The need to call for consultant support may vary with the experience of the staff involved. This guideline suggests scenarios where advice of a consultant should normally be sought, however the list is not exhaustive, consultant advice should be sought any time that the junior medical team and/or experienced nurses feel the need for support

* Consultant normally expected to attend in person

Before birth

• Delivery <27 weeks’ gestation*
• Unexpected birth of baby with congenital diaphragmatic hernia*
• If stated in neonatal alert form/antenatal MDT plan 

During resuscitation

• No heart beat at 5 min/continuing resuscitation at 10 min*
• Request of consultant obstetrician

Admission

• <28 weeks’ gestation
• Ex-utero intensive care transfer
• Cord pH <7.0 and/or 10 min Apgar score <6
• Suspected subgaleal haemorrhage

Inpatient

• FiO₂ >0.6 with/without respiratory support
• Baby who has required endotracheal ventilation (do not wait for consultant before intubating and initiating ventilation)
• Anticipated need for HFOV
• PPHN likely to need nitric oxide*
• Continuing hypotension despite volume expansion and dobutamine and dopamine*
• Seizures
• Neonatal encephalopathy requiring therapeutic hypothermia
• Severe jaundice 
  • bilirubin above exchange level 
  • bilirubin rising >8.5 micromol/L/hr despite intensive phototherapy
• Major deterioration 
• Baby with ambiguous genitalia/disorder of sexual development
• Major congenital anomaly without antenatal plan 
• Renal failure with serum K⁺ >7 mmol/L or Na⁺ <120 mmol/L
• Known subgaleal haemorrhage with haemodynamic instability needing volume or blood products replacement*
• Unexpected death*
• Initiation of, or unexpected withdrawal of, intensive care*
• Escalation level requiring in-utero or ex-utero transfers out or refusals from other units 
• Middle grade doctor and nursing team cannot agree management plan for baby 
• Inability immediately to site essential line*