Neonatal Transfer by roadNeonatal Transfer by road

David BreslerDavid BreslerMETROMETRO

ObjectivesObjectives

• What is a neonate?What is a neonate?• Highlight the logistics required for safe Highlight the logistics required for safe

transportation of the neonate.transportation of the neonate.• The checks done preparing for transportation.The checks done preparing for transportation.• Which type of illnesses are commonly Which type of illnesses are commonly

transferredtransferred

(high risk)(high risk)

The receiving hospitalThe receiving hospital

What is a neonate?What is a neonate?

• Neonate - 1Neonate - 1stst 28 days, 28 days, full term 38-40wksfull term 38-40wks

• Premature Neonate - < 38 wks / < 2,5kgsPremature Neonate - < 38 wks / < 2,5kgs

• Post term – born after 42wksPost term – born after 42wks

Neonates vitalsNeonates vitals

• Pulse Rate Pulse Rate 80 – 160 (acceptable)80 – 160 (acceptable)• Haemoglobin Haemoglobin 17 g/dl 17 g/dl • Respiration Respiration 30 – 8030 – 80• Posture Posture flexedflexed• Sight Sight can distinguish light & darkcan distinguish light & dark• Hearing Hearing well established at birthwell established at birth

The medium of travelThe medium of travel

• Lets state the obvious…Lets state the obvious…

• Code 10 drivers licence.Code 10 drivers licence.

• Competent personnel.Competent personnel.

• Enough petrol.Enough petrol.

• Roadworthy vehicle.Roadworthy vehicle.

EquipmentEquipment

• Adequate, functioning equipment (suction, Adequate, functioning equipment (suction, ECG with additional batteries and paper, ECG with additional batteries and paper, charging or charged dinamap)charging or charged dinamap)

• Enough 02 for the journey.Enough 02 for the journey.

• A working heater (cold weather)A working heater (cold weather)

EquipmentEquipment

• Syringe driver for specific drug dosage Syringe driver for specific drug dosage administration.administration.

• Ventilator with serviced connections and Ventilator with serviced connections and tubing.tubing.

• Telethermometer.Telethermometer.

EquipmentEquipment

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

The incubatorThe incubator

• Transportable.Transportable.

• Light weight.Light weight.

• Must be able to be battery supported.Must be able to be battery supported.

• Must have accessible portholes.Must have accessible portholes.

• Must fit onto ambulance stretcher.Must fit onto ambulance stretcher.

IncubatorIncubator

• Must have power access to ambulance.Must have power access to ambulance.

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

PreparationPreparation

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

PreparationPreparation

““right way around” right way around”

on scene.on scene.

When infant is placed intoWhen infant is placed into

“ “bed”, it will be nicelybed”, it will be nicely

warmed up.warmed up.

PreparationPreparation

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

Preparing for transportPreparing for transport

Vitals:Vitals:

Respiratory rateRespiratory rate Check setting on ventilator, and setCheck setting on ventilator, and setbabylog accordingly.babylog accordingly.

NB: Always keep a close eye on babies clinical NB: Always keep a close eye on babies clinical picture and vitals.picture and vitals.

Preparing for transportPreparing for transport

Easy formula to set ventilator if no parameters to Easy formula to set ventilator if no parameters to work on:work on:

( 60 seconds / respiratory rate / I+E = Inspiratory ( 60 seconds / respiratory rate / I+E = Inspiratory time)time)

If I:E is 1:1 divide by 2, if I:E 1:2, divide by 3, etc.If I:E is 1:1 divide by 2, if I:E 1:2, divide by 3, etc.Once you have inspiratory time, work out expiratoryOnce you have inspiratory time, work out expiratorytime, based on ratio.time, based on ratio.

Flow/ sec = Tidal volume / Inspiratory time.Flow/ sec = Tidal volume / Inspiratory time.On ventipac : Inspiratory + expiratory times + flow/ On ventipac : Inspiratory + expiratory times + flow/

litres per sec = minute volume.litres per sec = minute volume.

Preparing for transportPreparing for transport

Blood pressureBlood pressure( gestational age of prem baby same as M.A.P. on ( gestational age of prem baby same as M.A.P. on

Dinamap)Dinamap)

Temp Temp 36,5 C36,5 C

Heart rateHeart rate 120-160 normal 120-160 normal

HGT HGT 3,5 mmol/l min.3,5 mmol/l min.Remember to dilute to 12,5 % if low.Remember to dilute to 12,5 % if low.(For every 1 ml of 50% Dextrose (For every 1 ml of 50% Dextrose / kg, dilute with 3mls sterile water or / kg, dilute with 3mls sterile water or 0.9 % sodium chloride.0.9 % sodium chloride.

Prepare for transportPrepare for transport

Check ID, compare with mothers folder. Check ID, compare with mothers folder.

IV fluids ( Neonatalyte)IV fluids ( Neonatalyte)

HistoryHistory

Reason for transferReason for transfer

Escorts?Escorts?

High risk neonateHigh risk neonate

• Hypoxia Hypoxia

• Hypoglycaemia Hypoglycaemia

• HypothermiaHypothermia

• HyperbilirumenaemiaHyperbilirumenaemia

High risk neonateHigh risk neonate

• HypovolaemiaHypovolaemia

• Heavy sedationHeavy sedation

• InfectionInfection

Receiving hospitalReceiving hospital

• Ensure receiving hospital is aware of patients Ensure receiving hospital is aware of patients condition.condition.

• Receiving Doctors name.Receiving Doctors name.

SUMMARYSUMMARY

• What is a neonate?What is a neonate?• Highlight the logistics required for safe Highlight the logistics required for safe

transportation of the neonate.transportation of the neonate.• The checks done preparing for transportation.The checks done preparing for transportation.• Which type of illnesses are commonly Which type of illnesses are commonly

transferredtransferred

(high risk)(high risk)

The receiving hospitalThe receiving hospital

Questions

End