Component Task: Transporting a Sick Neonate

Newborns who are sick or preterm are transferred from the labour ward to the neonatal intensive care unit. This is done when the newborn shows danger signs of morbidity and mortality and needs further assessment and management. A trained and highly skilled nurse accompanies baby in a specially equipped vehicle e.g. an ambulance or wrapped up in a cot sheet/blanket to keep baby warm.

Aims

·         Stabilize the neonate

·         Receive advance care

·         Prevent complications

·         Prevent neonatal mortality

Types

·         Transfer from a lower health facility to a higher health facility

·         Transfer from one department to the other

Requirements

·         Transport incubator

·         Mobile/portable oxygen cylinder

·         Extra sheets/blanket

·         Self inflating bag with neonatal size mask

·         Flowmeter

·         Oxygen tubing

·         Pulse oximeter

·         Cannula

·         Endotracheal tubes (size 2.5, 3.0, 3.5,4.0mm)

·         Laryngoscope with size 00, 0 and 1 blade

·         Laryngoscope batteries

·         Tape to secure endotracheal tubes

·         Prescribed medication e.g. normal saline, phenobarbitone, 10% calcium gluconate, adrenaline etc.

·         Suction apparatus with catheters

·         Feeding tubes (size 5,6,7,8)

·         Sterile gloves

·         Examination gloves

·         Stethoscope

·         Glucometer with strips

·         Drip stand with infusion pump

·         20ml syringe for gastric decompression

·         Syringes and needles (size 2,5,20,50)

·         Three way stop cork

·         Cardiac monitor

·         Baby’s folder

Steps

1.        Identify staff capable of transferring the neonate

2.      Establish rapport with mother or care giver (Refer to steps)

3.      Explain to caregiver the need for transfer

4.      Call the referral center and give brief history of neonate

5.      Ensure baby is stable for transportation

6.      Ensure the transport incubator is clean, oxygen is flowing and incubator is warm

7.       Perform five moment of hand hygiene

8.      Ensure all transfer documentation and entry of data is documented before the team leaves the referral centre

9.      Keep baby warm in incubator, check vital signs, random blood sugar and oxygen saturation

10.    Ensure warmth of baby on the way to the referral centre with a cloth covering the head and extremities or skin to skin contact for mother and baby if transport incubator is not available

11.      Allow mother/family member to accompany baby if possible

12.    Ensure a skilled transport team accompany the neonate to provide necessary care on the way to the referral center

13.    Assess airway for presence of secretions during transportation and suction if available

14.    Position baby with the neck slightly extended

15.    Assess for warm peripheries, capillary refill time, tone, activity and blood pressure

16.    Minimize staff risk by ensuring that ambulance does not move at an unnecessary high speed

17.    Use the shortest route to the referral center

18.    Provide continuous pulse oximetry monitoring

19.    Communicate adequately and timely about baby’s condition to the family

20.  Ensure transporting team carry a mobile phone for constant communication with the receiving hospital

21.    Support and encourage accompanying caregiver to relieve stress and anxiety

22.  Hand over neonate and caregiver information to receiving hospital

23.  Follow up should be done to evaluate the outcome of care

24.  Document findings electronically/manually

25.  Ensure that the ambulance suite has been decontaminated and cleaned for next use


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