SCF-DBI NICU & PRETERM CRITICAL CARE SOP | NICU Admission Workflow, Delivery Room Stabilization, Maternal-Fetal Handoff & Initial SCF-DBI Assessment

Binder Section 2

NICU Admission Workflow, Delivery Room Stabilization, Maternal-Fetal Handoff & Initial SCF-DBI Assessment

Program Code: SCF-DBI-NICU-0001

Operational Window: Birth → 6 Hours of Life

Clinical Objective: Establish physiologic stability, preserve developmental biological intelligence, and activate RHENOVA NICU Innovations.

SECTION 2.1

NICU ADMISSION ACTIVATION CRITERIA

Automatic SCF-DBI NICU Activation

Extremely Preterm

< 28 Weeks Gestation

Very Preterm

28–31 Weeks Gestation

Birth Weight

<1500 grams

Critical Respiratory Disease

RDS
Respiratory failure
Pulmonary hypertension
Meconium aspiration

Neurologic Risk

HIE
Seizures
Severe acidosis
Birth trauma

Cardiovascular Risk

Congenital heart disease
Shock
Persistent pulmonary hypertension

Gastrointestinal Risk

NEC suspicion
Gastroschisis
Omphalocele
Intestinal atresia

Infectious Risk

Maternal chorioamnionitis
Early-onset sepsis risk
Severe maternal infection

SECTION 2.2

DELIVERY ROOM SCF-PCR STABILIZATION WORKFLOW

PREVENTATIVE PHASE

Objective

Prevent secondary injury during neonatal transition.

Step P-1

Thermal Protection

Initiate:

Servo-controlled warmer
Polyethylene wrap for extremely preterm infants
Thermal mattress if indicated

Target:

Temperature 36.5–37.5°C

Step P-2

Oxygen Stewardship

Avoid:

Hyperoxia
Hypoxia

Utilize gestational-age appropriate oxygen targets.

Step P-3

Neuroprotection

Avoid:

Excessive stimulation
Rapid BP fluctuations
Hypercapnia
Hypocapnia

Step P-4

Glycocalyx Protection Bundle Activation

Initiate immediately.

Objectives:

Maintain perfusion
Minimize endothelial injury
Prevent capillary leak

CURATIVE PHASE

Step C-1

Airway Assessment

Evaluate:

Tone
Respiratory effort
Heart rate

Step C-2

Respiratory Support Escalation

Sequence:

Room Air

↓

CPAP

↓

NIPPV

↓

Mechanical Ventilation

↓

HFOV/HFJV

Step C-3

Circulatory Stabilization

Assess:

Capillary refill
Peripheral perfusion
Heart rate
Blood pressure

Step C-4

Emergency Stabilization

Activate if:

Severe acidosis
Persistent bradycardia
Shock
Pulmonary hypertension

RESTORATIVE PHASE

Step R-1

Neurodevelopment Preservation Bundle Activation

Initiate within first hour.

Objectives:

Preserve neural connectivity
Reduce neuroinflammation
Support developmental adaptation

Step R-2

Stem Cell Preservation Strategy Activation

Initiate immediately following stabilization.

Objectives:

Preserve regenerative capacity
Protect organogenesis pathways

SECTION 2.3

MATERNAL-FETAL HANDOFF SOP

Maternal Information Collection

Obstetric Data

Gestational age
Prenatal complications
Delivery mode

Maternal Disease History

Diabetes
Hypertension
Autoimmune disease
Infection

Maternal Medication Exposure

Steroids
Magnesium
Antibiotics
Immunomodulators

Placental Findings

Chorioamnionitis
Placental insufficiency
Abruption
Vascular pathology

SCF MATERNAL-FETAL ADAPTIVE INTELLIGENCE ASSESSMENT

Domain 1

Maternal Immune Adaptation

Domain 2

Placental Vascular Integrity

Domain 3

Fetal Growth Adaptation

Domain 4

Perinatal Stress Exposure

Domain 5

Developmental Risk Burden

SECTION 2.4

INITIAL SCF-DBI BIOLOGICAL INTELLIGENCE ASSESSMENT

Time Requirement

Complete within:

