Contents Chapter Topic Page Neonatology Respiratory Cardiology

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4. Immediately Before Departure Check vital signs and condition of the baby Check and secure all tubes Check the completeness and function of equipment Recommunicate with receiving doctor about the current status and the expected time of arrival 5. Intra-transport Care • Staff –Ideally, there should be a specialised neonatal transport team. If not, the medical escort should be a neonatal trained doctor with/without a neonatal trained staff nurse. A minimum of 2 escorts will be required for the ventilated/critically ill baby. The team should be familiar with resuscitation and care of a neonate. They should also be able to handle critical incidents. The team members should preferably not be prone to travel sickness! • Safety of the team must be a priority. Insurance, life jackets and survival equipment should be made available for the escort team and parents. • Monitoring – Regular monitoring of the vital signs, oxygenation and perfusion of the should be performed • Fluids – Intravenous fluids must be given to the ill child to prevent dehydration and acidosis during the transport. Boluses need to be given as necessary depending on the assessment of the perfusion and heart rate of the child. If catheterised, the urine output can be monitored. The orogastric tube should be aspirated as required. • Temperature Regulation – A check on the baby’s temperature should be made. Wet clothes should be changed if required especially in the child with abdominal wall defects. Disposable diapers and one way nappy liners can be very useful here. • Critical Incidents – Preoperative preparation is to minimise the critical incidents as these can cause loss of life and stress to the transport team. Edge et al (Critical Care Medicine, 1994) showed that the number of critical incidents that occurred during the transport by a nonspecialised team was 10 times the occurrence when transported by a specialised team. E.g. Airway – Blocked /dislodged endotracheal tube Oxygen Supply – exhausted Loss of IV Access Deterioration in patient’s condition Loss of life or injury to patient /co-worker 6. Arrival at the Receiving Hospital Reassessment of the baby Handover to the resident team
7. Special Surgical Conditions 7.1 Oesophageal Atresia with /without Tracheo-oesophageal fistula (These babies have a risk of aspiration of saliva as well as reflux of the gastric contents through the distal fistula) • Evaluation for other anomalies e.g. cardiac, pneumonia, intestinal atresias • Suction of the upper oesophageal pouch – A Replogle (sump suction) tube should be inserted and continuous low pressure done if possible. Otherwise, frequent intermittent (every 10-15 mins) suction of the oropharynx is done throughout the journey to prevent aspiration pneumonia. • Ventilation only if absolutely necessary if there is a tracheo-oesophageal fistula as it may lead to intubation of the fistula, insufflation of the GI tract, and possible perforation if there is a distal atresia of the bowel. • Warmth • Fluids - Maintenance fluids and resuscitation fluids as required • Position - Lie the baby lateral or prone to minimise aspiration of the saliva and reflux • Monitoring – Pulse oximetry and cardiorespiratory monitoring 7.2 Congenital Diaphragmatic Hernia • Evaluation for associated anomalies and persistent pulmonary hypertension of the newborn (PPHN) • Ventilation - Intubation and ventilation may be required pre-transport. Ventilation with a mask should be avoided and low ventilatory pressures used. A contralateral pneumothorax or PPHN need to be considered if the child deteriorates. If the baby is unstable or on high ventilatory settings, the baby should not be transported. Frequent consultation with a Paediatric Surgeon will be helpful to decide when to transport the baby. If a chest tube has been