NEONATAL TRANSPORT (PROF. DR CHAKRADHAR MADDELA)

NEONATAL TRANSPORT (PROF. DR CHAKRADHAR MADDELA)

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  NEONATAL RESUSCITATION WORKSHOP– NEONATAL TRANSPORT ORGANISED BY DEPARTMENT OF PAEDIATRICS (DIVISION OF NICU) Prof. Dr Chakradhar Maddela Neonatologist “AADVIDYA” 28/08/24, MNR MEDICAL COLLEGE MNR UNIVERSITY CAMPUS, SANGAREDDY TELANGANA INDIA
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  NEONATAL TRANSPORT -BACKGROUND  Anticipating High risk deliveries is not always possible  In utero transfer is the best but always not feasible  High risk neonatal transfer by self transport or in ill-equipped ambulance often results in clinical & metabolic deterioration, Multi organs dysfunction and failure  HR neonatal transport in dedicated well equipped ambulance (NTS) yields better clinical outcomes  Common clinical deterioration include development of hypoxia acidosis hypothermia hypotension shock hypoglycaemia and shock.
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  NEONATAL TRANSPORT- TYPES Types of neonatal transport: ❖ Home to health care centre ( home deliveries) ❖ Intra-hospital transport (delivery room to NICU) ❖ Inter-hospital transport- for specialist care services – cardiac, neurological, surgical etc ❖ Retrieval and reverse transport between level 1 – 2 to level 3 – 4 NICU units (to & from transport) ❖ ROAD TRANSPORT/ AIR TRANSPORT (FIXED WING PRESSURISED AIRCRAFT OR UNPRESSURISED HELICOPTER) ❖ NEONATAL TRANSPORT TEAM : Neonatal fellow, Neonatal nurse, GNM-ANM, RESPI-THERAPIST, Ambulance crew & Team leader
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  MEDICAL EQUIPMENT &DRUGS  Well equipped ambulance with  Two O2 cylinders Inverter Portable Power generator, Rails & fixations, Fastening belts for equipment, Electric power adapters & sockets, Permissible noise & vibration, Thermal control & infection control, safe to measures & insurance for all passengers.  Special equipment: Neonatal transport incubator, vital monitoring devices, resuscitation equipment, NIBP, transport ventilator, glucometer, ABG, Thermometer, suction (battery & manual) & syringe pumps  DRUGS: IV fluids – 0.9%NS, RL, 10 & 20%D, Calcium gluconate, Adrenalin, glucagon, NORAD, Dobutamine, midazolam, morphine, fentanyl, Na2CHO3, Surfactant, syringes, tubes & others
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  COMMUNICATION WITH REFERRINGUNIT & DOCUMENTATION  Once referral to Tertiary care unit is decided, contact and communicate with the referral – receiving unit for cot availability & confirm facilities needed for the child.  Communicate with SBAR  S – Situation- main problem, reason for transfer  B – Background- maternal & newborn history  A – Assessment- clinical status by examination & lab reports  R – request and recommendations- advice for further stabilisation & evaluation.  COMMUNICATE WITH PARENTS: Clinical status, severity, time, type & mode of transport, facilities at receiving unit, note name, mobile no. & address of receiving unit, care & procedures during transport, cot availability & reservation at receiving unit.
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  CLINICAL ASSESSMENT ANDSTABILISATION OF REFERRING BABY  STABILISATION: Done with structured protocols— “STABLE / TABCDE”  AIM: To restore physiological equilibrium before transfer like normothermia, euglycemia, prevention & management of hypoxia, acidosis & hypotension, surfactant therapy, assisted ventilation & adequate organ perfusion.  S – sugar bl glucose, T – temperature, A – assisted ventilation, B – BP, L – Lab work up, E – emotional support to parents & family  Keep ready the equipped ambulance ready for transfer.  DOCUMENTATION: Ante & intra natal records, H & E findings of newborn after birth, medications administered, procedures done, X ray, image & lab reports, address google map, mobile number of referring & receiving units, parents consent forms & evidence of verbal and written documentation of handover in presence of witnesses.
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  PREPARATION AND PLAN– HANDOVER & TAKEOVER  Handover should be done in presence of both referring & receiving teams in a conductive environment with written consent.  Transfer the baby by 2 persons by tail lift & secure with floor clamps  Prevent hypothermia by partially opening the port holes  Keep transport incubator on half side for maximum visibility  Secure all tubes & catheters  Secure the baby and equipment by neostrains & fastening the belts.  COMMUNICATION should be carried throughout the journey between team leader, parents, referring & receiving units
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  FEEDBACK COMMUNICATION &TAKEOVER AT RECEIVING UNIT  Once the baby received at receiving unit, the neonatal transport team leader will communicate the baby’s status to the parents & referring unit about the following:  Clinical status  Probable diagnosis  Prognosis  Hospital stay  Finances  Insurance  Further management  Probable date & time of reverse transport
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  FURTHER READING Advanced reading: 1.Chakradhar Maddela et al “ Organisation of Neonatal Transport Service with Regional Perspective- Review Article. Acta Scientific Paediatrics 5.3 (2022): 19-24. 2. Peter Barry Andrew Lesile “ Neonatal and Pediatric Critical Care transport BMJ 2003.