Diagnostics in the delivery room

The pulse oximetry transducer (for SaO2 and HR monitoring) is secured with elastic tape by the second or third assistant, preferably on the neonate's right hand, after suctioning and drying (i.e., within first minute of life). Pulse oximetry is used for monitoring during neonatal resuscitation and transport (see pp. 131–2). SpO2 and blood pressure values obtained from the right arm and leg may provide information on right-to-left (ductal) shunting and outflow tract obstructions (e.g., coarctation of the aorta, interrupted aortic arch); the latter are rarely immediately evident in the delivery room since a large patent ductus arteriosus is common and may “bridge” outflow tract obstruction in these lesions. Capillary or venous blood gas analysis and blood glucose sticks (quick test with test strips) should be performed for all initially depressed neonates with metabolic acidosis (umbilical arterial pH <7.15), for preterm infants and for growth-restricted term infants. An arterial blood gas analysis is the gold standard for assessment of oxygenation and ventilation of the newborn. For the transport team (NETS), it is advisable to obtain and document these measurements (i.e., capillary or venous blood gas plus blood glucose), even in well-adapted neonates with a normal umbilical artery pH, approximately 30 min after birth or prior to transport (for legal reasons). If the newborn infant is depressed, blood gas sampling must be done earlier and should be repeated while the neonate's condition remains critical.