nur, nur

1

Structured Neonatal Transition Protocol in Obstetric OR: Course Project

Serah Olayemi

Rasmussen University

NU280/NUR2868

Role, Scope, Quality, and Leadership in Professional Nursing

Professor Sandra Kaufman

07/19/2024

2

Structured Neonatal Transition Protocol in Obstetric OR: Course Project

The “Golden Minute” is the very first minute after birth during which immediate care is essential

for the newborn’s successful transition to extrauterine life (Branche, Perez, & Saugstad, 2020). The

physiological systems of a newborn must adapt from functioning in the controlled environment of the

womb to surviving independently outside the mother’s body. There is increased blood flow to the lube

caused by all fetal shunts (e.g., ductus arteriosus, foramen oval) that are essential for fetal circulation.

The lungs need to start functioning to oxygenate the blood and remove carbon dioxide; this is essential

in births by cesarean section as the baby does not experience the normal compression of the thorax that

occurs during vaginal delivery. Without this process, excess fluid can remain in the lungs, leading to

McKinlay, or issues. Lastly, neonates are no longer in the stable, warm environment of the womb, so

rewarming presents another concern in a healthy transition, particularly for preterm infants (Riviere,

McKinlay, & Bloomfield, 2017). According to the International Liaison Committee on Resuscitation

(ILCOR) algorithm, key interventions like drying, warming, wrapping the baby in plastic (for those born

before 28 weeks gestation), securing the airway, stimulating the baby, and auscultating the heart and

respiratory rates should be promptly carried out. Failure to take control of the perinatal environment in

the first minute may lead to increased respiratory effort (Transient Tachypnea of the Newborn/TTN,

Respiratory Distress Syndrome, or RDS). Prolonged oxygen deprivation can cause damage to the brain

and central nervous system, potentially resulting in cerebral palsy, developmental delays, or permanent

disability. In most industrialized countries, the incidence of birth asphyxia has dropped considerably and

now represents less than 0.1% of newborn deaths. Conversely, in developing countries, the rate of birth

asphyxia remains significantly higher, with a case fatality rate of 40% or more (Yitayew & Yalew, 2022).

Immediate and effective neonatal care can prevent respiratory issues, ensure proper thermoregulation,

and mitigate long-term complications. This proposal outlines the need for a structured neonatal

transition protocol in the obstetric OR to improve health outcomes for newborns.

3

Needs Assessment:

The primary needs identified in the neonatal period include:

Immediate Respiratory Support:

1. Use a bulb syringe or suction device to clear any mucus or fluid from the mouth and nose to

ensure the airway is open.

2. For preterm infants, administer exogenous surfactant to help reduce surface tension in the

alveoli and improve lung function.

3. Use supplemental oxygen if the baby shows signs of respiratory distress or if their oxygen

saturation levels are below normal. This can be done via:

a. Oxygen mask or cannula: for non-invasive support.

b. Continuous Positive Airway Pressure (CPAP): Helps keep the airways open by providing a

continuous flow of air. If the newborn is not breathing adequately or has a very low

heart rate, use a bag-mask ventilation system (ambu bag) to assist with breathing until

spontaneous breathing resumes. In cases of severe respiratory distress where bag-mask

ventilation is ineffective, intubation may be required to secure the airway.

Effective Thermoregulation:

1. Upon delivery, the newborn should be promptly dried to remove amniotic fluid and prevent

heat loss. This should be followed by placing the baby under a pre-warmed radiant warmer or in

a warm, dry environment to maintain body temperature.

2. Early and continuous skin-to-skin contact between the mother and the newborn can help

regulate the baby’s temperature. The mother’s body acts as a natural incubator, providing

warmth and promoting bonding.

4

3. The baby should be wrapped in warm, dry blankets or a thermal blanket to minimize heat loss.

For extremely preterm infants or those born in colder environments, additional measures like

placing them in plastic wrap or a pre-warmed incubator may be necessary.

