Identification And Transport

Of Sick NeonateL S DESHMUKH

DM(NEONATOLOGY)

PROFESSOR,

GMCH, AURANGABAD

Signs of Good Health at Birth

Objective measures

Breathing

Heart rate above

100 beats/minute

Subjective measures

Vigorous cry

Pink skin

Good muscular tone

Good reactions to

stimulus

•Most important measure is whether newborn is breathing

• Assessing all of above delays resuscitation, if it is necessary.

Sick newborn

Early detection,

prompt treatment and

referral (if required)

necessary to prevent high mortality

Problems in early diagnosis of

sick newborn

Many NBs referred unnecessarily

Non-specific signs

Difficulties in preterm and LBW babies

Identifying Sick New born – Danger

Signs

Danger signs

Lethargy

Hypothermia

Respiratory distress

Cyanosis

Convulsion

Abd. distension

Bleeding

Yellow palms/

soles

Excessive wt. loss

Vomiting

Diarrhea

Lethargy and poor sucking

In a term baby who was feeding earlier

indicates neonatal illness

(as perceived by mother)

In a preterm baby needs careful

assessment because it may be due to cold

stress or immaturity

Capillary refill time (CRT)

Indicates tissue perfusion

Normal CRT < 3 seconds

Prolonged CRT > 3 seconds *

Use 10ml/kg normal saline bolus

* Hypotension, hypothermia, acidosis

Capillary refill time (CRT)

Respiratory problems

RR > 60 / min*

Retractions

Grunt

Central cyanosis

Apnea

*Rate should be counted in a quiet state

and not immediately after feed

R

E

T

R

A

C

T

I

O

N

S

Body temperature in newborn

infant (oC)

Normal range

Cold stress

Moderate hypothermia

Severe hypothermia Outlook grave, skilled

care urgently needed

Danger, warm baby

Cause for concern

37.5o

36.5o

36.0o

32.0o

Failure to pass meconium and

urineFailure to pass meconium

Majority pass within 24 hrs Delayed passage May have passed in –utero Don’t miss Imperforate Anus Suspect obstruction PolyhydramniosFailure to pass urine

Majority pass within 48 hrs Many pass in LR Delayed passage Exclude obstructive uropathy or renal agenesis Oligohydamnios

Causes of vomiting*

Commonly Amniotic fluid gastritis

Systemic illness

CCF

Raised ICP – IVH, asphyxia

Metabolic disorders (CAH, galactosemia)

• Persistent, projectile or bile stained –

r / o intestinal obstruction

Causes of diarrhea Infective diarrhea* (often non breast fed

baby)

Maternal ingestion of drugs (ampicillin,

laxatives)

Metabolic disorders

Thyrotoxicosis

Maternal drug addiction

*Infective diarrhea needs treatment with

systemic antibiotics

Cyanosis

Peripheral

Normal at birth

Seen in extremities due to cold

Central

Always needs appropriate referral

Seen on Tongue (Mucosa)

Indicates cardiac or pulmonary disease

Peripheral cyanosis

Central cyanosis

Yellow staining of soles

Yellow Palms & Soles

Tracheo-esophageal fistula

Excessive drooling; choking; cyanosis

during feeds; respiratory distress

Failure to pass red rubber catheter

beyond 8 to 10 cm from mouth

Polyhydramnios

Look for other anomalies

Tracheo-esophageal fistula

Suspect cardiac disease

Cyanosis

Tachycardia

Murmur

Hepatomegaly

Shock

Cardiomegaly

Abnormal weight loss pattern

> 10 percent of birth weight in term

> 15 percent in preterm

> 5 percent acute weight loss

Danger signs

Lethargy

Hypothermia

Respiratory distress

Cyanosis

Convulsion

Abd. distension

Bleeding

Yellow palms/

soles

Excessive wt. loss

Vomiting

Diarrhea

Importance of Looking at Feet

• Temp

• Hb

• O2 Saturations

• BP

• Jaundice

• Maturity

• Deformity

Neonatal Transport - Goal

Taking Right New born at the Right

Time , By Right Personnel, to the

Right Place, By the Right form of

Transport, and receive the Right

Care Throughout .

Neonatal Transport - Practical constraints Facilities are scarce and not easily available

Families have poor resources

Organized transport services are not available.

No health provider is available to accompany the

baby

Mostly self-transport (Taxi/Rickshaw/public transport)

Facilities are not fully geared up to receive sick

neonates

Communication systems are non existent or inefficient

Neonatal Transport - Practical

constraintsSpecialized Transport – 108 ETS

Transport team imp

“Organised transport reduces

morbidity and mortality”

Prepare well before transport

Assess – necessity

Correct Hypothermia

Write a Note

Encourage mother to accompany

Arrange a care provider to accompany

Pre-transport stabilization:

STABLE:

Sugar,

Temperature,

Artificial breathing,

Blood pressure, (CRT)

Laboratory work,

Emotional support.

Care during transport

Ensure warm feet

Ensure an open airway

Check breathing

Provide feeds

[NB: Intravenous fluid administration during transport is best avoided]

Ensure warm transport

Skin to skin care (Kangaroo Mother Care)

Cover the baby

Transport incubator

Improvised containers

Neonatal Transport - Equipments

Communication

Explain the condition,

the prognosis

the reasons for referral of the baby to the

family.

Explain where to go and indicate whom to

contact.

Inform the referral facility beforehand, if

possible.

THANK YOU