Transfer Guidelines
Summary
- for infants expected to require treatment in a level 2 or level 3 institution, maternal transfer prior to delivery is usually wiser than a postnatal transfer
- exceptions apply where the pregnancy complication is of such a severe degree that any delay in delivery would jeopardize the survival or quality of survival of the infant or mother, or where delivery might occur during the transfer
- all delivery room and nursery equipment should be in good order at all times and readily available for use
Introduction
Every hospital providing newborn care services should develop guidelines regarding
- newborns for whom they can provide continuing care
- relationships with regional centres in order to facilitate care for those needing more complex levels of care
Guidelines must be flexible enough to take into account variation from time to time in availability of facilities and staff; each hospital will need to make its own assessment of its capabilities.
The following are guidelines developed for use in Victoria regarding provision of care and equipment standards. Resuscitation and intubation equipment is required in all hospitals and staff should be competent in using the equipment.
Level 1:
Newborn Problems
- uncomplicated
- gestation 37 weeks or greater
- birthweight > 2500 g
- emergency stabilization after resuscitation
- minor conditions not requiring additional nursing or specialist medical treatment
- phototherapy - with paediatric consultation
- some simple convalescent infants eg gavage feeding
Nursery Equipment Requirements
- high flow oxygen meter
- high flow air meter or oxygen diluter
- oxygen headbox
- oxygen analyzer
- incubator
- perspex cot
- bubble plastic/plastic cling wrap
- low reading thermometer
- blood glucose monitor
- scales
- oxygen saturation monitor (pulse oximeter) with neonatal probe
Optional:
- constant infusion pump for neonatal use
- ambient temperature monitor
- phototherapy unit
Level 2:
Low Dependency Level 2 Newborn Problems
- as for level 1; in addition -
- uncomplicated
- gestation 34 weeks or greater
- birthweight 2000 g or greater
- incubator care
- short term transitional problems e.g. oxygen requirement up to 40%
- infants in need of -
- simple apnoea monitoring
- blood glucose monitoring
- short term intravenous therapy
- phototherapy
- gavage feeding
Equipment Requirements
As for Level I and
- apnoea monitor
- constant infusion pump for neonatal use
- heater and humidifier for inspired gases
- low flow oxygen meter
Optional
- external temperature monitor
- cardio-respiratory monitor
- non-invasive blood pressure monitor
- mechanical ventilator
High Dependency Level 2 Newborn Problems
- as for level 1 and Low Dependency level 2; in addition -
- uncomplicated
- gestation 32 weeks or greater
- birthweight 1300 g or greater
- other sick infants eg oxygen requirement up to 60%
- infants in need of -
- cardiorespiratory monitoring
- intra-arterial blood gas monitoring (short term)
- non-invasive blood pressure monitoring
- close observation eg neonatal abstinence syndrome
- short-term ventilator care pending transfer (less than 6 hours)
- special services
- Availability will vary between hospitals, not all units will have protocols established to provide all services and protocols must be consistent with relevant guidelines. Where provided, services should be undertaken following consultation with a tertiary centre.
- nasal CPAP
- exchange transfusion
- Availability will vary between hospitals, not all units will have protocols established to provide all services and protocols must be consistent with relevant guidelines. Where provided, services should be undertaken following consultation with a tertiary centre.
Equipment Requirements
As for Level 2 Low Dependency and
- radiant heater with servo control
- heater and humidifier for inspired gases
- cardio-respiratory monitor
- non-invasive blood pressure monitor
- equipment for intra-arterial fluid administration and blood gas monitoring
- conventional mechanical ventilator
- low flow oxygen meter
Optional
- external temperature monitor
- transcutaneous oxygen/carbon dioxide monitor
- incubator with servo-control
Level 3:
Neonatal Problems
- as for Level 1 & 2; in addition to
- all Neonatal Intensive Care
Essential Resuscitation Equipment:
- resuscitation cot with overhead radiant heater or resuscitaire.
- clock (with second hand).
- overhead lighting
- pre-warmed linen - at least two wraps to receive newborn
- paediatric stethoscope
- oxygen supply: cylinder in use and spare cylinder readily accessible
- 6 Fr. Intranasal oxygen catheter
- self-inflating bag (Laerdal Infant Resuscitator or anaesthetic bag and circuit) with pressure gauge attached and spare resuscitator
- face masks of appropriate size (0/1 and spare)
- suction apparatus with pressure gauge
- "Y" suction catheters sizes:- 6, 8, 10 Fr.
- intubation equipment (see below)
- umbilical venous catheterization tray and additional equipment
- needles and syringes, eg 19, 21, 23, 25 G and 1mL, 2mL, 5mL, 10mL, 20mL syringes
- butterfly needles eg 21 and 23 G (for emergency pneumothorax drainage)
- alcohol swabs
- resuscitation drugs:
Sodium bicarbonate 8.4% 10mL ampoules x4 Sterile water for injection 10mL ampoules x4 Naloxone 0.4mg/mL 2mL ampoules x2 Adrenaline 1 in 10,000 10mL ampoules x2 Sodium chloride 0.9% 5mL & 10mL ampoules x4
Intubation Equipment:
- laryngoscope with suitable sized blade for preterm/term neonate:
- Handle: Penlon miniature with hook-on fitting
- Blades: Miller 0 (Premature), Seward 1 (Neonatal)
- introducer (in sterile package)
- magills forceps (used for nasal intubation)
- endotracheal tubes: Sizes 2.5, 3.0 and 3.5mm
- connectors to fit between ET tubes and ventilation system
- tapes for securing ET tubes - Sleek "trousers", Leukoplast, cotton tie
- skin prep swabs
- cotton buds
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