricians and Gynecologists (ACOG) is going to have a large impact on many hospitals in all states across the

United States. The document is titled Levels of Maternity Care and to understand why it is so important, we have to first take a

brief trip back to the 1970’s….

In the 1970’s neonatal intensive care technologies were expanding rapidly, such that preterm infants at progressively lower

gestational ages had less morbidity and less mortality. As these units continued to improve care for very vulnerable neonates, stud-

ies assessing newborn mortality in hospitals with and without NICU’s were published. The findings were consistent and remarka-

ble. Newborns born in a hospital that had a NICU were much more likely to survive than were newborns born in hospitals that did

not have an NICU unit. This finding was the basis of the maternal and neonatal care regionalization that we know today in Northern

California. Regionalization facilitates the transport of high-risk women and/or infants to the setting in which they are able to get the

best care.

However, more than 50% of all births in the United Sates occur in hospitals that deliver fewer than 1000 babies per year and

while regionalization has worked very well in some settings and it has not taken hold in others. In addition, regionalization for high

-risk maternal care has lagged behind regionalization for neonatal care, Meanwhile maternal mortality in the United States has in-

creased significantly in the last few decades

Thus it has become clear that regionalization for women with high-risk pregnancies is acutely needed and it is anticipated that

this document will be the blueprint for increased efforts nationally to provide care to women in the setting in which they are best

served. Several other health care professional associations including the Association of Women’s Health, Obstetric, and Neonatal

Nurses (AWHONN) have endorsed the Levels of Maternity Care document. The following table provides a brief description of the

Levels of Maternity Care. More information may be obtained at http://www.acog.org/Resources-And-Publications/Obstetric-Care-

Consensus-Series/Levels-of-Maternal-Care

Levels of Maternity Care by Tekoa King CNM, MPH

Setting Description

Birth Center Peripartum care for low-risk women with an uncomplicated singleton

term pregnancy in whom an uncomplicated birth is anticipated.

Care providers include midwives and/or physicians.

Example: Term uncomplicated pregnancy with singleton fetus in vertex

presentation.

Level 1

(Basic Care) Birth center capabilities plus ability to begin emergency cesarean

delivery, provision of support services such as ultrasound and blood

bank

Care providers include birth center providers plus continuous

availability of registered nurses, obstetric providers who can perform

cesarean sections, anesthesia services.

Example: Term twin gestation, trial of labor after previous cesarean.

Level II

(Specialty

Care)

Level I facility capabilities plus CT scan, MRI scan, special

equipment for obese women, ultrasound

Care providers include Level 1 providers plus OB-Gyn available at all

times, MFM available for consultation, Anesthesia available at all

times.

Example: Severe preeclampsia, placenta previa without previous

uterine surgery.

Level III

(Subspecialty

Care

Level II facility capabilities plus advanced imaging available at all

times, acts as a regional center, medical and surgical ICU.

Care providers include Level II providers plus Ob/Gyn available on

site at all times, Director of service is board certified MFM,

Anesthesia available on site at all times.

Example: Suspected placenta accreta, preeclampsia at less than 34

weeks.

Level IV

(Regional

Perinatal

Health Care

Center)

Level III facility capabilities plus on-site ICU for obstetric patients,

son-site medical and surgical care of complex maternal conditions.

Care providers include Level III providers plus MFM care team able

to care for women in critical condition, Board certified MFM

available on-site at all times, Obstetric anesthesia service, medical and

surgical specialty and subspecialty consultants on site at all times.

Example: Severe maternal cardiac conditions, severe liver failure

PAGE 5 VOLUME 7, ISSUE 1

Resuscitation at limits of viability

>26 weeks – Universal resuscitation

25 0/7 - 25 6/7 – Resuscitation is default option, with parental choice for comfort care or resuscitation

24 0/7 - 24 6/7 – Do not recommend resuscitation. Parental choice for comfort care or resuscitation,

based on individual risk factors, e.g. chorio, IUGR, etc.

23 0/7 – 23 6/7 – Strong recommendation against resuscitation. Parental choice IF meets ALL manda-

tory criteria to be considered:

CRITERIA MANDATORY TO BE OFFERED RESUSCITATION AT 23 0/7-23 6/7

[ ] No major congenital anomalies

Anomalies that require surgical care for survival- e.g. TEF, single ventricle, CDH

Anomalies that are incompatible with life: e.g. bilateral renal agenesis

Known chromosomal anomalies with known significant impairment: e.g. T13, T18

All fetal treatment patients to be discussed on an individual basis with MFM, neonatology, and fetal surgery teams prior to

providing options to the family, as these will differ with different cases.