inserted, it should not be clamped during the journey • Orogastric Tube –– Gastric decompression is essential here and a Size 6 or 8 Fr tube is inserted, aspirated 4 hourly aspiration and placed on free drainage. • Fluids – Caution required as dehydration and overload can precipitate PPHN • Monitoring • Warmth • Consent - High risk • Position – lie baby lateral with the affected side down to optimise ventilation • Air transport considerations 7.3 Abdominal Wall Defects Exomphalos and Gastroschisis are the more common abdominal wall defects. Fluid loss and hypothermia are important considerations in these babies. Gastroschisis - defect in the anterior abdominal wall about 2-3 cm diameter to the right of the umbilicus with loops of small and large bowel prolapsing freely without a covering membrane. Exomphalos -Defect of anterior abdominal wall of variable size (diameter of base) It has a membranous covering (amnion, Wharton’s jelly, peritoneum) and the umbilical cord is usually attached to the apex of the defect. The content of the
Page 1 and 2: Contents Chapter Topic Page 1 Norma
Page 3 and 4: Dermatology 67 Atopic Dermatitis…
Page 5 and 6: Dato’ Dr. Lim Nyok Ling Consultan
Page 7 and 8: ISSN 1823-3856 Printed by: Perniaga
Page 9 and 10: Foreword One of the maxims of scien
Page 11 and 12: B. Anthropometric Measurements a) H
Page 13 and 14: Immunisation 1. Immunisation schedu
Page 15 and 16: 2 General Notes 2.1 Many vaccines (
Page 17 and 18: 3.5.6 Rubella - Contraindicated in
Page 19 and 20: 4.8 Rubella May have rash, fever,
Page 21 and 22: 5.5 Close contacts of immuno-defici
Page 23 and 24: Developmental Assessment Developmen
Page 25 and 26: Hearing Assessment Warning signs fo
Page 27 and 28: Global Developmental Delay History
Page 29 and 30: Developmental Milestones Table AGE
Page 31 and 32: AGE Gross Motor Vision & Fine Motor
Page 33 and 34: Principles of Transport of the Sick
Page 35 and 36: 3.1 Airway Management Establish a p
Page 37: 3.7 Environment Neutral Thermal Env
Page 41 and 42: • Ventilation - Most of the babie
Page 43 and 44: Neonatal Resuscitation High Risk De
Page 45 and 46: • Drugs are available (and prepar
Page 47 and 48: Meconium stained liquor: Meconium i
Page 49 and 50: Summary: Use of medications during
Page 51 and 52: Definition Premature infant: < 37 w
Page 53 and 54: 8. Supplements: a. At birth : Vitam
Page 55 and 56: Enteral Feeding in Neonates 1. Intr
Page 57 and 58: 32 weeks Well babies Start milk imm
Page 59 and 60: Total Parenteral Nutrition for Neon
Page 61 and 62: Clearance is usually monitored by m
Page 63 and 64: Daily weight Meticulous care of th
Page 65 and 66: Monitor BUSE and correct any imbala
Page 67 and 68: C. UAC and UVC care UAC position Le
Page 69 and 70: HIGH FREQUENCY OSCILLATORY VENTILAT
Page 71 and 72: 6. Infants must be monitored closel
Page 73 and 74: pH , PaCO2, PaO2, HCO3 - , Bases Ex
Page 75 and 76: Q. Name a likely diagnosis A. RDS 3
Page 77 and 78: A. Definition Birth Asphyxia There
Page 79 and 80: E. Management I. Good intrapartum c
Page 81 and 82: c. All doctors managing such infant
Page 83 and 84: Etiology Determination of etiology
Page 85 and 86: FLOW CHART: MANAGEMENT OF NEONATAL
Page 87 and 88: 2. Klauss & Fanaroff: Care of The H
Page 89 and 90:
D. Asymptomatic Hypoglycaemia Feed
Page 91 and 92:
NEONATAL JAUNDICE What is jaundice?
Page 93 and 94:
Physical examination • General co
Page 95 and 96:
Once the baby is on phototherapy, v
Page 97 and 98:
Reference: extracted from MOH publi
Page 99 and 100:
- 1ml of 4.2% NaHCO3 given for ever
Page 101 and 102:
a. If unconjugated hyperbilirubinae
Page 103 and 104:
APNOEA IN THE NEWBORN Definition :
Page 105 and 106:
History NEONATAL SEPSIS Septic Neon
Page 107:
Antibiotic choice will depend on pr
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Contents Chapter Topic Page Neonatology Respiratory Cardiology

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