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Discussion

bedside resuscitation?

Hello NICU nurses!

I am a student CNM (6 weeks left till I am done!) and an LDRP RN. A year or so ago the busy tertiary hospital I was rotating at instituted delayed cord clamping (and uninterrupted s2s) as a standard of care for all normal SVB. It was a big culture shift for that unit but after some initial bumps in the road it has been very successful and both the nurses and providers are completely on board.

A few months ago we had an interesting multi-specialty Grand Rounds with OB, NICU and peds. The topic was bringing delayed cord clamping to at-risk newborns- specifically premature babies. We had a great presentation from a researcher about the prelim results of her large, multi-center study on this topic. Of specific interest was bringing resuscitation to the bedside to keep the cord intact. They talked about high and low tech ways that this was being done- specialized warmers that were designed to be used at the bedside, or modifications of current equipment/routines/protocols to allow bedside resus. There was even talk about having NICU scrub in for sections to initiate care to allow delayed cord clamping at c/s!

I currently work as a student CNM at a very family-centered birthing unit and the nurses and providers have been talking casually about this issue, so it brought it to the front of my mind again. I am wondering if any NICU nurses have direct experience with this. I'd also love to hear your thoughts and opinions on this idea in general. It seems to be more of a culture/systems issue than simply the problem of having the right equipment.

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    I'm having a hard time visualizing all these people at the end of table. And I can see cost being a deterrent in some institutions as they would have to purchase these tables/equipment.

    We do a modified delayed cord clamping, we try to give preemies 1 minute out of mom before they are brought to us. Due to the threat if litigation, we still have to follow NRP. Maybe if they change their stance it will become more standard across the board.

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    I have a few thoughts on this. We do DCC for mostly all newborns, especially preemies and have done for at least a few years. We can start our resuscitation on the perineum and those tasks usually take until 30 seconds, which is how long we delay. My thought (and not necessarily backed up by science but I don't have enough time to research it right now) is that if the placenta was working really well, the kid wouldn't be so down to begin with and resuscitation needs to start. I don't have a problem with DCC but we can resuscitate far better without the baby attached to the cord and that's probably where to focus and effort needs to be.

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