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Example: CABC clinical evaluation

Management of care of neonates born with respiratory and/or cardiac depression

Updated November 1, 2022

In management of emergencies, CABC accreditation includes an evaluation of the management of care of neonates born with respiratory and/or cardiac depression as follows:

  1. Criteria for pulling medical records for review include the following:
    1. Apgar scores less than 7 at five minutes
    2. neonatal transfer for any indication
    3. newborn readmission after discharge from birth center
    4. neonatal complications not requiring transfer, including neonatal resuscitation
  2. Review of Center’s P&P’s for neonatal resuscitation and management of depressed neonates for consistency with national standards and guidelines -specifically AABC Standards for Birth Centers and AAP/AHA NRP guidelines.
  3. Review of risk criteria for inclusion of criteria for neonatal transfer or consultation regarding neonatal care for newborns falling outside normal ranges, including but not limited to 5-minute Apgar <7; newborn requiring more than brief resuscitation; congenital anomaly requiring immediate treatment or observation, respiratory issues, such as tachypnea, retractions, cyanosis.
  4. Review of neonatal transport arrangements to assure inclusion of a mechanism for safe transport of an unstable neonate (i.e.- requiring resuscitation enroute) and receiving facility with appropriate services for neonatal stabilization and/or care.
  5. Inspection of neonatal emergency supplies and equipment for adequacy, storage so readily available in emergency, and evidence of regular inspection as part of Center’s CQI program.  Must include at minimum:
    1. Heat source (defined in 4B.1.d)
    2. Airway management supplies for two resuscitation efforts on site:
      1. Neonatal oral airways
      2. Neonatal face mask equipment that:
        1. is AHA/NRP approved
        2. works with or without oxygen
        3. and has a pop-off pressure valve or a manometer
        4. EITHER laryngeal mask airways in size 1
        5. OR 3.5 ET tube with laryngoscope with functioning bulb and size 1 blade attached
      3. Oxygen source with flow meter and tubing xii
      4. Suction mechanism (electric or mechanical)
      5. Advanced airway management devices:
    3. Pulse oximeter with neonatal sensors
    4. Supplies for emergency vascular access (umbilical catheterization kit or intraosseous supplies)
    5. Sterile Normal Saline
    6. Neonatal IV supplies and syringes
    7. Epinephrine 1:10,000
  6. Review of personnel files to confirm successful completion of current NRP training, all modules including medications and intubation by all clinical staff who attend births (as primary birth attendant or as birth assistant).
  7. Confirm documentation that quarterly medical emergency drills are conducted, and include neonatal resuscitation, management of care of depressed neonate and neonatal transport.
  8. Review of general consent form and process to assure that families are informed regarding criteria for transfer, including neonatal indications, and procedures for such transfers whether emergent or non-emergent.

CABC also reviews other relevant areas, such as policies and procedures for intermittent auscultation of fetal heart tones, review of criteria for antepartum medical referral to screen for women in whom there is a higher than average expectation of a compromised newborn.

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