• Identify nurse responsible for admission and redistribute existing babies 
• Ensure incubator set up and pre-warmed with humidity set at maximum 
• Check monitor and appropriate connections 
• Set oxygen saturation targets to 90–94% by setting alarm limits to 90% and 96% 
• Ensure ventilator and Neopuff^TM plugged in and checked 
• Ensure appropriate size face masks available 
• Prepare suction and catheters 
• Ensure transport incubator pre-warmed and cylinders full 
• Ensure endotracheal tube (ETT) sizes 2.5 and 3.0 are available
• Set up trolley for umbilical arterial catheter (UAC) and umbilical venous catheter (UVC) beside incubator 
• Prepare infusion fluids for UAC and UVC
• Take resuscitation bag and saturation monitor to delivery

• Registrar/experienced ANNP is responsible for early care of babies <28 weeks’ gestation
  • counsel parents appropriate to gestation
• <27 weeks, discuss delivery with consultant
• Prescribe infusions for UAC and UVC
• Check resuscitaire in delivery suite
  • ensure overhead heater switched on and set to maximum
  • set peak inspiratory pressure (PIP) at 20 cm H₂O and FiO₂ at 0.21
  • check saturation monitor and probe available 
  • ECG monitor and leads (if available)
• Prepare plastic bag

• Keep baby warm with plastic bag and hat 
• Assist with resuscitation 
• Accurate time-keeping including resuscitation and procedures 
• Attach oxygen saturation probe to right hand
• Do not attach ECG leads <26 weeks’ gestation. Only use if 26–27 weeks or if concern with critical cardiac arrhythmia
• Assist with ETT fixation
• Pre-warm surfactant and prepare surfactant administration equipment 
• Set up transport incubator (if used locally) and transfer baby to it 
• Ensure baby labels in place before transport 
• Ensure midwives have taken cord gases
• Transfer baby to NNU 

• Competent practitioner, ANNP or middle grade doctor to attend 
• Aim for delayed clamping of cord for 1 min, keeping baby warm 
• If baby compromised, cut cord immediately and take baby to resuscitaire 
• Place baby in plastic bag
• Use warmed humidified gases and thermal mattress as required
• Cover baby’s head with appropriate size warmed hat
• Assess colour, tone, heart rate and breathing 
• If baby breathing regularly, commence CPAP at 5–6 cm H₂O 
• If baby not breathing regularly, give 5 inflation breaths at 20–25 cm H₂O using T-piece and face mask
  • monitor response: check heart rate, colour and respiratory effort
  • if baby does not start to breathe (but chest moving with inflation breaths) give ventilation breaths with pressure of 20/5 and rate of 40–60/min
  • if heart rate not >100 bpm or falls, observe chest movement and if poor, increase pressures to 25/5
  • observe chest movement throughout and consider reducing inspiratory pressure if necessary (e.g. to 16–18)
  • when heart rate >100 bpm or chest movement seen, check saturation monitor and adjust FiO₂ aiming to bring saturations close to NLS guidance
• If continued IPPV necessary, intubate 
• If unit policy is to give surfactant on labour ward, ensure appropriate ETT position and fix securely before administering surfactant 
• Review baby before transfer to NNU (some units use transport incubator):
  • air entry
  • colour
  • heart rate 
  • saturation
• Complete joint resuscitation record and obtain signature from maternity team
• Show baby to parents
• Senior member of staff to talk briefly to parents 
• Transfer baby to NNU

• Aim for at least 1:1 nursing care for first hour
• Transfer to incubator in plastic bag
• Weigh baby in plastic bag
• Leave baby in plastic bag until incubator reaches adequate humidity
• Attach baby to ventilator or non-invasive support equipment and reassess ABC
• Monitor heart rate and saturation
• Record blood pressure + baseline observations
  Do not use ECG leads on babies <26 weeks’ gestation
• Measure axillary temperature on arrival
• Insert nasogastric tube (NGT)
• Assist doctor/ANNP with lines 
• Give vitamin K
• Give first dose of antibiotics
• Commence prescribed infusions - do not wait for X-ray confirmation of umbilical lines
• Take photograph for parents 

• Reassess ABC
• Split tasks between doctors/ANNPs

Doctor/ANNP A 

• Prescribe weight-dependent drugs and infusions, and vitamin K
• Prepare blood test forms and blood bottles
• Start admission notes (BadgerNet)

Doctor/ANNP B

• Check ETT position clinically and administer surfactant if not previously given on labour ward 
• Check ventilation – review tidal volume and chest movement
• Commence with tidal volume of 5 mL/kg 
  • targeted tidal volume ventilation should be commenced
  • maximum PIP set appropriately and reviewed  
• If not oxygenating/ventilating, consider increasing tidal volumes and review PIP
  • if tidal volume >5 mL/kg or vigorous chest movement, reduce PIP or tidal volume target without waiting for first gas
  • check saturation and adjust FiO₂ to keep saturation 90–94%
• Insert UAC and UVC through hole in plastic bag
  • commence infusions as soon as line secured
  • give IV antibiotics
• Take blood for:
  • FBC
  • group and DCT
  • blood culture
  • blood glucose 
  • pre-transfusion bloodspots 
  • arterial gas
• Defer peripheral IV cannula insertion unless unable to gain umbilical access
• Once lines inserted, request X-rays
• Document 
  • ETT position
  • NGT length
  • UAC and UVC positions at time X-ray taken
• Write X-ray report in notes
• Update parents and document in notes