First 2 Hours of Life

Domain A

Neurodevelopmental Intelligence

Assess:

Tone

Reflexes

Consciousness

Behavioral State

Cerebral Oxygenation

Domain B

Neuroimmune Intelligence

Assess:

Maternal Infection Risk

Neonatal Inflammatory Risk

Early Sepsis Indicators

Domain C

Neurovascular Intelligence

Assess:

Perfusion

Lactate

BP Stability

Capillary Refill

Domain D

Neurometabolic Intelligence

Assess:

Glucose

Lactate

Acid-Base Status

Energy Balance

Domain E

Microbiome Intelligence

Assess:

Feeding Readiness

Maternal Milk Availability

Antibiotic Exposure

NEC Risk

SECTION 2.5

BASELINE RHENOVA RISK STRATIFICATION

Tier 1

Low Risk

Stable adaptation

Tier 2

Moderate Risk

Early compensation

Tier 3

High Risk

Threatened adaptation

Tier 4

Critical Risk

High collapse potential

SECTION 2.6

ANMS NEONATAL BASELINE ESTABLISHMENT

Purpose

Establish initial biologic intelligence profile.

Neuroimmune Domain

Baseline Variables

CRP
CBC
Maternal infection risk

Neurocardiac Domain

Baseline Variables

Heart rate
HRV
Lactate
Perfusion

Neurovascular Domain

Baseline Variables

BP
Capillary refill
Cerebral oxygenation

Neurometabolic Domain

Baseline Variables

Glucose
Lactate
Acid-base balance

Neuroendocrine Domain

Baseline Variables

Perinatal stress burden
Cortisol risk profile

Initial ANMS Classification

Green

ANMS >80

Yellow

ANMS 60–79

Orange

ANMS 40–59

Red

ANMS <40

SECTION 2.7

RHENOVA INNOVATION ACTIVATION PROTOCOL

0–6 HOURS OF LIFE

Innovation 1

Neurodevelopment Preservation Bundle

Activate:

Within first hour

Core Actions:

Cerebral NIRS
Noise reduction
Positioning optimization
Sleep protection

Innovation 2

Glycocalyx Protection Bundle

Activate:

Immediately after stabilization

Core Actions:

Perfusion optimization
Fluid stewardship
Oxygen stewardship

Innovation 3

Stem Cell Preservation Strategy

Activate:

Within first 3 hours

Core Actions:

Early nutrition planning
Oxidative stress minimization
Growth factor preservation

Innovation 4

Microbiome Stabilization Protocol

Activate:

Within first 6 hours

Core Actions:

Human milk prioritization
NEC surveillance
Antibiotic stewardship

SECTION 2.8

FIRST SIX-HOUR CLINICAL ENDPOINTS

Physiologic

Temperature stable
Oxygenation stable
Hemodynamics stable

Neurodevelopmental

Cerebral oxygenation maintained
No acute neurologic deterioration

Endothelial

Perfusion preserved
No progressive shock

Metabolic

Glucose stable
Lactate improving

Microbiome

Feeding plan established
NEC prevention pathway active

PAGE 2 COMPLETION

Next Page (Page 3):

Respiratory Distress Syndrome (RDS) SOP

Pulmonary Transition Failure SOP

Surfactant Administration Workflow

Mechanical Ventilation Escalation Pathway

Bronchopulmonary Dysplasia Prevention Program

RHENOVA Neurovascular Lung Protection Protocol

MASTER REGISTRY INDEX

SCF-DBI-NICU-ADMIT-0001 — NICU Admission Workflow

SCF-DBI-NICU-DRS-0001 — Delivery Room Stabilization SOP

SCF-DBI-NICU-MFH-0001 — Maternal-Fetal Handoff SOP

SCF-DBI-NICU-BIA-0001 — Biological Intelligence Assessment Framework

SCF-ANMS-NICU-BASE-0001 — Neonatal ANMS Baseline Establishment Protocol

SCF-RHENOVA-NICU-ACT-0001 — RHENOVA Innovation Activation Workflow

SCF-DBI-PCR-NICU-0001 — Preventative-Curative-Restorative Neonatal Care Framework