BULLETIN

newborn metabolic screening (nbms) programme

The following messages are from the National Screening Unit:

• Sample test cards will be accepted for processing from 24 hours, although the recommended time is still 48-72 hours, and as close to 48 hours as is feasible.

• There will be a change of card colour from buff to white as new cards are printed.

Continue to use the older buff cards until the stock is used up.

• New information will be required on the cards related to the location where the sample was taken (home/birth unit/hospital).

• The courier tracking number should be recorded before blood spot sample test cards are sent to the lab. Take one of the number labels from the courier pack and attach it to the baby’s health care record.

• Ensure you are receiving all test results within 7-10 days of the sample being taken and sent. If results are not received in this timeframe, check that the lab has received the sample. Call 0800 LABLINK to enquire about the sample/result, quoting the courier tracking number.

• When parents/guardians/whānau decline

NBMS for the baby, please ask them if they agree to a blood spot card being filled out with their demographic information, to monitor participation in the programme. With their approval, fill the sample card with as much detail as possible, including a note that screening was declined, and courier it to the laboratory.

• Resources: lancets, cards and courier bags can be ordered via newbornscreening resources@adhb.govt.nz or phoning (09) 307 4949 ext 23806.

• Reminder that results are no longer being sent by fax so if you answer ‘yes’ to either of the following questions, please contact the NSU as soon as possible to update your preferred contact details.

• Do you receive screening results from the lab by fax?

• Do you receive results via paper (mail) but would prefer to receive these via email or HL7 message?

Please email Elaine at education@nzcom.org.nz if you have any professional queries relating to any of these changes. square

WAITAHA INFANT FEEDING RESOURCE

The Waitaha Infant Feeding Resource was launched on 3 August 2021, in conjunction with World Breastfeeding Week. The online resource was developed by Canterbury/West Coast Regional College Breastfeeding Representative Catherine Rietveld, in collaboration with the Canterbury/West Coast Regional College Breastfeeding Focus Group.

The focus group included representatives from a wide variety of organisations, including Māori, Pasifika and LGBTQIA+ members involved in breastfeeding support. Three key principles were identified in the development of the

Canterbury/West Coast Regional College Breastfeeding Focus Group. resource, including: manaakitanga, kaitiakitanga and whānaungatanga.

The application of these guiding principles within the context of infant feeding are explained in the resource, which can be found on the Canterbury/West Coast College region’s website and an adapted version will also be added to the national College website in due course.

Aimed at bringing together a vast array of relevant feeding resources into one centralised location, it’s hoped the resource will assist midwives in easily and quickly accessing appropriate breastfeeding education, advice and support services for wāhine and whānau under their care. As a living resource, it will be updated regularly as new evidence or developments within infant feeding emerge. square

ONLINE TEACHING PACKAGE: WORKING WITH PASIFIKA WOMEN

Moana Research have developed an online teaching package, Pacific women and pregnancy, for health professionals. Focused on the significance of Pacific knowledge systems and cultural perspectives during the perinatal period, the online module is aimed at improving outcomes for Pacific women and their families.

There will be two other learning modules available in the coming months: Working with Pacific families experiencing unconscious bias and Pacific infant health. square

induction of labour guideline published

The Ministry of Health has published the Induction of Labour in Aotearoa New Zealand: A Clinical Practice Guideline.

The guideline has gone through the Ministry’s external maternity clinical guideline appraisal process and has been ratified by the National Maternity Monitoring Group (NMMG). The guideline covers:

• Indication and timing of induction of labour, neonatal risk factors and non-pharmacological methods

• Methods of cervical ripening and induction of labour and the appropriate clinical setting. square

covid-19 vaccination during pregnancy

Just as the June 2021 issue of Midwife went to print, the Ministry’s updated advice regarding Covid-19 vaccination during pregnancy was released.

The Ministry’s messages are: • If you’re pregnant, we encourage you to get a COVID-19 vaccine as part of Group 3 at any stage of your pregnancy. This is because people who are pregnant can become very sick if they get COVID-19 infection. • Evidence from the large number of pregnant people who have already been vaccinated globally, indicates that there are no safety concerns with administering COVID-19 vaccines at any stage of pregnancy. • Vaccinating during pregnancy may also be helpful for the baby, as there is evidence of antibody transfer in cord blood and breast milk, which may offer protection to infants through passive immunity. • If you have any questions or concerns, discuss them with your healthcare professional. The College worked with Dr Nikki Turner and Dr Mary Nowlan from the Immunisation Advisory Centre (IMAC) to run a second webinar for midwives about the science behind the recommendations, and to update the IMAC information sheet for health professionals. You can find these useful resources on the College website under News & Events/Covid-19 Vaccination, Pregnancy & Lactation: June 2021 Update. square

Correction: In the bulletin of Issue 101 of Midwife (p.8), Pauline Dawson was mistakenly reported to have completed her doctoral degree through Otago Polytechnic. In fact, Pauline attained her doctorate through the University of Otago.

updated newborn resuscitation guidelines

In 2020 the International Liaison Committee on Resuscitation (ILCOR) undertook an extensive review of new evidence from the last five years, and updated its recommendations.

Evidence review topics included:

• use of suction in the presence of both clear and meconium-stained amniotic fluid

• sustained inflations for initiation of positive-pressure ventilation

• initial oxygen concentrations for initiation of resuscitation in both pre-term and term infants

• use of epinephrine (adrenaline) when ventilation and compressions fail to stabilise the newborn infant

• appropriate routes of drug delivery during resuscitation

• consideration of when it is appropriate to redirect resuscitation efforts after significant efforts have failed (Wyckoff el al, 2020).

As a result of ILCOR updating its recommendations, the Australian and New Zealand Committee on Resuscitation (ANZCOR) has subsequently published changes to its guidelines. The following table summarises significant changes to the ANZCOR guidelines, with an emphasis on those that are of particular importance to midwifery practice.

TOPIC IN GUIDELINE 2021 CHANGES

Introduction to resuscitation of the newborn For infants born at less than 34 weeks’ gestation who do not require immediate resuscitation after birth, defer clamping the cord for at least 30 seconds.

For term and late pre-term infants born at ≥34 weeks’ gestation who are vigorous or deemed not to require immediate resuscitation at birth, later (delayed or deferred) clamping of the cord at ≥ 60 seconds.

Intact cord milking for infants born at less than 28+0 weeks’ gestation is not supported.

Airway management and mask ventilation of the newborn

The resuscitation of the newborn in special circumstances

Ethical issues in resuscitation of the newborn For all newborns exposed to meconium-stained amniotic fluid, ANZCOR suggests against routine direct laryngoscopy immediately after birth, with or without tracheal suctioning.

For pre-term infants born at less than 35 weeks’ gestation commence resuscitation either using room air or blended air and oxygen up to an oxygen concentration of 30% rather than higher initial oxygen concentration (60%-100%).

If, despite provision of all the recommended steps of resuscitation and excluding reversible causes, a newborn requires ongoing cardiopulmonary resuscitation (CPR) after birth, ANZCOR suggest discussion of discontinuing resuscitative efforts with the clinical team and family. A reasonable timeframe to consider this change in goals of care is around 20 minutes after birth.