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Report from the Committee on Fetus and Newborn

Report from the Committee on Fetus and Newborn. AAP NCE, New Orleans, LA October 21, 2012. Who Is COFN?. Seven neonatologists who are appointed by the AAP Board of Directors. Appointment is for 2 years with the option to be renewed x2 for a total of 6 years.

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Report from the Committee on Fetus and Newborn

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  1. Report from the Committee on Fetus and Newborn AAP NCE, New Orleans, LA October 21, 2012

  2. Who Is COFN? • Seven neonatologists who are appointed by the AAP Board of Directors. • Appointment is for 2 years with the option to be renewed x2 for a total of 6 years. • Chair is appointed for 2 years with an opting for renewal x1 for a total of 4 years.

  3. Committee on Fetus and Newborn Liaisons • American College of Obstetricians and Gynecologists (ACOG) • Canadian Pediatric Society • Centers for Disease Control (CDC) • National Association of Neonatal Nurses • TonseRaju – NICHD AAP Section Members • William Benitz – Perinatal Pediatrics • Kasper Wang - Surgery

  4. What Does COFN Do? Studies issues and current advances in fetal and neonatal care Makes recommendations regarding neonatal practice Collaborates with ACOG to consider perinatal issues on which the practices of obstetrics and pediatrics merge Works cooperatively with ACOG on new editions of Guidelines for Perinatal Care

  5. Editors Associate Editors Laura Riley (ACOG) Sarah Kilpatrick (ACOG) Ann Stark (AAP) Lu-Ann Papile (AAP) 7th Edition available at this meeting!

  6. Statements Published in Pediatrics2012 • Neonatal Drug Withdrawal (January) • Epidemiology and Diagnosis of Health Care-Associated Infections in the NICU (April) • Strategies for the Prevention of Health Care-Associated Infections in the NICU (April)

  7. Statements Published in Pediatrics2012 (cont) • Management of Neonates with Suspected or Proven Early-Onset Bacterial Sepsis (May) • Levels of Neonatal Care (August) • Assessment and Management of Inguinal Hernia in Infants (October)

  8. Guidelines for Perinatal Care Collaborative effort of ACOG Committee on Obstetric Practice and AAP Committee on Fetus and Newborn First published in 1983 Revised approximately every 4 years

  9. Guidelines for Perinatal Care • GPC 6th Edition • 10 Chapters • Interhospital Care of the Perinatal Patient • Neonatal Complications • GPC 7th Edition (2012) • 11th Chapter - Continuous Quality Improvement and Patient Safety • Interhospital Transfer of Pregnant Women and Neonates • Neonatal Complications and Management of the Higk-Risk Neonate

  10. Guidelines for Perinatal Care • Issues that may be of interest • Planned home birth • Immersion in water for labor and delivery

  11. Planned Home Birth • ACOG StatementWomen….. should be informed….. that although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth. • AAP COFN • We are developing a statement regarding care of the infant in the event of a planned home which should be published in 2013

  12. Underwater Birth ACOG and COFN Statement in GPC …underwater birth should be considered an experimental procedurethat should not be performed except within the context of anappropriately designed randomized controlled trial after informed consent. A joint statement should be published in 2013

  13. Levels of Neonatal Care • Revision of the 2004 statement was published in Pediatrics, August 2012 • The next 10 slides outline the similarities and differences between the statments

  14. Levels of Neonatal Care • 2007 • Level I • Level II A • Level II B • Level III A • Level III B • Level III C • 2012 • Level I • Level II • Level III • Level IV

  15. Level I (basic) • 2007 and 2012 • Provide neonatal resuscitation at every delivery, as needed • Provide care for infants born at 35-37 weeks who are physiologically stable • Stabilize infants born <35 weeks or who are ill until transfer to a higher level of care facility

  16. Level II (Specialty Care) • 2007 and 2012 • Provide care for infants ≥32 weeksor≥1500 grams who have physiological immaturity (e.g. apnea, inability to feed orally) or who are moderately ill with problems that are expected resolve rapidly and are not anticipated to need subspecialty services on an urgent basis.

  17. Level II (Specialty Care) • 2007 • IIA – assisted ventilation on a limited basis • IIB – mechanical ventilation for ≤24 hours or CPAP • 2012 – Combined II A and II B • II -assisted ventilation for ≤24 hours or CPAP or both

  18. Level II (Specialty Care) • 2007 and 2012 • Personnel and equipment continuously*available: • neonatologists, NNPs • specialized nurses, respiratory therapists • radiology and laboratory technicians • portable x-ray machine • blood gas analyzer * II B requirement only

  19. Level III (Subspecialty Care) • 2007 • Provide sustained life support • III A – infants >1000 g or >28 wk, conventional ventilation (no HFV), minor surgical procedures • III B – infants <1000 g and <28 wk, severe and/or complex illness, HFV, iNO • III C – ECMO, CHD surgery requiring bypass

  20. Level III (Subspecialty Care) • 2012 • Provide sustained life support and comprehensive care for infants <32 wk and <1500 g, and all critically ill infants • Provide a full range of respiratory support which may include conventional and/or HFO and iNO text= addition in 2012

  21. Level III (Subspecialty Care) 2007 (III B) 2012 (III) Prompt and readily available access to a full range of pediatric medical subspecialists, pediatric surgical specialists, pediatric anesthesiologists and pediatric ophthalmologists on site or at a closely related institution by pre-arranged consultative agreement • Prompt and on site access to a full range of pediatric medical subspecialists (IIIB) • Pediatric surgical specialists and pediatric anesthesiologists on site or at a closely related institution (IIIB) text= addition in 2012

  22. Level III (Subspecialty Care) • 2007 and 2012 • Capability to perform advanced imaging with interpretation on an urgent basis, including computed tomography, magnetic resonance imaging and echocardiography

  23. Level IV (Subspecialty Care) 2007 (III C) 2012 (IV) Located within an institution with the capability to provide surgical repair of complex congenital or acquired conditions • Located within an institution with the capability to provide surgical repair of serious congenital heart anomalies that require cardio-pulmonary bypass, and/or ECMO for medical conditions. text= addition in 2012

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