Stabilisation and transfer

Question 1

Describe the role of PIPER in the escalation of care of the unwell newborn

Answer 1

PIPER is a service which transfers neonates and antenatal women who require care at tertiary hospitals

Question 2

Discuss the main principles regarding stabilisation and transfer of the unwell neonate prior to transfer

Answer 2

Use the acronym STABLE and the 4 P’s
Sugar
Temperature
Acid base balance, assisted breathing
Blood pressure
Lab work
Emotional support

Physical environment
Paperwork ready and give copies
Pathology - placenta, bloods
Parents

Question 3

Consider the role of the midwife in providing family centred care during this process

Question 4

Differentiate between primary and secondary apnoea

Answer 4

Primary apnoea - the infant comes out bradycardic, requires tactile stimulation and then breathes

Secondary apnoea - the infant experiences a hypoxic event, gasps, which leads to further hypoxia. Comes out flat, floppy and pale, low or absent HR, and likely won’t breathe without ventilation

Question 5

What are the indications for transfer

Answer 5

• Gestation or weight
• Babies requiring certain medications
• RDS requiring ventilation >24hrs or surfactant
• PPHN
• MAS
• Severe NAS
• severe HIE, cooling
• hyperinsulinaemia requiring insulin infusion (commonly related to overwhelming sepsis)
• jaundice requiring exchange transfusion