ABCD-Emergent Neonatal Blood Transfusion In the Delivery Room
- Describe multidisciplinary response to neonatal resuscitation with emergent need for a blood transfusion.
- Identify potential barriers to accessing uncrossmatched blood products for a neonatal emergency in the delivery room.
- Determine safe, effective interventions in an emergent situation when you must rely on your critical nursing judgment.
Case: A 28 year old primigravida is involved in a motor vehicle crash at 34 weeks gestation and within 30 minutes of admission to the hospital she undergoes a STAT Cesarean Section secondary to signs of a Placental Abruption. A 2 kilogram, female, infant is delivered in a pool of blood without spontaneous respirations, a weak umbilical pulse, palor and poor muscle tone. Following initial oralpharyngeal sucitoning and PPV the baby is intubated and given epinephrine with poor response. An umbilical vein catheter (UVC) is placed and normal saline administered with poor response. A unit of uncrossmatched blood is requested by "desperate issue" protocol and delivered to the operating room (OR) prior to birth of the baby. The Pediatrician ordered 10 mLs per kilogam of Packed Red Blood Cells (PRBC); which is drawn through a blood filter into a 20 mL syringe with stopcock attached and the cold blood in syringe is warmed by the physicians hand as it is administered via UVC. The neonate required three doses of saline and 2 doses of PRBCs in the OR before stabilization and transport to the Special Care Nursery.
Conclusion: A severly compromised, preterm infant survives because of the expertise demonstrated in recognizing a urgent situation and appropriate intervention. A situation such as this exemplifies the teamwork and communication that must be exercised expeditiously and cautiously to achieve the optimal outcome.
Keywords: Emergent, Neonatal, Blood, Transfusion,
