NYI stabilization, referral and transfer

Learning objectives

After completion of this session the participant should be able to:

• List conditions which need urgent referral
• List conditions which need less urgent referral

If the baby needs to be transferred to a special care neonatal unit, ensure a safe and timely transfer. It is important to prepare the baby for transfer, communicate with the receiving facility, and provide care during transfer.

Indications of transfer from district to tertiary neonatal care unit

• Abdominal distension with bilious vomiting etc.

• Major congenital malformations e.g. tracheo-esophageal fistula, diaphragmatic hernia, meningomyelocele etc.

Assess

Make careful assessment of the baby. Make sure that there is a genuine indication for referral.
Ideally discuss with the referral centre as in some cases there may be no benefit from transferring.

Stabilize the neonate

Stabilize with respect to temperature, airway, breathing, circulation and blood sugar. Give the first dose of antibiotics.

Write a note

Write a precise note for the providers at the referral facility providing details of the baby’s condition, results of investigations, reasons for referral and treatment given to the baby. Explain the need for referral and mother should come with the baby

Send ALL x-rays and investigations with the infant.

Pathway referral

Step 1: Determine the indication to transport the baby to a higher health facility;

• Major congenital malformations
• These may require urgent referral such as gastrointestinal atresia and imperforate anus or less urgent referral such as meningomyelocele and spina bifida.
• Abdominal distension with bilious vomiting require urgent referral

Step II: Preparation for baby

• Stablilise the baby (temperature, airway, breathing, circulation and blood sugar)
• Ensure baby is kept warm with kangaroo care or warmly dressed and covered
• Oxygen if indicated (either a tank of oxygen or a portable concentrator if available)
• Secure IV line if necessary and give treatment before transfer

Step II: Prepare for transport

• Counsel the parents and family before transport
• Communicate with & write a note to the referral hospital
• Arrange a capable healthcare provider, mother and a relative to accompany (if available)
• Assemble supplies and equipment to carry and arrange for transport
• Give one dose of antibiotics before transport
• Bring extra drugs for the journey such as anticonvulsants if the child is fitting
• IV fluids if they are shocked, IV glucose if their sugar was low

Step IV: Care during transport

• Monitor frequently (temperature, airway and breathing, circulation, IV cannula and infusions)
• Ensure that the baby receives feeds or fluid
• Oxygen if indicated
• Stop the vehicle if necessary, to manage problems

Step V: Feedback by tertiary hospital

• Diagnosis of the condition
• Outcome of the baby, post-discharge advice & follow up