Neonatal Transport

Question 1

Def of neonatal transport

Answer 1

act of moving a neonate from one setting or facility to another to allow for provision of a level of care and / or type of service that is not available in the former.

Question 2

Here’s a question based on the text:

What is generally preferred to having a high-risk neonate born in a setting not equipped to take care of it?

Answer 2

maternal transport prior to birth is generally preferred to having a high-risk neonate born in a setting not equipped to take care of it.

Question 3

What type of facilities are high-risk neonates typically transferred to for specialized care?

Answer 3

high-risk neonates are typically transferred to tertiary care facilities for specialized care.

Question 4

Why are most high-risk neonates delivered in facilities not matched to their needs?

Answer 4

According to the text, most high-risk neonates are not identified before birth, which is why they are often delivered in facilities not matched to their needs.

Question 5

What is neonatal transport defined as?

Answer 5

act of moving a neonate from one setting or facility to another to allow for provision of a level of care and / or type of service that is not available in the former.

Question 6

Is neonatal transport limited to inter-facility transfers, or can it occur within the same facility?

Answer 6

According to the text, neonatal transport can indeed occur within the same facility, such as transferring a neonate from the birth area to the nursery.

Question 7

What determines the need for neonatal transport?

Answer 7

the need for neonatal transport is determined by the need for a level of care or type of service that is not available in the current facility.

Question 8

Here’s another question:

What is one scenario where neonatal transport might be necessary, aside from transferring to a tertiary care facility?

Answer 8

Necessary to know the process and resources necessary for transporting pregnant women envisaged as high risk or sick newborn to a center with expertise and facilities for provision of intensive care so as to improve outcome.

Question 9

NICUs’ became available in ?

Answer 9

Late 1950’s and early 1960’s

New Millennium 2000

Question 10

The concept of regionalized care for neonates was first introduced in ?

Answer 10

in 1970s (March of Dime Reports) towards improving outcome in pregnancy.

Question 11

Regionalized care sim

Answer 11

emphasize the importance of providing regionalized care for neonates in facilities with adequate personel and equipment forr an infant’s severity of illness.

Question 12

Classification of nursery care

Answer 12

1) primary I, ( level 1)
2) secondary II ( level 2 )
3) tertiary III. ( level 3 )

Question 13

Function of Level I Nurseries

Answer 13

1) Routine well $ Newborn care newborn ( Basic neonatal care ) eg neonatal resuscitation and care for healthy term and late term infants).

4) To stabilize high risk newborn
Capacity to stabilize ill and preterm before transporting to a higher level of care.

Question 14

Function of Level Il Nurseries

Answer 14

care for moderately ill term infants
Paediatrician/neonatologist, neonatal nurse practiotioners.

1) Level I + support to smaller sicker infants
2) Healthy growing premature ( babies > 32 GA, >1500gms (feeding difficulties, apnea of prematurity, RDS requiring CPAP, temperature regulation).
3) infants on IV support
4) infants on oxygen
5) No prolonged ventilation

Question 15

Function or characteristic of Level III Nurseries ( Neonatal intensive care units (NICU).)

Answer 15

1) Complete neonatal intensive care( care for extremely preterm and critically ill neonates.)
personelle and equipment to manage ang treat all conditions

2) Consultation with subspecialists
3) Pediatric surgical
4) support Transport team

Question 16

What is the primary role of a Level I neonatal care facility?

Answer 16

Level I neonatal care facilities provide
1) Basic neonatal care”
2) equipped to perform neonatal resuscitation and care for healthy term and late-term infants,
3) stabilize ill and preterm infants before transporting them to a higher level of care.

Question 17

What is the gestational age criteria for babies that can be cared for in a Level II facility?

Answer 17

> 32 GA

Question 18

What type of care is provided in a Level III Neonatal Intensive Care Unit (NICU)?

Answer 18

1) Equipped to care for extremely preterm and critically ill neonates.
•2) Available personelle and equipment to manage and treat all conditions
•3) Subspecialty and paediatric surgeon

Question 19

What kind of personnel are typically available in a Level II neonatal care facility?

Answer 19

Level II facilities typically have a 1)pediatrician/neonatologist
2) neonatal nurse practitioners.

Question 20

What is the primary role of a Level II neonatal care facility?

Answer 20

1) care for moderately ill term infants expected to heal quickly.
•2) Care for babies >32/52 GA, >1500gms
3) babies with feeding difficulties, apnea of prematurity, RDS requiring CPAP, temperature regulation

Question 21

What is a key feature of a Level III Neonatal Intensive Care Unit (NICU)?

