Melinda is a 33-year-old primigravida who has had a normal pregnancy. Melinda lives in rural Victoria and identifies as being of Aboriginal/Torres Strait Islander decent. She is booked to birth at her local hospital with a level 4 Special Care Nursery (SCN).

Case history

Melinda is a 33-year-old primigravida who has had a normal pregnancy. Melinda lives in rural Victoria and identifies as being of Aboriginal/Torres Strait Islander decent. She is booked to birth at her local hospital with a level 4 Special Care Nursery (SCN). Melinda was Group B streptococcus (GBS) positive on her vaginal swab at 36 weeks and has received a course of oral antibiotics. She spontaneously commenced labour at 39.4 weeks. When her membranes ruptured there was fresh meconium­stained liquor and peripartum monitoring indicated that the fetus was mildly distressed. After 22 hours of labour, Karen was exhausted, and her obstetrician decided to assist the birth by ventouse (vacuum) extraction.

Immediately following birth, baby Bethany is cyanosed, floppy and makes no effort to breathe. The resuscitation team commenced intermittent positive pressure ventilation (I PPV) via a mask and T-piece device. She received cardiac compressions for 3 minutes before her heart rate increased above 60 beats per minute (BPM) and stabilised >100 BPM at 5 minutes of age. IPPV was ceased at 7 minutes with Bethany breathing spontaneously in a fraction of inspired oxygen (Fi02) of 0.30 and receiving continuous positive airway pressure (CPAP) via a mask and T-piece device.

Her Apgar scores were 3 at 1 minute, 5 at 5 minutes and 8 at 10 minutes.

Bethany is transferred to the Special Care Nursery (SCN) at 30 minutes of age and no longer requires CPAP.

Her birth weight is 3870g.

Her admission temperature is 35.5°C. Heart rate (HR) 112, respiratory rate (RR) 38. Her peripheral oxygen saturation (Sp02) is 91% in air.

She is lethargic and floppy with constricted but responsive pupils (size 2). She has a weak sucking reflex and has episodes of shallow, periodic breathing.

A venous blood gas is performed during intravenous (IV) cannula insertion which shows the below result (note: Bethany shows minimal response to IV insertion).

pH 7.20
pCO2 73
p02 42
HCO3 12
BELactate

Glucose

-16.49.5

1.8

The paediatrician confers with the Paediatric Infant and Perinatal Retrieval (PIPER) service at 1.5 hours of age and the retrieval team is dispatched. Estimated time of arrival is when Bethany will be approximately 5 hours old.

Question 1 (25 marks)

Using Bethany's case history, describe the initial nursing care she should receive in the first 1.5 hours following admission. Include rationale for your suggested interventions.

Question 2 (10 marks)

Using the modified Sarnat scoring system, explain what score you would give Bethany and include a rationale as to why you have assigned this score.

Question 3 (10 marks)

As Bethany will be 5 hours old before the PIPER team arrive at her birth hospital, discuss whether cooling would be recommended, how it may be commenced in a non-tertiary centre and include how you would describe her care to Bethany's parents.

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