for obstetricians, general practitioners, all those caring for newborns

1. Identification And Transport
Of Sick Neonate
L S DESHMUKH
DM(NEONATOLOGY)
PROFESSOR,
GMCH, AURANGABAD

2. Signs of Good Health at Birth
Objective measures
 Breathing
 Heart rate above
100 beats/minute
Subjective measures
 Vigorous cry
 Pink skin
 Good muscular tone
 Good reactions to
stimulus
•Most important measure is whether newborn is breathing
•Assessing all of above delays resuscitation, if it is necessary.

3. Sick newborn
 Early detection,
 prompt treatment and
 referral (if required)
necessary to prevent high mortality

4. Problems in early diagnosis of
sick newborn
 Many NBs referred unnecessarily
 Non-specific signs
 Difficulties in preterm and LBW babies

5. Identifying Sick New born – Danger
Signs

6. Danger signs
Lethargy
Hypothermia
Respiratory distress
Cyanosis
Convulsion
Abd. distension
Bleeding
Yellow palms/
soles
Excessive wt. loss
Vomiting
Diarrhea

7. Lethargy and poor sucking
In a term baby who was feeding earlier 
indicates neonatal illness
(as perceived by mother)
In a preterm baby  needs careful
assessment because it may be due to cold
stress or immaturity

8. Capillary refill time (CRT)
 Indicates tissue perfusion
 Normal CRT < 3 seconds
 Prolonged CRT > 3 seconds *
Use 10ml/kg normal saline bolus
* Hypotension, hypothermia, acidosis

9. Capillary refill time (CRT)

10. Respiratory problems
 RR > 60 / min*
 Retractions
 Grunt
 Central cyanosis
 Apnea
*Rate should be counted in a quiet state
and not immediately after feed

11. R
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T
R
A
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12. Body temperature in newborn
infant (oC)
Normal range
Cold stress
Moderate hypothermia
Severe hypothermia Outlook grave, skilled
care urgently needed
Danger, warm baby
Cause for concern
37.5o
36.5o
36.0o
32.0o

13. Failure to pass meconium and
urine
Failure to pass meconium
Majority pass within 24 hrs
 Delayed passage
 May have passed in –utero
 Don’t miss Imperforate Anus
 Suspect obstruction
 Polyhydramnios
Failure to pass urine
Majority pass within 48 hrs
 Many pass in LR
 Delayed passage
 Exclude obstructive uropathy or renal agenesis
 Oligohydamnios

14. Causes of vomiting*
Commonly Amniotic fluid gastritis
Systemic illness
CCF
Raised ICP – IVH, asphyxia
Metabolic disorders (CAH, galactosemia)
• Persistent, projectile or bile stained –
r / o intestinal obstruction

15. Causes of diarrhea
 Infective diarrhea* (often non breast fed
baby)
 Maternal ingestion of drugs (ampicillin,
laxatives)
 Metabolic disorders
 Thyrotoxicosis
 Maternal drug addiction
*Infective diarrhea needs treatment with
systemic antibiotics

16. Cyanosis
Peripheral
Normal at birth
Seen in extremities due to cold
Central
Always needs appropriate referral
Seen on Tongue (Mucosa)
Indicates cardiac or pulmonary disease

17. Peripheral cyanosis

18. Central cyanosis

19. Yellow staining of soles

20. Yellow Palms & Soles

21. Tracheo-esophageal fistula
 Excessive drooling; choking; cyanosis
during feeds; respiratory distress
 Failure to pass red rubber catheter
beyond 8 to 10 cm from mouth
 Polyhydramnios
 Look for other anomalies

22. Tracheo-esophageal fistula

23. Suspect cardiac disease
 Cyanosis
 Tachycardia
 Murmur
 Hepatomegaly
 Shock
 Cardiomegaly

24. Abnormal weight loss pattern
 > 10 percent of birth weight in term
 > 15 percent in preterm
 > 5 percent acute weight loss

25. Danger signs
Lethargy
Hypothermia
Respiratory distress
Cyanosis
Convulsion
Abd. distension
Bleeding
Yellow palms/
soles
Excessive wt. loss
Vomiting
Diarrhea

26. Importance of Looking at Feet
• Temp
• Hb
• O2 Saturations
• BP
• Jaundice
• Maturity
• Deformity

27. Neonatal Transport - Goal
Taking Right New born at the Right
Time , By Right Personnel, to the
Right Place, By the Right form of
Transport, and receive the Right
Care Throughout .

28. Neonatal Transport - Practical constraints
 Facilities are scarce and not easily available
 Families have poor resources
 Organized transport services are not available.
 No health provider is available to accompany the
baby
 Mostly self-transport (Taxi/Rickshaw/public transport)
 Facilities are not fully geared up to receive sick
neonates
 Communication systems are non existent or inefficient

29. Neonatal Transport - Practical
constraints
 Specialized Transport – 108 ETS
 Transport team imp
“Organised transport reduces
morbidity and mortality”

30. Prepare well before transport
 Assess – necessity
 Correct Hypothermia
 Write a Note
 Encourage mother to accompany
 Arrange a care provider to accompany

31. Pre-transport stabilization:
 STABLE:
 Sugar,
 Temperature,
 Artificial breathing,
 Blood pressure, (CRT)
 Laboratory work,
 Emotional support.

32. Care during transport
 Ensure warm feet
 Ensure an open airway
 Check breathing
 Provide feeds
 [NB: Intravenous fluid administration during transport is best
avoided]

33. Ensure warm transport
 Skin to skin care (Kangaroo Mother Care)
 Cover the baby
 Transport incubator
 Improvised containers

34. Neonatal Transport - Equipments

35. Communication
 Explain the condition,
 the prognosis
 the reasons for referral of the baby to the
family.
 Explain where to go and indicate whom to
contact.
 Inform the referral facility beforehand, if
possible.

37. THANK YOU