Resuscitation and stabilisation of a significantly preterm infant prior to transfer to the neonatal intensive care unit (NICU) including newborn life support (NLS), consideration of thermoregulation, intubation and surfactant delivery.

Stage 1: Imminent delivery of preterm infant. Call to neonatal team and effective handover from maternity team. Checking of equipment and role allocation.

Stage 2: Delivery of the preterm infant, assessment regarding delayed cord clamping.

Stage 3a: Establishing thermoregulation and pulmonary gas exchange.

Stage 3b: (Only proceed to stage 3b if effective ventilation not achieved). Infant deteriorates, need to ensure effective inflation breaths.

Stage 4: Intubation, surfactant delivery and planning for transfer to NICU.

Mother – Emma Smith, 28 years old, primiparous with uneventful pregnancy and normal antenatal scans.

Emma has developed severe pre-eclampsia requiring delivery. Has had nifedipine and IV labetalol to control BP. Has had one complete course of dexamethasone, last dose 12 hours before delivery, and magnesium sulphate for neuroprotection (and severe pre-eclampsia). No perinatal risk factors for sepsis.

25-week gestation infant is born by vaginal delivery and is found to be in poor condition, requiring initial inflation and ventilation breaths, proceeding to intubation and administration of endotracheal surfactant for lung immaturity.

If effective airway and breathing support is given, the heart rate will respond and there will be no cardiovascular compromise (i.e. chest compressions and drugs will not be required).

The scenario also focuses on decision-making regarding transfer to the neonatal unit and awareness of needing to update the family.