Neonatal Transfer by road David Bresler METRO

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Neonatal Transfer by roadDavid BreslerMETRO
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Objectives

• What is a neonate?
• Highlight the logistics required for safe
  transportation of the neonate.
• The checks done preparing for transportation.
• Which type of illnesses are commonly transferred
• (high risk)
• The receiving hospital

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What is a neonate?

• Neonate - 1st 28 days, full term 38-40wks
• Premature Neonate - lt 38 wks / lt 2,5kgs
• Post term born after 42wks

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Neonates vitals

• Pulse Rate 80 160 (acceptable)
• Haemoglobin 17 g/dl
• Respiration 30 80
• Posture flexed
• Sight can distinguish light
  dark
• Hearing well established at birth

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The medium of travel

• Lets state the obvious
• Code 10 drivers licence.
• Competent personnel.
• Enough petrol.
• Roadworthy vehicle.

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Equipment

• Adequate, functioning equipment (suction, ECG
  with additional batteries and paper, charging or
  charged dinamap)
• Enough 02 for the journey.
• A working heater (cold weather)

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Equipment

• Syringe driver for specific drug dosage
  administration.
• Ventilator with serviced connections and tubing.
• Telethermometer.

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Equipment

• Whenever using ventilator, ALWAYS have a BVMR in
  incubator, connected to a separate, closed, small
  02 cylinder, in case of ventilator malfunction.

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The incubator

• Transportable.
• Light weight.
• Must be able to be battery supported.
• Must have accessible portholes.
• Must fit onto ambulance stretcher.

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Incubator

• Must have power access to ambulance.
• While out of ambulance, incubator should have
  either charged-up extended battery life, or
  back-up portable battery support system.

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Preparation

• Pre-warm neonatal mattress on the way to
  transferring hospital, by inverting mattress onto
  base of incubator, and then place it

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Preparation

• right way around
• on scene.
• When infant is placed into
• bed, it will be nicely
• warmed up.

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Preparation

• Remember to pre-clean incubator with soap and
  warm water, and then disinfectant solution,
  before and after conveying infant.

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Preparing for transport

• Vitals
• Respiratory rate Check setting on ventilator, and
  set
• babylog accordingly.
• NB Always keep a close eye on babies clinical
  picture and vitals.

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Preparing for transport

• Easy formula to set ventilator if no parameters
  to work on
• ( 60 seconds / respiratory rate / IE
  Inspiratory time)
• If IE is 11 divide by 2, if IE 12, divide by
  3, etc.
• Once you have inspiratory time, work out
  expiratory
• time, based on ratio.
• Flow/ sec Tidal volume / Inspiratory time.
• On ventipac Inspiratory expiratory times
  flow/ litres per sec minute volume.

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Preparing for transport

• Blood pressure
• ( gestational age of prem baby same as M.A.P.
  on Dinamap)
• Temp 36,5 C
• Heart rate 120-160 normal
• HGT 3,5 mmol/l min.
• Remember to dilute to 12,5 if low.
• (For every 1 ml of 50 Dextrose
• / kg, dilute with 3mls sterile water or
• 0.9 sodium chloride.

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Prepare for transport

• Check ID, compare with mothers folder.
• IV fluids ( Neonatalyte)
• History
• Reason for transfer
• Escorts?

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High risk neonate

• Hypoxia
• Hypoglycaemia
• Hypothermia
• Hyperbilirumenaemia

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High risk neonate

• Hypovolaemia
• Heavy sedation
• Infection

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Receiving hospital

• Ensure receiving hospital is aware of patients
  condition.
• Receiving Doctors name.

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SUMMARY

• What is a neonate?
• Highlight the logistics required for safe
  transportation of the neonate.
• The checks done preparing for transportation.
• Which type of illnesses are commonly transferred
• (high risk)
• The receiving hospital

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Questions

• End