Investigations and imaging

4.4. Investigations and imaging

Ideally, these investigations should be performed within an hour of birth for all infants who have required resuscitation in the delivery room.

1. Blood glucose level

  • Any infant who has required resuscitation is at risk of hypoglycaemia.
  • Check the blood glucose level within an hour of birth.
  • If the bedside reagent strip result is low (less than 2.6 mmol/L), send a true blood glucose to the laboratory.
  • Aim for a true blood glucose level above 3.0mmol/L for all infants who have required resuscitation.

2. Blood gas analysis

  • Any infant who has required prolonged positive pressure ventilation, intubation and/or external chest compressions at birth will require blood gas analysis.
  • A pre-ductal (right radial) arterial blood gas is the gold standard.
  • A capillary or venous sample will suffice for obtaining a pH, CO2, HCO3, base excess and lactate if an arterial sample cannot be obtained.

3. Full blood count

  • Severe anaemia may explain why a newborn infant required extensive resuscitation or was unresponsive to resuscitation interventions.
  • Severe anaemia may occur secondary to a feto-maternal haemorrhage.
  • An arterial or venous sample is preferable, although a capillary sample will suffice.
  • A low white cell count or neutropenia may indicate severe infection.

4. Blood Cultures

  • An arterial or venous sample is required for blood cultures.
  • Do not delay the administration of antibiotics if unable to obtain blood cultures.
  • Antibiotics should be administered within 1 hour of birth for all infants at risk of infection.

5. Urea and electrolytes

  • U & E’s are not usually required in the first 24 hours of age.

6. Placental pathology

The Consultative Council on Obstetric and Paediatric Mortality and Morbidity (Victoria) guidelines state that a placenta should be examined by a perinatal pathologist in the following circumstances:

  • Stillbirth
  • All high risk infants, including those who have required resuscitation at birth
  • Neonatal death in the delivery room
  • Multiple births
  • Small for gestational age infants
  • Preterm births < 34 weeks’ gestation
  • Antepartum haemorrhage
  • Suspected chorioamnionitis
  • Neonatal hypoxic-ischaemic encephalopathy
  • Macroscopic placental abnormalities
  • Diabetes
  • Pre-eclampsia

Send the placenta chilled and unfixed to the pathology service for microbiological cultures.

If your hospital does not have a perinatal pathology service, the neonatal transport team will take the placenta to the receiving tertiary centre. Please double bag the placenta in an infectious waste bag and place it in a suitable container with a lid. Label the container with the infant’s bradma.

Imaging

Chest X-Ray

  • Any infant who has an early oxygen requirement greater than 30% oxygen should have a chest x-ray within an hour of birth.
  • Any infant who is still requiring a low concentration of oxygen (less than 30%) at 6 hours of age should have a chest x-ray.
  • The clinical presentation of many respiratory and non-respiratory diseases can be similar. A chest-x-ray can assist in diagnosis of:
    • Respiratory distress syndrome (hyaline membrane disease)
    • Transient tachypnoea of the newborn (TTN)
    • Congenital anomalies (such as a diaphragmatic hernia)
    • Pulmonary hypoplasia
    • Pneumothorax
    • Other air leak syndromes
  • If the infant requires endotracheal intubation, a chest x-ray should be performed to check the position of the endotracheal tube in addition to evaluating evolving pulmonary pathology.
  • Ideally, the chest x-ray should be taken with a naso-gastric tube insitu to check the position of the gastric tube in the stomach.
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