Newborn Transport A Closer Look Author: Patricia Muncey RNC, BSN Updated presentation: Susan Greenleaf RNC, BSN

Objectives: Discuss what happens when the transport team is called Identify what the referring units need to have ready for the transport team Understand what goes on when the transport team arrives Discuss how to help the parents when their infant is transported

The TGH Neonatal Transport Service – Who Are We? Regional center for high risk OB and Neonatal services Coverage area Southwest Washington Ground-only transport Team composition Transport Medical Director RNC, RRT, and EMT The occasional visitor

Who Are We ….. Statistics Consultation vs. Referral

What Happens When the NTS is Activated Physician to Physician Consultation vs. Referral Need for delivery attendance? Charge Nurse to Charge Nurse Bed space Staffing considerations Reasons for deferring to Seattle

What Happens….. Team Response To TGH within 30 minutes Leave TGH within 45 minutes Rural Metro and our Rig

When the NTS Arrives Our approach First priority is always the patient Teaching opportunities may need to wait QA process… Plan of care dictated by patient status Teamwork is everything Timing is everything Collaboration is everything

S = Sugar NPO – if it’s too sick to stay, it’s too sick to eat Risk of aspiration Poor intestinal perfusion Increased energy demands & consumption IV Access 80ml/kg/day Bolus 2ml/kg Indications for UAC/UVC

T = Temperature Heat loss – the famous 4 Conduction, convection, evaporation, radiation Those at greatest risk Detrimental effects of cold stress Acidosis Increased metabolic rate Increased O2 consumption Process for re-warming

A = Artificial Breathing Please place me prone! Indications for NCPAP Indications for intubation Proper ET size is everyone’s responsibility Proper placement is everyone’s responsibility Use of sedation

B = Blood Pressure Causes of hypotension Hypovolemia Cardiogenic or Septic shock Prematurity Diagnosis – history, S/S, labwork Treatment Volume expansion Blood Vasopressor

L = Lab Work Minimum: Blood culture (before antibiotics) CBC with diff Blood gas Blood sugar Any & all prenatal lab work on mom HIPAA concerns

E = Emotional Support Accompany the team to the parent’s room Help clarify team explanations Ask the team to identify TGH personnel if possible Ask the family if you can call support people for them Take pictures of infant

E = Emotional Support… Call infant by first name Offer follow-up call on arrival at TGH Find out if mother is planning on breastfeeding

What We Need from You Prenatal Information Maternal prenatal lab work Prenatal history Delivery Information Resuscitation efforts NRP! Newborn care Physician summary

What We Need…. All newborn lab & blood gas results Blood culture to TGH? No longer take maternal blood X-rays Copies of all x-rays Validates or clarifies diagnosis Verification of our ETT and CL placement Decreases exposure to radiation Breast Milk on ice

What We Need… Admit meds given? PKU and Hep B vaccine? And on behalf of our EMTs…… At least 2 face sheets please!

QA Process and Education Summary to TGH physician before departing What triggers a QA memo Clinical concerns Low pH, low temp, intubation in route, resuscitation in route, expiration Equipment failure or not available Communication concerns Education need

And Last But Not Least…. THANK YOU We wouldn’t have such great patient outcomes without you!

References Karlsen, K. A. (2001). Transporting Newborns the S.T.A.B.L.E. Way. (2001 ed.). Park City:Author