Neonatal Stabilization and Transfer Flashcards
Why is the neonate considered a unique surgical patient?
While neonates have endocrine systems geared for stress, recover rapidly, and are generally free from acquired or degenerative diseases, they can deteriorate quickly due to dehydration, sepsis, or hypothermia.
What is the most common reason for surgery in the first week of life?
The correction of congenital abnormalities, particularly those affecting the gastrointestinal tract.
Why is early recognition of neonatal surgical emergencies important?
Neonates deteriorate rapidly, and early intervention can prevent severe complications and improve outcomes.
What are the key red flags that may indicate a neonatal surgical emergency?
These findings are the so-called ‘RED FLAGS’:
* Maternal polyhydramnios
* Prematurity
* Rapid respiration more than 40/min.
* Difficult respiration
* Cyanosis
* Excessive salivation
* Abdominal distension
* Abdominal mass
* Bile-stained vomiting
* Failure to pass meconium in first 24 hrs of life
* Inability to void or poor urinary stream
* Convulsions
* Lethargy
* Jaundice within the first day of life
When should a neonate be referred to another facility?
Any neonate that your facility does not have the resources to treat should be referred.
What is the first step before referring a neonate?
Make personal contact with senior staff at the receiving hospital.
When should referral be arranged?
As soon as possible, while focusing on stabilizing the baby.
Can an unstable neonate be transported?
No, only stable neonates can be transported to ensure safe transfer.
What information should be provided to the receiving hospital and transport personnel?
Full clinical details, including the neonate’s condition, interventions performed, and ongoing management needs.
Who is responsible for the neonate until transfer is complete?
The neonate remains the responsibility of the referring facility until the receiving hospital assumes care.
What is the most common surgical problem in neonates?
Bowel obstruction is the most common issue requiring surgical intervention.
Why is rapid intervention critical for neonates with surgical conditions?
Neonates can deteriorate quickly, becoming dehydrated, septic, or hypothermic within hours.
What are the key steps in resuscitation and stabilization of a neonate?
Maintain airway, breathing, and circulation (ABC approach)
- Prevent hypothermia by using warmers and blankets
- Establish intravenous (IV) access for fluids and medications
- Monitor and correct hypoglycemia and electrolyte imbalances
- Nasogastric (NG) tube decompression for bowel obstruction
- Start broad-spectrum antibiotics if sepsis is suspected
- Ensure oxygenation and respiratory support if required
How is GIT decompression achieved in neonates with bowel obstruction?
By placing a nasogastric (NG) tube on free drainage with optional intermittent aspiration of swallowed air and gastrointestinal secretions.
Why must the neonate be kept nil by mouth (NPO)?
To prevent further accumulation of gastrointestinal contents, reducing the risk of abdominal distension, perforation, and aspiration pneumonia.
What are the three key benefits of GIT decompression?
- Prevents abdominal distension – Overstretching of the bowel wall can lead to perforation, while diaphragmatic splinting can impair breathing.
- Prevents vomiting and aspiration pneumonia – Stops accumulation of gastrointestinal contents that could lead to aspiration.
- Allows measurement and replacement of GIT losses – Helps prevent dehydration and electrolyte imbalances.
What are the three components of IV fluid management in neonates?
The “3 R’s”:
- Resuscitation fluid
- Regular ongoing maintenance fluid
- Replacement of ongoing losses
What fluid is used for resuscitation in dehydrated or hypovolemic neonates?
0.9% NaCl (normal saline) bolus at 10-20 mL/kg, repeated as needed.
Why is fluid resuscitation important in neonates with bowel obstruction?
Vomiting and fluid sequestration in the obstructed bowel lumen can cause hypovolemia and dehydration, requiring rapid correction.
What is the preferred maintenance fluid in neonates?
10% dextrose-containing fluids such as Neonatalyte.
How are ongoing losses replaced?
Fluids are replaced based on measured losses.
Potassium supplementation is added as needed, provided urine output is adequate.
When should broad-spectrum IV antibiotics be given to a neonate?
When should broad-spectrum IV antibiotics be given to a neonate?
How can neonatal warmth be maintained?
Use an incubator or “kangaroo” skin-to-skin contact with the mother if the neonate is stable.