4. For preterm or very ill infants, incubators provide a controlled environment that maintains

warmth and humidity.

Goals of the Project & Expected Outcomes

The primary goal is to implement a structured neonatal transition protocol within the Obstetric

OR that ensures timely and standardized care for newborns immediately after birth.

1. Improved Health Outcomes: The adoption of a structured protocol is anticipated to

reduce the incidence of respiratory distress and hypothermia in newborns, leading to

fewer complications and a lower rate of neonatal intensive care admissions.

2. Increased Compliance: Improved training and standardized procedures will foster

consistency in care practices across the obstetric OR.

3. Reduced Morbidity and Mortality: By addressing the first needs of newborns in the

“Golden Minute,” the project aims to further lower the rates of birth asphyxia and its

associated long-term disability.

Target Audience:

1. Healthcare Professionals: Obstetricians, neonatologists, and labor and delivery nurses

involved in the delivery and immediate care of newborns.

2. Healthcare Institutions: hospitals and birthing centers where cesarean deliveries and

other high-risk births occur.

5

Implementing a structured neonatal transition protocol will address the emergent needs of

newborns during the immediate post-delivery period, improving their health outcomes and reducing the

incidence of complications associated with inadequate transitional care.

6

References

Branche, T., Perez, M., & Saugstad, O. D. (2020). The first golden minute—Is it relevant? Resuscitation,

156, 284-285.

Riviere, D., McKinlay, C. J., & Bloomfield, F. H. (2017). Adaptation for life after birth: a review of neonatal

physiology. Anaesthesia & Intensive Care Medicine, 18(2), 59-67.

Sharma, D. (2017). The golden hour of neonatal life: Need of the hour. Maternal health, neonatology,

and perinatology, 3, 1-21.

Yitayew, Y. A., & Yalew, Z. M. (2022). Survival status and predictors of mortality among

asphyxiated neonates admitted to the NICU of Dessie Comprehensive Specialized

Hospital, Amhara region, Northeast Ethiopia. PLoS One, 17(12), e0279451.

1

Structured Neonatal Transition Protocol in Obstetric OR: Course Project

Serah Olayemi

Rasmussen University

NU280/NUR2868

Role, Scope, Quality, and Leadership in Professional Nursing

Professor Sandra Kaufman

07/19/2024

2

Structured Neonatal Transition Protocol in Obstetric OR: Course Project

The “Golden Minute” is the very first minute after birth during which immediate care is essential

for the newborn’s successful transition to extrauterine life (Branche, Perez, & Saugstad, 2020). The

physiological systems of a newborn must adapt from functioning in the controlled environment of the

womb to surviving independently outside the mother’s body. There is increased blood flow to the lube

caused by all fetal shunts (e.g., ductus arteriosus, foramen oval) that are essential for fetal circulation.

The lungs need to start functioning to oxygenate the blood and remove carbon dioxide; this is essential

in births by cesarean section as the baby does not experience the normal compression of the thorax that

occurs during vaginal delivery. Without this process, excess fluid can remain in the lungs, leading to

McKinlay, or issues. Lastly, neonates are no longer in the stable, warm environment of the womb, so

rewarming presents another concern in a healthy transition, particularly for preterm infants (Riviere,

McKinlay, & Bloomfield, 2017). According to the International Liaison Committee on Resuscitation

(ILCOR) algorithm, key interventions like drying, warming, wrapping the baby in plastic (for those born

before 28 weeks gestation), securing the airway, stimulating the baby, and auscultating the heart and

respiratory rates should be promptly carried out. Failure to take control of the perinatal environment in

the first minute may lead to increased respiratory effort (Transient Tachypnea of the Newborn/TTN,

Respiratory Distress Syndrome, or RDS). Prolonged oxygen deprivation can cause damage to the brain

and central nervous system, potentially resulting in cerebral palsy, developmental delays, or permanent

disability. In most industrialized countries, the incidence of birth asphyxia has dropped considerably and

now represents less than 0.1% of newborn deaths. Conversely, in developing countries, the rate of birth

asphyxia remains significantly higher, with a case fatality rate of 40% or more (Yitayew & Yalew, 2022).

