High+Risk+Neonatal+&+Perinatal+Delivery+Planning

[|High Risk Delivery Algorithm]
toc The above algorithm is to help guide decision making on whether or not to recommend delivery at CCRMC or a level III NICU facility in situations where either mother or newborn has significant medical risks.

Background:
The pediatric department is in house 24 hours a day. The staff is competent in resuscitation of routine and high risk newborns. However we are a level II facility and depending on the risk involved a particular delivery may be managed better at a level III facility with a complete high risk team always available. We have a contract with Children’s Hospital Neonatalogy and they will come assist with the unexpected very high risk deliveries such as preterm (< 32 weeks) and newborns with significant abnormalities or birth complications requiring transfer to a higher level of care. When complications or concerns can be anticipated prenatally, it is of best interest to the patient and her family to discuss this with the appropriate staff in advance to determine a plan of care that will provide the safest and highest quality of care. This plan may include delivery at CCRMC with or without a family case conference or may require a plan to deliver at a tertiary center. The pediatric department working with the entire perinatal staff is here to assist the prenatal providers with this decision making process.

Pediatric Consultation:
Below is a list of prenatal findings/diagnoses during prenatal care that would suggest a need for pediatric consultation 1) Known or suspected fetal chromosomal abnormality with level II ultrasound findings 2) Significant known or suspected fetal structural abnormality - ideally confirmed by level II ultrasound (exclusions include but are not limited to: mild pelviectasis, small cardiac echogenic focus, etc) 3) Significant IUGR in a term or late preterm pregnancy with an estimated fetal weight of <1800 gms. 4) Mother with significant psychiatric history with poor state of mental health during the pregnancy 5) Mother currently on Methadone, Suboxone, other chronic opiate use or other significant substance abuse where the infant will likely withdraw(family often benefits from meeting with staff in advance of delivery) 6) Mother with significant systemic disease that may affect the fetus 7) Mother with HIV only if low CD4 count, symptomatic disease or other complications 8) Any other condition or question that may arise that the prenatal provider wants to discuss