Referral and Transport of the Sick NYI
(Chapter 19)
Learning Objectives
After completion of this chapter the participant should be able to:
See Neonatal Referral Form
All facilities, which do not have capacity to care for the neonate, need to refer to next level of care.
Babies requiring next level care should be referred urgently. 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 to next level of care:
- Abdominal distension with bilious vomiting and other surgical emergencies.
- Major congenital malformations, such as tracheo-oesophageal fistula, diaphragmatic
hernia, meningomyelocele, gastroschisis.
- All conditions requiring special care from facilities without a Sick Newborn Care Unit
(SNCU).
- Facility does not have equipment required for continued care of babies who need next
level care.
Components of Neonatal Transport
Step 1: Assess
Determine the indication for transporting the baby to a higher health facility.
- Make a careful assessment of the baby.
- Make sure that there is a genuine indication for referral.
- Always try to discuss with the referral centre, as in some cases there may be no benefit
from transferring.
- Major congenital malformations: Infant may require urgent referral, such as for
gastrointestinal atresia and imperforate anus, or less urgent referral, such as
meningomyelocele and spina bifida.
- Abdominal distension with bilious vomiting requires urgent referral.
Step 2: Preparation of baby
- Stabilise the baby (including temperature, airway, breathing, circulation and blood sugar).
- Ensure baby is kept warm with kangaroo care or warmly dressed and covered.
- Oxygen is provided if indicated (either a tank of oxygen or a portable concentrator, if
available).
- Secure IV line if necessary and give treatment before transfer, including the first dose of
antibiotics.
- Continue monitoring and management as you are waiting for transport
Step 3: Prepare for transport, including writing a referral note
- Counsel the parents and family before transport.
- Arrange a capable healthcare provider, the mother, and a relative to accompany (if
available).
- Ensure the mother comes along with the baby, if possible.
- Communicate with and write a note to the referral hospital, explaining the need for referral.
- Where possible, communicate with the referral facility regarding the condition of the
patient and your decision to refer. This will allow them to provide any guidance concerning
the patient, discuss appropriateness of the referral, and allows the referral team to prepare
for the patient. It can also avoid unnecessary and futile referrals.
- Write a precise note for the providers at the referral facility providing details of the baby’s
condition, pregnancy, labour and delivery history results of investigations, reasons for
referral, and treatment given to the baby.
- Send ALL x-rays and investigation results with the infant.
- Assemble supplies and equipment to carry and arrange for transport.
- Bring extra drugs for the journey, such as anticonvulsants if the child is fitting, IV fluids if
they are shocked and IV glucose if their sugar was low.
Step 4: Care of neonate during transport
- The neonate needs to be escorted by a competent health worker with equipment to help
manage any emergencies.
- Make sure the baby is kept warm during transfer i.e., KMC (can be done by the
mother/father/guardian), wrapping well when the baby is unaccompanied, or in a transport
incubator if available.
- Put baby on oxygen, if indicated.
- Ensure neonate receives feeds or fluids.
- Monitor neonate frequently (temperature, airway, breathing, circulation, IV cannula and
infusion).
- Stop the ambulance/vehicle to manage problems, if necessary.
Step 5: Feedback by tertiary hospital
- Communicate with team at referral hospital and inform them of:
- Diagnosis of the condition.
- Outcome of the baby, post-discharge advice, and follow up.
Key Facts for Providers:
Referral and Transport of Sick Neonate |
- Be clear about indications for transfer to another facility.
- Communicate with the facility you are referring to for pre-referral care and so
that they can prepare for the patient.
- Prepare the patient – ensure they are stable, kept warm during the transfer,
provide appropriate pre-referral treatment.
- Write a clear referral note and send relevant documentation including tests and
interventions done.
- Ensure transport is available and appropriate.
- Ensure ongoing care for the patient as they await transport.
- Follow up the patient for feedback.
|