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VOL. 27 NO. 2 | AUGUST 2013THE PERINATAL OUTREACH PROGRAMThe Perinatal Outreach Program is a collaborative effortbetween SSM Maternity Care at St. Mary’s Health Center, SSMCardinal Glennon Children’s Medical Center and Saint LouisUniversity School of Medicine.It is designed to improve outcomes for mothers and babiesthrough educational programs and quality improvementactivities for regional perinatal care providers in eastern Missouriand Southern Illinois.The Perinatal Outreach Program is the designated AdministrativePerinatal Center for Southern Illinois.PERINATAL TIMES EDITORIAL BOARDConnie Thompson, RNC, BSN, EditorSSM Cardinal Glennon SSM St. Mary’s Health CenterChildren’s Medical Center Erol Amon, MD, JDAyoob Ali, MD, MPHKathy Canchola, RN, BSNGlenn Barber, RNC, BSN Gilad A. Gross, MDRobyn Gude, RN, MSN Katie Kulaitis, RN, BSNMary Hope, RN, BSNThomas Myles, MDWilliam Keenan, MDPam Randazzo, RNC, BSNPatricia OberkirschSharon Rector, RNC, MSNJudy Wilson-Griffin, RNC, PNCNSFUNDINGFinancial support for the The Perinatal Times is provided bySSM Health Care - St. Louis and the Illinois Department ofPublic Health.LETTERSThe Perinatal Times welcomes comments on any of its articlesand will consider such letters for publication. Suggestions forfuture topics of interest or announcements are encouraged.Please send correspondence to:The Perinatal TimesConnie Thompson, EditorSSM St. Mary’s Health Center6420 Clayton Road, Richmond Heights, MO 63317connie_thompson@ssmhc.comIN THIS ISSUE:13456MONITOR8ACTIVENRP IN THEKNOW: DELIVERYROOM OXIMETRYFORMULARYFACTS: HIV REVIEW& UPDATESOPTIMAL TIMING OFUMBILICAL CORDCLAMPING AFTER DELIVERYRESOURCE ROUND-UP:THE LATEST RESOURCESIN ONE SPOTCORNER:IRREGULARITIES OF FETALCARDIAC RHYTHMMANAGEMENTOF THE THIRD STAGE OFLABOR – HOW ACTIVE IS IT?To be added to The Perinatal Times email list to receivean electronic version, please email Patricia Oberkirsch atpatricia_oberkirsch@ssmhc.com
NRP IN THE KNOWDELIVERY ROOM OXIMETRY BY GLENN BARBER, RNC-NIC, BSNA 22 year old primigravida mother was admitted in activelabor and delivered a 39 2/7 week gestation infant with clearamniotic fluid. The mother had an uncomplicated pregnancyand received good prenatal care. Immediately after birth,the infant was non-vigorous. The baby was placed under aradiant warmer, dried, stimulated and positioned with thehead slightly extended. The infant had no respiratory effortand bag/mask ventilation was started on room air (21%FiO2). After 15-20 seconds of effective ventilation, the heartrate was auscultated at 80 beats per minute and the infantshowed no signs of improvement. Which of the followinginterventions would be appropriate for this infant?1. Evaluate the skin color. If cyanotic, increase the oxygento 100%.2. Place oximetry probe on left wrist/hand and considergiving blended oxygen based on NRP target oxygensaturations.3. Place oximetry probe on right wrist/hand and considergiving blended oxygen based on NRP target oxygensaturations.4. Start chest compression and consider giving a dose ofEpinephrine.CORRECT RESPONSEPlace oximetry probe on right wrist/hand and consider givingblended oxygen based on NRP target oxygen saturations.DISCUSSIONAccording to the Neonatal Resuscitation Program (NRP), 6thedition, the goal is to achieve pre-ductal oxygen saturationssimilar to those of a healthy term neonate during the first10 minutes after delivery. Based on studies that evaluatednewborns undergoing normal transition, the NRP hasset targeted pre-ductal oxygen saturations that begin at60% at birth and allows 10 minutes to reach 90%. 1,2Usingoximetry and oxygen blenders in the delivery room is arecommendation that has been a practice change for manyhealth care providers. Oximetry is recommended in thefollowing situations: 3»»When resuscitation is anticipated»»When positive-pressure ventilation is required for morethan a few breaths»»When central cyanosis is persistent»»When supplemental oxygen is administered»»To confirm your perception of cyanosisProper placement of the oximeter probe is crucial. The probeshould be positioned on the right wrist or hand to evaluatepre-ductal oxygen saturations. This allows the clinician toassess the oxygen saturation of the blood in the aorta beforeit reaches the ductus arteriosus. A probe placed on the lefthand/wrist or feet (post-ductal) may have a lower saturationbecause of the possible mixing of blue blood from thepulmonary artery. The ductus arteriosus may remain open forseveral hours after birth.For the most rapid signal, the probe should be place on theinfant before it is connected to the oximeter. Most oximetersrequire a consistent pulse foran accurate & trustworthyreading.Once a reliable oxygensaturation is displayed,an increased percentageof inspired oxygen maybe indicated. The oxygenconcentration can beadjusted from 21% to 100% byusing an air-oxygen blender.Using the blender, theoxygen should be titrated toachieve the target pre-ductalsaturation values based on the age of the infant (see Table 1).The goal is to give just the right dose of oxygen that is nottoo high or too low – either of which can be harmful. •REFERENCESTABLE 1Targeted Pre-ductalSPO2 After Birth1 min 60% - 65%2 min 65% - 70%3 min 70% - 75%4 min 75% - 80%5 min 80% - 85%10 min 85% - 95%1. Dawson JA, Kamlin OF, Vento M, et al. Defining the ReferenceRange for Oxygen Saturation for Infants After Birth. Pediatrics.2010; Jun; 125:e1340-1347.2. Mariana G, Dik PB, Ezquer A, et al. Pre-ductal and Post-ductal O2Saturation in Healthy Term Neonates after Birth. J. Pediatr. 2007;150:418-21.3. Kattwinkel J, McGowan JE, Zaichkin J. Textbook of NeonatalResuscitation. 6th ed. Elk Grove Village: American Academy ofPediatrics; 2011.ABOUT THE AUTHORGlenn Barber is a Neonatal Outreach Educator in the PerinatalOutreach Department at SSM Cardinal Glennon. Glenn is a RegionalNRP Instructor and a Lead STABLE Instructor with almost 25 years ofclinical experience. He is also nationally recognized as a Master Trainerfor the Helping Babies Breathe (HBB) Program. Contact Glenn atglenn_barber@ssmhc.comTHE PERINATAL TIMES | 1
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