[ ] No chorioamnionitis on presentation, clinical diagnosis made by obstetrics team

It is understood that chorioamnionitis is an evolving picture, and if develops prior to 24+0, would remove a candidate from

resuscitation

[ ] Greater than 24 hours from first dose of BMZ

[ ] Category 1 or 2 Fetal Heart Rate Tracing; no evidence of category III tracing on presentation

[ ] No prior or current laminaria placement

RELATIVE CONTRAINDICATIONS TO RESUSCITATION AT 23 0/7 – 23 6/7, unless otherwise

specified

[ ] within 24 hours s/p select fetal treatment procedure (i.e. Twin to twin), though all fetal treatment cases

need to be discussed an on individual basis with MFM, Neonatology, and the fetal treatment team pri-

or to fetal intervention

[ ] multiple gestation pregnancy

[ ] IUGR(<10%)

[ ] Unexplained or prolonged oligohydramnios Continued page 6

New Periviability Counseling at UCSF by Cynthia Jensen, RN MS CNS

We have recently implemented a periviability checklist used to guide care and counsel women who may deliver an extremely pre-

term baby. This guideline was created through a joint consensus between perinatology and neonatology in response to requests

for resuscitation between 23 0/7-23 6/7 weeks. Historically, UCSF as an institution, does not recommend resuscitation for ba-

bies less than 24 weeks. However if there is a parental request to resuscitate before 24 weeks then the guidelines below will be

followed by all of our providers using strict criteria. Our approach to counseling has also changed so that a multidisciplinary

team is present including MDs and Nursing. Please find the checklist and preparation parameters below.

PAGE 6 VOLUME 7, ISSUE 1

In 2016, the UCSF Antepartum Intrapartum Management Conference will be held for the 40th consecutive

year. This anniversary year will include special guests and presentations designed to share new research and

new guidelines with our audience. Holly Kennedy CNM, PhD, FACNM, FAAN will be the midwifery spe-

cial guest. Holly will discuss techniques for how to facilitate normal physiologic birth. Dr. Steven Clark

and Dr. Dee Wing will be the two physician guests. Dr. Clark is known for his work in risk reduction in-

cluding research that has evaluated bundles, checklists and protocols. Dr. Wing has studied different miso-

prostol doses and methods of inducing labor so that inductions are safer and easier for the women who need

induction. UCSF faculty will contribute presentations on the benefits of laborists, new medications for man-

aging severe nausea and vomiting, nitrous oxide use, labor care of women who are obese, and new guide-

lines on care of periviability. One day will be dedicated to fetal heart rate monitoring in which we will re-

view the 3-tier system, present new data, review cases, and discuss the value of umbilical cord gases.

Please join us June 9-11, 2016. Information about tuition for UCSF contract hospitals can be obtained from

http://www.ucsfcme.com or by calling 415-476-5808.

Anterpartum Intrapartum Management Conference

by Tekoa King CNM, MPH

AIM Conference 40th Anniversary

Special Pricing for Outreach Affiliates

UCSF New Periviability Checklist continued from page 5

Preparation:

[ ] Joint counseling with main stakeholders:

Pregnant patient, with partner, intended parent(s) or other anticipated

guardian, if applicable

MFM Fellow, and/or MFM or OB attending

Neonatology Fellow and/or Attending

Fetal treatment attending, if indicated

L&D bedside RN

ICN triage RN

UCSF Contract Hospital physicians: $550 ($600 after 1/31/16)

UCSF Contract Hospital nurses: $415 ($450 after 1/31/16)

PAGE 7 VOLUME 7, ISSUE 1

As this year comes to an end, now is the time to review your department readiness regarding maternal safety.

Preeclampsia is often associated with severe maternal morbidity and mortality for pregnant mothers, every peri-

natal unit should have established standards of maternal early warning signs. The following warning signs have

been set forth by the National Partnership for Maternal Safety and have been endorsed by the following profes-

sional organizations: ACOG, AWHONN, ACNM, and SMFA. Chances are if you were asked on a multiple

choice test which of the following below criteria are abnormal: you would answer “all of the above”. Yet, every

day these warning signs go unrecognized and contribute to serious maternal morbidity and death.

