Neonatal transport

Definition

• Newborn transport is used to move premature and other sick infants from hospitals without specialist, intensive care facilities require for optimal care of the baby to hospitals with neonatal intensive care and other specialist services.

Out born newborns

• A significant number of neonates require emergent transfer to a tertiary care center, often because of medical, surgical, or rapidly emerging postpartum problems. These are termed “outborn” neonates, because they have been born somewhere besides the facility to which they’ve been transferred.

TRANSFER

• Transfer can be within the hospital; to ICU• Transfer can be to other hospital

Neonatal transfer types

• Emergency: unplanned • Elective : planned and informed

How can we transfer?

• The short distance transport within the hospital can be accomplished in a transport incubator.

• The use of plastic basket with perforated sides coupled with careful placing of hot water bottles is recommended for use in the rural setting.

• The baby can be wrapped in tin foil or covered with several layers of cotton.

• Themocele (polystyrene) box is an effective insulator and can be used in community.

• Skin to skin contact with mother or a care taker is a useful modality of transport in rural areas or resource poor settings.

Indications of neonatal transport

• Preterm infant with a birth weight <1500g or gestation <32 weeks

• Respiratory distress requiring CPAP or assisted ventilation

• Severe hypoxic-ischemic encephalopathy• Life threatening sepsis• Intractable seizures• Bleeding neonate

• Congenital anomalies or surgical neonate• Inborn errors of metabolism• Severe jaundice• Procedures or diagnostic facilities

unavailable at parent hospital.

Transport equipments 1. Transport incubator with multi channel

vital signs monitor for recording temperature, heart rate, NIBP, oxygen saturation

2. CPAP facility with nasal prongs and portable ventilator

3. Airway equipment: suction devices, oral airways, bag and mask, laryngoscopes (size 00,0 and 1 blades)

4. Infusion facilities: infusates, infusion pumps, glucometer

5. oxygen, compressed air cylinder, oxygen mask, hood, heat and light, sources of electric powers and adapters.

6. disposables: catheters (5,6,7,8,10,12Fr), syringes, needles, feeding tubes (8 & 10Fr), alcohol, betadine swabs, micropore tape, gloves etc.

7. Instrument tray for ET intubation, vascular access, insertion of chest tubes, NG tube etc

8. Life saving drugs

Note

• All the equipment should have a battery back up and should be kept fully charged all the time.

• Enough O2 supply should be carried which should last during the period of journey.

Transport team

• The neonate needing special or intensive care should be transported by a skilled transport team.

• Teams include at least, a) One senior resident b) One specially trained neonatal nurse

Principles of safe transport

• Sugar

• Temperature

• Airway

• Blood pressure

• Lab work

• Emotional support

• Sugar

• Arterial circulatory support

• Family support

• Environment

• Respiratory support

• Temperature

• Oxygenation (airway and breathing)

• Perfusion

• Sugar

Protocols i. Maintain airway, oxygenation, thermal

stability and tissue perfusionii. Stop oral feeding and start parenteral

feeding with 10% of dextrose.iii. Ensure umbilical or peripheral venous

accessiv. Insert an NG tube and decompress the

stomachv. Maintain adequate blood glucose level

vi. Obtain culture samples and administer first dose of antibiotics.

vii. Obtain a recent chest skiagram as a base line and to check the position of catheters and tubes.

viii. Take the family member or parents along with the baby whenever feasible.

ix. When required transport team should undertake life saving procedures (like ET tube insertion, chest tube insertion etc)

x. administer life saving drugs like surfactant and prostaglandins

xi. The referring hospital should prepare a detailed transport note including copies of obstetric and neonatal charts for the transport team.

xii. Monitor the baby’s color and temperature.

Arrival at the receiving NICU

• The transport team should remain in constant touch with the referral NICU during the course of journey.

• The team should brief the NICU care givers regarding the status of the baby and immediate clinical concerns.

• Hand over all the documents.

• The referring hospital and parents should be informed about the safe arrival and latest condition of the baby.

• The inventory of transport equipment should be checked, medications and essential supplies should be restocked for the next transport service.