Why is it important to monitor serum glucose levels in neonates?
- Hyperglycemia may indicate stress or sepsis.
Hypoglycemia is common due to vomiting, stress response, or low glucose stores, especially in premature infants.
When is respiratory support needed?
If the neonate has respiratory distress, oxygen should be provided via:
Nasal cannula for mild distress
Intubation and ventilation for severe distress
What is the first sign of depleted intravascular volume in a neonate?
Tachycardia (elevated pulse rate).
Why is hypotension a late sign of shock in neonates?
Neonates compensate for hypovolemia by increasing heart rate to maintain stroke volume.
Bradycardia and hypotension indicate advanced shock, requiring aggressive fluid resuscitation.
What can cause apnea and respiratory distress in neonates?
- Aspiration pneumonia
- Sepsis
- Diaphragmatic splinting from abdominal distension
What is the normal urine output for neonates?
1-2 mL/kg/hour, which is a key indicator of hydration status.
Why should blood gases be monitored in neonates with delayed presentation?
- Base excess, lactate, and pH should be assessed to detect and correct metabolic imbalances.
- Metabolic acidosis may develop due to sepsis and shock.
- Metabolic alkalosis can occur from excessive vomiting.
Who should be contacted before transferring a neonate?
Both the neonatologist/paediatrician in charge of the neonatal ICU and the paediatric surgeon at the receiving tertiary institution.
What essential documentation must accompany the baby?
X-rays and other investigations already done
Consent form (if the mother cannot accompany the baby)
What must be done before transferring a neonate?
The baby must be stabilized.
All resuscitation and stabilization steps (temperature control, IV fluids, GIT decompression, glucose monitoring, and respiratory support) must continue during transport.
Why should the mother be transferred to the same institution if possible?
- Allows bonding
Facilitates the consent process for surgery
What should be done if the mother cannot travel?
- Counsel her on the baby’s condition
Seek consent for the required procedure
Who should accompany the baby during transport?
A doctor, professional nurse, or paramedic trained in neonatal care.
Is the mother alone a suitable escort?
No. A trained medical professional must always accompany the neonate.
What essential medication should be given before transfer?
Vitamin K to prevent hemorrhagic disease of the newborn.
Prerequisites for transport
Use the acronym ‘TWO SIDES”
- Tubes: ETT, NGT, Urine catheter, ICD
- Warmth
- Oxygen
- Sugar monitoring, Sedation
- IV access, fluid intake, glucose monitoring, urine output
- Drugs – Vit K, Documentation: Card, Notes, Consent for surgery, Radiology
- Extras of all consumables
- Samples (X-Match, cord blood, stool)
What tubes should be secured before transport?
ETT (Endotracheal tube), NGT (Nasogastric tube), Urine catheter, ICD (Intercostal drain) if indicated
How should neonatal warmth be maintained during transport?
Incubator or Kangaroo care (skin-to-skin with mother) if stable
When should oxygen be provided during transport?
If the neonate shows respiratory distress, cyanosis, or low oxygen saturation. Options:
Nasal cannula
Intubation and ventilation if necessary
Why is sugar monitoring important before and during transport?
Neonates are at risk of hypoglycemia, especially if they are nil by mouth or septic. Monitor glucose and correct as needed.
When is sedation needed during transport?
If intubated or in severe distress, sedation may be necessary to prevent agitation and desaturation.
What IV access and fluids should be ensured before transport?
- Secure IV access
- Resuscitation fluids (0.9% NaCl bolus if needed)
- Maintenance fluids (10% dextrose-based solutions like Neonatalyte)
- Monitor urine output (target: 1-2mL/kg/hr)
What drugs and documentation should be prepared before transport?
Vitamin K (to prevent hemorrhagic disease of the newborn)
Documentation:
- Hospital card
- Clinical notes
- Consent for surgery
- Radiology (X-rays, scans)
Why are extra consumables needed during transport?
To prevent emergencies mid-transport, always carry spares of all critical supplies:
Oxygen, IV fluids, tubing, suction catheters, and emergency drugs
What samples should be collected before transport?
Cross-match (X-Match) blood sample
Cord blood
Stool sample (if needed for specific conditions)