Maternal Early Obstetric Warning Signs (MEOWS) by Valerie Huwe, RNC-OB, MS, CNS

The Maternal Early Warning Criteria

Measure Value

Systolic Blood Pressure (mm Hg) <90 OR > 160

Diastolic Blood Pressure (mm Hg) >100

Heart rate (beats per minute) <50 OR >120

Respiratory Rate (breaths per minute) <10 OR > 30

Oxygen Saturation on room air at sea level <95

Oliguria, mL/hr for = 2 hrs < 35

Maternal agitation, confusion or unresponsiveness

Woman with preeclampsia reporting a non-remitting headache or shortness of breath

If a patient in your department has any one of these validated criteria, then a prompt bedside evaluation by a

physician or other clinician who can initiate emergency diagnostic and therapeutic interventions should

occur. All too often there is a tendency to disregard these warning signs or “normalize” an abnormal clinical

presentation. Close nursing surveillance, followed by a well-chosen, well-executed team response to these

criteria can prevent serious morbidity and maternal death. As 2015 comes to an end, take time to review your

perinatal guidelines and treatment of maternal warning signs in your department. Consider establishing goals

for 2016 that promote maternal safety and optimize health outcomes for pregnant women and infants. If

UCSF Maternal Fetal Medicine consultative services are needed; don’t hesitate to call our Access Center 1

(877) 822-4453 and speak directly with one of our specialists.

PAGE 8 VOLUME 7, ISSUE 1

It was a dark and stormy night… I traveled

to Eureka to teach a S.T.A.B.L.E. course last Febru-

ary. Before teaching a Monday morning class I turned

in early after a long rainy drive and dinner. My phone

started to vibrate at midnight with texts from a St Jo-

seph’s Eureka nurse, who is also a friend. The text

said something to the effect of “We are going to have

a 24 weeker, do you want to come in?” A few minutes

later I was getting dressed and heading out the door.

I knew the weather was bad and worried that we

wouldn’t be able to fly a transport team up. As luck

would have it there was already a UCSF pediatric

transport team who arrived to take a sick child back

to SF. They had all of the equipment needed…for a

child. Because they have the skills to take care of any

pediatric patient they were asked to be present at the

delivery to assess if the baby was viable and to assist

with the resuscitation. When I arrived, UCSF Flight

Nurse Charlie Hood and Transport nurse Catherine

Brown were already back in the NICU with a feisty

little 700 gram baby and were helping to manage her

respiratory needs. Also present were 2 St Joe’s

RNs, an RT and pediatrician. It always amazes me

how a 700 gram baby can take on a room full of

providers and make them run non-stop! It was a

group effort to get the tiny girl intubated, “surfed”

and settled.

Charlie and Catherine had to race off to the other

child so I stayed behind watching and assisting the

providers at St Joe’s to help this little person and pre-

pare for transport. The weather was iffy and the travel

window was only open for a short time to send anoth-

er neonatal team from UCSF but this lucky little lady

had the odds in her favor again and the team was giv-

en the green light. I felt good leaving her in St Joe’s

capable hands before the neonatal transport team ar-

rived. She had an airway, had been given surfactant,

had IV access, stable glucoses and was normothermic,

you really can’t ask for more than that.

Baby Codie spent a total of 132 days in the NICU and

was discharged home on nasal cannula. Codie’s mom

Corrie is a police officer who had hundreds of vaca-

tion hours donated by her coworkers at Eureka PD so

that she could stay with Codie for the duration of her

hospitalization in our newly opened single-patient

room ICN. Corrie and her family’s dedication and

constant presence no doubt contributed to Codie’s

ability to thrive, grow and overcome significant medi-

cal challenges. It took a village of professionals, col-

laboration, communication, feistiness, luck and a fam-

ily’s love to get Codie to be the sassy, thriving girl she

is today!!

I wanted to share a story with you that highlights what outreach is all about celebrating the relationships we have

to provide better outcomes for women, infants and children. By Cynthia Jensen, Outreach Program Manager

Codie , 4 days old Feb 2015

Charlie Hood RN, CFRN, CCRN, CEN , transport nurse is

reunited with Baby Codie and her mom Corrie during a

follow up visit

Codie Dec. 2015

PAGE 9 VOLUME 7, ISSUE 1

Magnesium Sulfate Update: In Utero Neuroprotection for Early Preterm Infants

Valerie Huwe RNC-OB, MS, CNS

Brain injury associated with prematurity can lead to lifelong motor and sensory disabilities. Doyle and col-

leagues concluded that the number of pregnant women needed to be treated with magnesium sulfate in or-

der to prevent one pediatric case of Cerebral Palsy was 63.

