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Table 5 CheckCe, particularly during the skin to skin contact [148]

From: Apparent Life-Threatening Events (ALTE): Italian guidelines

  1. Position: Prone position of the newborn during skin-to-skin contact (SSC) should not obstruct the airways or prevent adequate breathing. The healthcare professional should intervene to correct at risk positions
  2. Colour: Areas to be examined are lips and tongue. Assess the presence of abnormal skin colour: cyanotic or pale
  3. Breath: Breathing pattern, respiratory rate, and amplitude of breaths are physiologically irregular in the newborn. The presence of the following abnormal conditions must be assessed: (a) mouth or nose obstruction; (b) respiratory rate > 60 breaths/min or <30 breaths/min; (c) apnoea or dyspnoea (flaring of the nostrils, grunting, or intercostal retractions)
  4. Pulse oximetry: This should be measured only if the infant shows some abnormal signs during surveillance, appears “unconvincing” to the observer, or if judged appropriate in the local settings due to staff shortage. For term newborns, a value higher than 90% (10° percentile) is considered normal after the first 10 min of life
  5. Skin temperature: Normal skin temperature is 36.5 °C-37.5 °C
  6. Mother and infant should never be left alone: mother-infant SSC should be supervised periodically (at 30, 60, 90, and 120 min of life) by midwives. Presence of the father or another person should be guaranteed. The room should be adequately lit, so that the baby’s skin colour can be seen. Should the mother appear fatigued or drowsy, consider placing the infant in his or her own crib or have the father hold him or her. Emergency call procedures should be clearly explained to parents. If no surveillance can be provided and the parents’ reliability cannot be assessed, the safest option is to admit the newborn infant to the regular nursery. It is recommended to turn off mobile phones to avoid a well-known and relevant source of distraction