Immediate and effective neonatal care can prevent respiratory issues, ensure proper thermoregulation,

and mitigate long-term complications. This proposal outlines the need for a structured neonatal

transition protocol in the obstetric OR to improve health outcomes for newborns.

3

Needs Assessment:

The primary needs identified in the neonatal period include:

Immediate Respiratory Support:

1. Use a bulb syringe or suction device to clear any mucus or fluid from the mouth and nose to

ensure the airway is open.

2. For preterm infants, administer exogenous surfactant to help reduce surface tension in the

alveoli and improve lung function.

3. Use supplemental oxygen if the baby shows signs of respiratory distress or if their oxygen

saturation levels are below normal. This can be done via:

a. Oxygen mask or cannula: for non-invasive support.

b. Continuous Positive Airway Pressure (CPAP): Helps keep the airways open by providing a

continuous flow of air. If the newborn is not breathing adequately or has a very low

heart rate, use a bag-mask ventilation system (ambu bag) to assist with breathing until

spontaneous breathing resumes. In cases of severe respiratory distress where bag-mask

ventilation is ineffective, intubation may be required to secure the airway.

Effective Thermoregulation:

1. Upon delivery, the newborn should be promptly dried to remove amniotic fluid and prevent

heat loss. This should be followed by placing the baby under a pre-warmed radiant warmer or in

a warm, dry environment to maintain body temperature.

2. Early and continuous skin-to-skin contact between the mother and the newborn can help

regulate the baby’s temperature. The mother’s body acts as a natural incubator, providing

warmth and promoting bonding.

4

3. The baby should be wrapped in warm, dry blankets or a thermal blanket to minimize heat loss.

For extremely preterm infants or those born in colder environments, additional measures like

placing them in plastic wrap or a pre-warmed incubator may be necessary.

4. For preterm or very ill infants, incubators provide a controlled environment that maintains

warmth and humidity.

Goals of the Project & Expected Outcomes

The primary goal is to implement a structured neonatal transition protocol within the Obstetric

OR that ensures timely and standardized care for newborns immediately after birth.

1. Improved Health Outcomes: The adoption of a structured protocol is anticipated to

reduce the incidence of respiratory distress and hypothermia in newborns, leading to

fewer complications and a lower rate of neonatal intensive care admissions.

2. Increased Compliance: Improved training and standardized procedures will foster

consistency in care practices across the obstetric OR.

3. Reduced Morbidity and Mortality: By addressing the first needs of newborns in the

“Golden Minute,” the project aims to further lower the rates of birth asphyxia and its

associated long-term disability.

Target Audience:

1. Healthcare Professionals: Obstetricians, neonatologists, and labor and delivery nurses

involved in the delivery and immediate care of newborns.

2. Healthcare Institutions: hospitals and birthing centers where cesarean deliveries and

other high-risk births occur.

5

Implementing a structured neonatal transition protocol will address the emergent needs of

newborns during the immediate post-delivery period, improving their health outcomes and reducing the

incidence of complications associated with inadequate transitional care.

6

References

Branche, T., Perez, M., & Saugstad, O. D. (2020). The first golden minute—Is it relevant? Resuscitation,

156, 284-285.

Riviere, D., McKinlay, C. J., & Bloomfield, F. H. (2017). Adaptation for life after birth: a review of neonatal

physiology. Anaesthesia & Intensive Care Medicine, 18(2), 59-67.

Sharma, D. (2017). The golden hour of neonatal life: Need of the hour. Maternal health, neonatology,

and perinatology, 3, 1-21.

Yitayew, Y. A., & Yalew, Z. M. (2022). Survival status and predictors of mortality among

asphyxiated neonates admitted to the NICU of Dessie Comprehensive Specialized

Hospital, Amhara region, Northeast Ethiopia. PLoS One, 17(12), e0279451.