The exact mechanism of fetal neuroprotection is not fully understood however several theories exist regard-

ing the role of magnesium sulfate. Most theoretical models suggest that magnesium sulfate may minimize

the inflammatory pathways of injured neurons and can induce healing substances that promote repair of in-

jured neuronal tissue.

Recent concern for fetal and neonatal bone demineralization and fractures associated with long-term in

utero exposure to magnesium sulfate have led to an FDA drug reclassification of Magnesium Sulfate from

Category A to Category D and advise continued use not exceed seven days. Accordingly, ACOG continues

to support the use of magnesium sulfate for fetal neuroprotection before anticipated early preterm delivery

when the gestational age is <32 weeks.

In a recent publication by Molly Killion MS, RN, CNS she highlights magnesium sulfate as a worthwhile

strategy to prevent cerebral palsy for preterm and low birth weight infants with relatively low risk to the

mother. She also points out; the optimal treatment regimen has not yet been established. Dosing considera-

tions include: provider comfort, institutional familiarity, and safe medication administration practices. More

research is needed to determine the least amount of magnesium sulfate required for pregnant women to pre-

vent cerebral palsy in preterm (<32wk) infants.

Physicians electing to use magnesium

sulfate for fetal neuroprotection

should use specific guidelines such as

the UCSF protocol. The UCSF pro-

tocol defines: the inclusion criteria,

treatment regimens, concurrent tocol-

ysis recommendations, monitoring

parameters, and is available to our

contract hospitals on our website.

References:

American College of Obstetricians and Gynecologists. (2012). Patient safety checklist No. 7: Magnesium sulfate before anticipated preterm birth for neuroprotection. Obstetrics and Gynecology, 120(2 Pt 1), 432-433. doi:10.1097/AOG.0b013e318268054c American College of Obstetricians and Gynecologists, & Society for Maternal-Fetal Medicine. (2010). Committee Opinion No. 455: Magnesium sulfate before anticipated preterm birth for neuroprotection. Obstetrics and Gynecology, 115(3), 669- 671. doi:10.1097/AOG.0b013e3181d4ffa5 Doyle LW, Crowther CA, Middleton P, Marret S, Rouse D: Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev. 2009:CD004661 Killion MM. (2015). Magnesium Sulfate for Neuroprotection. MCN. 40(6):394. doi: 10.1097/NMC.0000000000000187. Salmeen, K. E., Jelin, A. C., & Thiet, M. P. (2014). Perinatal neuroprotection. F1000 Prime Reports, 6, 6. doi:10.12703/P6-6.

PAGE 10 VOLUME 7, ISSUE 1

This past summer, UCSF Benioff Children’s Hospital San Francisco adopted the American Academy of Pediat-

rics recommendations related to infant safe sleep practices to reduce the risk of Sudden Infant Death Syndrome

(SIDS) and sleep-related suffocation, asphyxia and entrapment among infants. Unless there is a medical reason,

infants less than 1 year are placed on their back to sleep and children under 35 inches or less than 2 years of age

will sleep in a crib. No toys, stuffed animals, pillows, crib bumpers or extra bedding will be in the crib. For the

baby’s safety, bed sharing or co-sleeping is not allowed. Parent and family education is provided to reinforce

safe sleep practices. For a copy of our Safe Sleep policy, please contact the UCSF BCH Outreach office.

UCSF BCH Implements Safe Sleep Policy by June Shu-Ling Chan, RN MSN MSA

I said this newsletter was about change and there are some major changes coming to a delivery room near you.!!

The NRP is updated every 5 years guided by the rigorous work of the International Liaison Committee on Re-

suscitation (ILCOR). Working together, the American Academy of Pediatrics, NRP Steering Committee and

the American Heart Association come to a consensus on the new guidelines and update the program accord-

ingly. The program updates were announced on October 15th 2015. Materials will be available in Spring 2016

and implementation will be required by January 1st 2017.

