The need for a specialist Neonatologist to attend a delivery depends on:

1. The experience of the registrar, fellow, or NS-ANP "on call".
2. The level of concern of the obstetric staff.
3. The clinical scenario.

There should be good communication between the neonatologist and both the resident neonatal staff and the obstetric service.  During office hours a "high risk" case should be discussed with the neonatologist "on duty" for level 3 and out of hours with the neonatologist "on call".

If an obstetrician has concerns regarding a potential delivery and wishes a specialist neonatologist to attend that delivery the specialist obstetrician should speak directly to the neonatologist.

It is envisaged that:

1. Deliveries <28/40 should be discussed so the neonatologist has the option of attending the delivery.
2. Deliveries of infants <26 weeks must be attended by a staff member with appropriate neonatal expertise (that is, an experienced senior registrar, NS-ANP, or specialist).  This should be discussed with the neonatologist in advance.  If in doubt, the neonatologist should always be called.
3. Deliveries of infants with fetal hydrops or life-threatening congenital anomalies (e.g. diaphragmatic hernia or other conditions) requiring immediate decisions regarding resuscitation should be attended by a neonatologist.
4. For any case in which the infant resuscitation was unexpectedly complex or where there is a poor response to resuscitation the attending neonatologist should be called urgently.

The attending neonatologist should be notified shortly before or as soon as practicable following the admission of infants to level 3 care who are:

1. <28/40, or <1000 g or ventilated or have significant respiratory disease.
2. Any sick baby causing concern for medical or senior nursing staff.
3. Any circumstance where the resident staff are inexperienced or not confident in undertaking a treatment or procedure required.