Dialogue Volume 13 Issue 3 2017 - Page 45

PRACTICE PARTNER heart rate did not increase to above 100 bpm until 14 minutes of age and yet the infant was not inten- sively monitored until the transport team arrived. The anesthetist transferred care to the pediatrician, but appears to have left the infant’s bedside 25 minutes after birth, well before the arrival of the pediatrician at 75 minutes after birth. This is a very critical period in which close assessment, supportive care and a decision about instituting therapeutic hypothermia often needs to be made. • It is recognized that this delivery took place in a Level 1 hospital and that quick access to person- nel that are skilled and experienced in resuscitation and the care of a sick newborn may be problematic. However, it is important that any hospital provid- ing obstetrical services have staff attending deliveries that are fully certified in NRP and assigned to care for the infant. In addition, when circumstances arise that carry with them increased risk of delivering a compromised infant, there should be attempts to mobilize individuals with special skills in neonatal resuscitation to attend the birth. Recommendations: 1.  The SOGC should consider developing a guide- line for difficult Cesareans, particularly including difficult extraction of the fetus, to better prepare obstetrical caregivers for these emergency situations. 2. At the time of the “surgical check list”, obstetrical care providers should discuss the possibility of difficult extraction and put a plan in place on how to approach it. 3. Those responsible for quality of care for mater- nal-newborn services at any hospital must en- sure that staff is adequately trained and acces- sible to provide full resuscitative efforts to any newborn as prescribed by Neonatal Resuscitation Program (NRP). 4. Obstetrical and neonatal care providers are re- minded of the need to document events related to the management of newborns accurately and contemporaneously. MD • The documentation of events surrounding the birth of this infant was inconsistent and at times, incomplete. ISSUE 3, 2017 DIALOGUE 45