Continued on page 11

A Summary of the 2017 NRP Guidelines by Cynthia Jensen

PAGE 11 VOLUME 7, ISSUE 1

Summary table of SOME of the Changes to NRP 2017 Topic 2017 Guidelines

Thermoregula-tion

Keep temp between 36.5 and 37.5 C (97.7 to 99.5 F) throughout resuscitation and stabilization for non-asphyxiated babies

Note: if a baby is a candidate for cooling therapy remember to acquire vascular access before the baby is cooled and avoid hyperthermia at all times

Suctioning for Meconium

Non-vigorous babies no longer need to be intubated for endotracheal suctioning of meconium however the presence of a team member with full resuscitation skills is required as meconium is a risk factor for perinatal depression

As of January 1st 2016 we are no longer intubating non vigorous babies for meconium at UCSF

Delayed Cord Clamping (DCC)

Current evidence shows that DCC for 30-60 seconds is beneficial for vigorous preterm and full term newborns

DCC not indicated if placental circulation is not intact (abruption, previa etc)

It is the practice at UCSF to perform 30 seconds of DCC for all babies <34 weeks to decrease the incidence of intraventricular hemorrhage, anemia and need for transfusions.

Assessment for Heart Rate

Use a stethoscope to assess heart rate

Cord palpation is less accurate

Consider placement of ECG leads and use of cardiorespiratory monitor (CR Monitor) and pulse oximeters when PPV is required

Use CR Monitor during chest compressions

Oxygen Begin PPV with 21% oxygen for babies ≥35 weeks

Begin PPV with 21-30% oxygen for babies < 35 weeks

Begin free flow oxygen (blow by) at 30% and adjust as needed

If baby has labored breathing or saturations do not increase with free flow oxygen, consider use of CPAP at 5cm H20

Positive Pressure Ventilation (PPV)

If a preemie needs PPV use a device that can give CPAP (flow inflating bag or T-piece resuscita-tor)

Assistant auscultates for increasing HR during first 15 seconds of PPV

If HR rises continue PPV for 15 more seconds and reassess

If HR <60 reassess ventilation, perform corrective steps as necessary and intubate or insert LMA.

If airway in place, chest moving and no ↑ in HR begin chest compressions in 100%

Chest compressions

Use 2 thumb technique

Once airway in place and secured, compressor moves to head of bed

Continue chest compressions for 60 seconds before assessing HR

Medications Use normal saline or O-negative blood for volume replacement

Consider I/O if no other access as all meds can be infused there

The preterm baby < 32 weeks

Keep delivery room 23-25 C (74-77 F)

Use polyethylene wrap, hat and chemical mattress

Monitor vital signs with leads and CR Monitor and pulse oximeter

Trial CPAP as alternative to intubation and surfactant administration

For a complete list of changes please see: Summary guideline: http://www2.aap.org/nrp/docs/15535_NRP%20Guidelines%20Flyer_English_FINAL.pdf For changes to training of providers and instructors see: http://www2.aap.org/nrp/docs/Busy%20People%20Summary%20Final%2010-2015.pdf

For the complete summary of changes please review: https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-13-neonatal-resuscitation/

PAGE 12 VOLUME 7, ISSUE 1

UCSF Benioff Children's Hospital Perinatal/Pediatric Outreach

Program 1975 Fourth Street

San Francisco, CA 94158 Phone: 415-353-1574

Fax: 415-353-1503 Email: bchsfoutreach@ucsf.edu

UCSF Benioff Children’s Hospital San Francisco

24/7 Access Center Hotline

at (877) UC-CHILD (877-822-4453)

A single point of access for maternal, neonatal and pediatric transfers, transports and admissions

Urgent specialty telephone consults and out-patient referrals available

Need help with directions to UCSF?

For printable directions to UCSF in English, Spanish, Chinese and Russian, please

refer to the following website:

http://www.ucsfbenioffchildrens.org/maps_and_directions/mission_bay/

Main number Mission Bay (415) 353-3000

Maternal-Neonatal-Pediatric Transport Services

How to Register for the New Outreach Website

1. Go to the site: bchsfoutreach.ucsf.edu

2. Go to the Log on/Register tab on the right

3. Use your hospital email to create your account so we can verify that you are an outreach affiliate

4. Your information will then come to our office and we will approve your account request in 1-3 days

5. You will receive an email from our Outreach account notifying you that your account is active

6. You will then have access to the password protected resources including policies and procedures,

clinical references and administrative info.

NEW Outreach Website: bchsfoutreach.ucsf.edu