Airway: establish airway with intubation and positive pressure ventilation.  Tape ETT

Weigh the baby.

Apply leads for heart rate monitoring

Apply oxygen saturation monitor

Administer surfactant as indicated

Vascular access with peripheral IV, obtain blood culture with PIV insertion if possible.  Draw D10W into a syringe from a bag of fluid obtained from the pyxis. Run on an infusion pump at the ordered IV rate until the computer ordered bag of fluids arrives.  For babies <1250 grams with hyperglycemia, make D7.5W by mixing 1mL sterile water with 3mL D10W. (pharmacy will be fixing the need to mix this in the near future by having D7.5 available)

Labwork:- blood culture, CBC, platelet count, differential, CRP, whole blood glucose

Antibiotic administration.  Initial dose of Ampicillin is in the Stahlman NICU pyxis. Administer through PIV. If unable to insert a PIV, administration can be through a central line..

Blood pressure in one extremity

Prepare for and place central line as needed may move to number 6 if PIV unsuccessful.  Ampicillin can be administered prior to the CXR/KUB

Call for CXR/KUB

Complete physical exam, including head circumference and length, Ballard exam (may do before central line if access is not urgent)

Obtain four extremity blood pressures

Update the family