Identification and transport of sick neonate
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Identification and transport of sick neonate
- 1. Identification And Transport Of Sick Neonate L S DESHMUKH DM(NEONATOLOGY) PROFESSOR, GMCH, AURANGABAD
- 2. 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.
- 3. Sick newborn Early detection, prompt treatment and referral (if required) necessary to prevent high mortality
- 4. Problems in early diagnosis of sick newborn Many NBs referred unnecessarily Non-specific signs Difficulties in preterm and LBW babies
- 5. Identifying Sick New born – Danger Signs
- 6. Danger signs Lethargy Hypothermia Respiratory distress Cyanosis Convulsion Abd. distension Bleeding Yellow palms/ soles Excessive wt. loss Vomiting Diarrhea
- 7. 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
- 8. Capillary refill time (CRT) Indicates tissue perfusion Normal CRT < 3 seconds Prolonged CRT > 3 seconds * Use 10ml/kg normal saline bolus * Hypotension, hypothermia, acidosis
- 9. Capillary refill time (CRT)
- 10. Respiratory problems RR > 60 / min* Retractions Grunt Central cyanosis Apnea *Rate should be counted in a quiet state and not immediately after feed
- 12. 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
- 13. Failure to pass meconium and urine Failure to pass meconium Majority pass within 24 hrs Delayed passage May have passed in –utero Don’t miss Imperforate Anus Suspect obstruction Polyhydramnios Failure to pass urine Majority pass within 48 hrs Many pass in LR Delayed passage Exclude obstructive uropathy or renal agenesis Oligohydamnios
- 14. 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
- 15. 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
- 16. 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
- 18. Central cyanosis
- 19. Yellow staining of soles
- 20. Yellow Palms & Soles
- 21. 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
- 23. Suspect cardiac disease Cyanosis Tachycardia Murmur Hepatomegaly Shock Cardiomegaly
- 24. Abnormal weight loss pattern > 10 percent of birth weight in term > 15 percent in preterm > 5 percent acute weight loss
- 25. Danger signs Lethargy Hypothermia Respiratory distress Cyanosis Convulsion Abd. distension Bleeding Yellow palms/ soles Excessive wt. loss Vomiting Diarrhea
- 26. Importance of Looking at Feet • Temp • Hb • O2 Saturations • BP • Jaundice • Maturity • Deformity
- 27. 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 .
- 28. 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
- 29. Neonatal Transport - Practical constraints Specialized Transport – 108 ETS Transport team imp “Organised transport reduces morbidity and mortality”
- 30. Prepare well before transport Assess – necessity Correct Hypothermia Write a Note Encourage mother to accompany Arrange a care provider to accompany
- 31. Pre-transport stabilization: STABLE: Sugar, Temperature, Artificial breathing, Blood pressure, (CRT) Laboratory work, Emotional support.
- 32. Care during transport Ensure warm feet Ensure an open airway Check breathing Provide feeds [NB: Intravenous fluid administration during transport is best avoided]
- 33. Ensure warm transport Skin to skin care (Kangaroo Mother Care) Cover the baby Transport incubator Improvised containers
- 34. Neonatal Transport - Equipments
- 35. 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.
- 37. THANK YOU