Answer 21

Spot on!
Level III NICUs have available personnel and equipment to manage and treat all conditions,
also have subspecialty and pediatric surgeons.

Question 22

What is one condition mentioned in the text that Level II facilities can care for?

Answer 22

Level II facilities can care for babies with:

• Feeding difficulties
• Apnea of prematurity
• RDS requiring CPAP
• Temperature regulation issues

CPAP stands for Continuous Positive Airway Pressure.

Question 23

What’s CPAP

Answer 23

It’s a type of respiratory support often used to help newborns (especially preterm babies) breathe more easily.

Question 24

What is the birth weight criteria for babies that can be cared for in a Level II facility?

Answer 24

> 1500g

Question 25

Importance of Regionalization

Answer 25

1) Early detection of high risk fetus 2) Maternal referral to a tertiary center 3) Sharing evidence between local and tertiary 4) centers Improved outcome

Question 26

What the benefit of Maternal transport

Answer 26

results in improved neonatal outcomes when compared with neonatal transport

Question 27

What are the prerequisites for neonatal transportation

Answer 27

1) Communication - inform caregiver about transportation to another facility. -Informed consent from parents/caregivers. -Confirm the vacancy at the hospital to be transported to and inform the approximate time of arrival. -Contact and names of key personel at referral hospital - communicate with Referring hospital and physician about a - important information about the patient ( neonatal data, parental data, perinatal data, diagnosis and reason for referral) -

Question 29

What are the Components of the neonatal transport system .

Answer 29

•1) Transport team •2) Transports means •3) Equipments for resuscitation during transpoertation. •4) Communication and family support •5) Documentation and consent form •6) Feedback to the referring unit.

Question 30

Do We Need Neonatal Transport Service ?

Answer 30

>30% or more of neonatal problems are identified after birth in Level I or Il centers So neonatal transport service is important to transport critical I’ll to level III

Question 31

What are Indications for neonatal transport ?

Answer 31

1) when Inutero transfer cannot be safely accomplished. •2) Infants requiring advanced medical care exceeding what is available in the current setting. •3) Transport of baby within the hospital for procedures. •4) Very pretem low birth weight infants <1500gms •5) Respiratory distress syndrome •6) Apnea •7) Active bleeding •8) Cyanosis •9) Congenital heart disease (antenatally or suspected) •9) Heart failure •10) Severely asphyxiated infant •11) Surgical condition requiring specialist intervention •12) Jaundice requiring treatment •13) Infant of a diabetic mother ( Macrosomic baby ) •14) Temperature instability 15) Difficulty with oral feeds 16) Cyanosis

Question 32

What are the components that make up the Transportation team ?

Answer 32

Transport team comprises at least 2 individuals 1) – registered nurses, 2) a respiratory therapist 3) a paramedic; 4) occasionally, neonatologist, 5) neonatologist nurse practitioner (critically ill neonate). •6) Medical control physician designated for communication with the transport team through out the transport as need arises.

Question 33

Requirements of Transport vehicle

Answer 33

1) Should have adequate room for the neonatal system and space for staff, accompanying family member and space to performprocedures. 2) • Equipped with appropriate emergency medications (adrenaline, phenobarbione, diazepam, calcium gluconate, sodium bicarbonate and dopamine) and devices -3) powe back up-fully charged and battery back up, 4) cylinders for oxygen, flow meter, oxygen tubing, neonatal positive pressure mask, transport incubators, laryngoscope, ET tube, mucus suction trap, suction catheter, feeding tube, stethoscope, microdrip set, infusion pump, IV catheter, synringes, gloves, glucometer, infusions, sterile water, tapes.

Question 34

Drugs found in a transport vehicle

Answer 34

• appropriate emergency medications 1) adrenaline: 1 in 10,000. 2) Phenobarbital 3) diazepam, 4) calcium gluconate, 5) sodium bicarbonate (8.4%) and 6) dopamine 7) Normal saline •8) Dextrose 10%.

Question 35

What are Transportation equipment ?

Answer 35

1) Transport incubator/ thermocol box. •2) Resuscitation equipment-appropriate size bag, mask, 3) laryngoscope, endotracheal tube. •4) Stethoscope •5) Thermometer •6) Suction device, 6) syringe and needles. •7) equipment to Monitor for HR, SaO2 and temperature. •8) Battery operated infusion pump. •9) Oxygen cylinder

Question 36

How should medications in neonatal transportation be kept ?

