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Emergency

Unexpected preterm delivery

Cold, under-supported preterm lungs do badly. In the first minutes the priorities are warmth, gentle breathing support, and calling for help early.

Call early - registrar / consultant. Under 32 weeks needs NETS; from 32 weeks the consultant decides. Even a few minutes of preparation helps.
Prepare

Even with minutes

  • Move to the procedure room / warmer.
  • Gather a small kit: small masks, ETT 2.5 / 3.0, polyethylene bag + hat, sats probe, T-piece with PEEP, surfactant, UVC kit, glucose.
  • Allocate roles before the baby arrives.
Thermoregulation

The biggest quick win

  • <32 weeks - do not dry. Place straight into a polyethylene bag / wrap with a hat, under a radiant warmer.
  • Aim for normothermia 36.5-37.5 C.
  • Cold significantly worsens outcomes.
Breathing support

Gentle

  • If breathing, support with PEEP / CPAP.
  • If PPV is needed, use a T-piece with PEEP and lower pressures.
  • Start oxygen at 30% and titrate to SpO2 targets - avoid hyperoxia.
  • Avoid routine sustained inflations.
The rest of the golden hour

  • Delayed cord clamping if the baby is stable.
  • Check and support glucose.
  • Consider early antibiotics if infection risk.
  • Surfactant per local threshold.
  • Discuss level of care / retrieval early.
Extreme prematurity / periviability: decisions about active management are gestation-dependent and senior-led - involve the consultant and family early. See Antenatal for counselling tools.
Educational summary - follow your local guideline and ANZCOR.
The full guide - who stays at Gosford, the first hour and what NETS will ask: Unexpected preterm birth →

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