Answer 36

Keep all the medications ready to use (pre-filled syringes).

Question 37

What are Problems encountered during transport

Answer 37

1) Hypothermia •2) Hypoglycaemia •3) Hypotension •4) Apnea •5) Septicaemia •6) Problems related to positive pressure ventilation given during transport.

Question 38

When do babies become most unstable ?

Answer 38

Babies become most unstable during transport

Question 39

How to Stabilization of the patient ( baby) before transportation

Answer 39

1) Airway is secured, 2) breathing providing oxygen and assisted ventilation, 3) maintaining circulation( HR, BP, UOP), 4) antimicrobial therapy. -5) Ensure thermoneutral warm environment -6) Blood sugar control >40mg/dl ●It is important to ensure and maintain these parameters during the transportation process also

Question 40

Meaning of STABLE before and during transfer

Answer 40

1) Sugar: 2) Temperature 3) Airway 4) Blood pressure 5) laboratory investigations 6) Emotional support to family

Question 41

What equipment is used to monitor Sugar and how to manage

Answer 41

1) measured using glucometer / dextrostix -3) Increase glucose dose regulation if required.

Question 42

How to maintain Temperature in stable

Answer 42

maintain temperature by -1) use a Transport incubator –ideal or a -2) Transport box or water filled bags -3) Water filled bags/bottles – no direct contact with the baby. -4) Cover the baby with warm clothes-cap and socks -5) Wrap in cotton and then by prewarmed linen. -6) A thin foil can be used as an effective heat insulator. -7) Kangaroo mother care for stable babies.

Question 43

When to monitor sugar, temperature, airway

Answer 43

1) Monitor sugar every ½-1 hourly 2) -Monitor temperature half hourly. 3) Preferably monitor the baby on a pulse oximeter half hourly. 4) Blood pressure-every 15 minutes

Question 44

What should be done under airway ?

Answer 44

1) Keep airway patent. 2) - Give oxygen and ventilatory support as indicated

Question 45

What should be done under blood pressure?

Answer 45

1) Ensure adequate circulation -2) keep vascular access in place -3) Dopamine if required

Question 46

What should be done under Laboratory investigations?

Answer 46

1) Blood chemistry ( FBC ) 2) CXR, 3) Urinalysis 4) Lumbar puncture etc

Question 47

What is the Transport protocol ?

Answer 47

1) Send the details of maternal and neonatal history along with investigations report. •2) Ensure asepsis during all the procedure. •3) Preferably transfer mother and baby together

Question 48

What are the various Medicolegal issues associated during transport.?

Answer 48

1) Risk of transport and transportation 2) Possibility of complication during transport •3) Death of the baby occurs, parents

Question 49

What should be done in case of various Medicolegal issues associated during transport.?

Answer 49

1) consent should be reviewed and obtained from the parents before transportation. •2) ambulance should be stopped and CPR commenced. 3) should be explained of death, death certificate issued by the medical personel.

Question 50

Who has the responsibility to make Seth certificate for the baby ?

Answer 50

It is the responsibility of the transporting team to make death certificate for the baby.

Question 51

What happens At the referral facility ?

Answer 51

1) Neonate is received at arrival and immediately reaccessed. •2) Transfer over the baby with complete transfer summary to the attending doctor. •3) Stabilization is continued •4) Give contact numbers to the attending doctor if need arises. •5) Specialized care instituted until when patient’s clinical condition is satisfactory and patient is stable.

Question 52

What is Reverse transport ?

Answer 52

Transfer of baby once baby is stable and intensive care is no longer need, back to the birth facility or home .

Question 53

Benefit of Reverse transport .

Answer 53

1) Aids in appropriate utilization of resources, 2) decrease cost of care and 3) promote parent-infant bonding because of proximity to mother’s home.

Question 54

Equipments found in a transport vehicle

Answer 54

1) cylinders for oxygen, 2) flow meter, 3) oxygen tubing, 4) neonatal positive pressure mask, 5)transport incubators, 6) laryngoscope, 7) ET tube, 8) mucus suction trap, 9) suction catheter, 10) feeding tube, 11) stethoscope, 12) microdrip set, 13) infusion pump, 14) IV catheter, 15 syringes, 16) gloves, 17) glucometer, 18) infusions, 19) sterile water, 20) tapes.