Management of Neonatal Movement

Procedures:

1. When a case is discovered where no space is available for the required medical service, the attending physician provides first aid to the child and prepares a medical report on the case.
2. The hospital assists the child’s family in finding an alternative place through the Ministry of Emergency and the Directorate and provides a report on the patient’s condition.
3. After confirming the receiving hospital’s approval, the responsible physician arranges for a properly equipped means of transportation suitable for the patient’s condition.
4. The attending physician completes the referral form, keeps a copy, and attaches it to the patient’s report, ensuring an appropriate escort is provided.
5. The attending physician provides medical guidance to the child’s family or escort during transportation.

Responsible Personnel:

• Attending physician
• Nursing staff

Neonatal Admission and Discharge Policy

Purpose:
To standardize neonatal admission and discharge criteria to ensure a high level of service without wasting resources or showing preference in providing medical care.

 Neonatal Admission Procedures:

1. Preparation:

• Prepare the necessary equipment for the newborn’s admission.
• Ensure the heating device is disinfected, place a sterile towel, and turn it on.
• Verify the efficiency of the suction device and ensure an oxygen source is available beside the heating device.
• Line the incubator with a sterile sheet and turn it on at least ten minutes before admission, adjusting the temperature as per the doctor’s orders.

2. Gathering Information from the Parents or Mother’s File:

• Gestational age, type, and place of delivery, any complications during pregnancy and delivery, any hereditary diseases.
• If the newborn’s condition is critical, prioritize stabilizing and warming the baby before collecting information.

3. Newborn Reception:

• Place the newborn on their back under the heating device and remove their clothes.
• Position a roll under the shoulders to keep the airway open.
• Place two identification bracelets on the newborn (one on the hand, one on the foot) with the mother’s name.
• Attach the temperature probe to the newborn’s abdomen.
• Assess the gestational age.
• Measure vital signs.
• Assess growth parameters.
• Clean the umbilical cord.
• Perform a newborn bath using sterile gauze moistened with warm water per the doctor’s instructions.
• Administer antiseptic eye drops.
• Insert an intravenous or peripheral cannula.
• Collect blood samples as ordered and place the newborn in the incubator, connecting them to necessary equipment.

4. Completing the Admission Process:

• Disinfect and return the used equipment to its place.
• Disinfect the heating device.
• Prepare the patient’s record for the physician to order tests and treatment instructions.
• Reassure the mother and inform her of the visiting schedule.

Neonatal Discharge Procedures:

• Ensure stable vital signs for 24 hours before discharge.
• Confirm the mother’s ability to breastfeed effectively.
• Complete administrative discharge procedures.
• Explain the baby’s health condition to the mother in simple, non-medical terms.
• Provide the mother with the following guidance:
• Maintaining the newborn’s body temperature.
• Protecting the newborn from infections.
• Umbilical cord care.
• Diaper area care.
• Newborn bathing using sterile gauze moistened with warm water to remove any visible dirt.
• Breastfeeding recommendations.
• If bottle-feeding, train the mother on proper use.
• Vaccination schedule.
• Thyroid function screening.
• Home treatment continuation.
• Follow-up appointment arrangements.

• Define the meaning and cases requiring neonatal transport or referral.
• Establish guidelines ensuring patient safety and identifying responsible personnel for neonatal transport within and outside the hospital.

Definition:
Neonatal transport refers to the official transfer of patient care responsibility from:

• One neonatal care unit to another.
• One medical service to another.
• One specialist to another.
• One facility to another.

The neonatal care physician determines the need for referral to a higher level of care in cases such as:

• Respiratory distress: when the unit lacks ventilators, blood gas analysis devices, or oxygen saturation monitors.
• Certain surgical conditions.
• Low birth weight (<1000g).
• Suspected congenital heart defects.
• Birth complications.
• Persistent low blood glucose unresponsive to standard treatment.

Procedures:

1. Role of the Nurse at the Referring Facility:
Before planning and preparing for neonatal transport, the nurse must ensure:

• Written and signed parental consent for the referral is obtained and kept in the newborn’s file.
• The neonatal unit physician has contacted the receiving facility’s physician.
• The newborn has an identification bracelet on the arm and leg with complete information.
• The newborn’s file includes:
• The physician’s signed referral order.
• A comprehensive medical examination and history.
• All previous test results.
• Neonatal data:
• Name.
• Apgar score and resuscitation steps.
• Birth weight and gestational age.
• Vital signs and growth measurements.

Stabilizing the Newborn’s Condition Before Transport:

• Monitor and record vital signs (temperature, pulse, respiratory rate, capillary refill time, blood pressure, oxygen saturation).
• Ensure stable body temperature.
• Secure the intravenous cannula and confirm functionality, noting insertion date and time.
• Check IV fluid administration rate and connections.
• Perform adequate suctioning.
• Confirm endotracheal tube placement and secure it properly, if applicable.
• If an umbilical or central catheter is present, ensure secure placement, cleanliness, and proper function before transport.
• Complete the referral form.

Important Notes:

• Any necessary interventions (e.g., intubation, IV line placement, chest decompression, shock treatment, glucose level correction) should be completed before transport.
• For pending test results, the referring hospital must communicate the results to the receiving hospital as soon as they are available.

2. Role of the Nurse During Transport:
The nurse must ensure the following:

• The transport incubator is fully charged.
• A monitor to track heart rate, respiration, blood pressure, and oxygen saturation is available.
• An oxygen source (full cylinder with a key and a spare cylinder).
• Equipment for feeding and IV administration, including:
• Cannulas (sizes 22, 24).
• Syringes (1, 3, 5, 10, 20 ml).
• Gauze, alcohol, and tape.
• IV infusion device and soluset.
• Feeding tube (sizes 6, 8).
• Suction equipment:
• Suction device.
• Catheters (sizes 6, 8).
• Intubation and umbilical catheterization equipment.
• Stethoscope.
• Resuscitation bag.
• Medications:
• Adrenaline.
• Saline solution and sterile water.
• The nurse must continuously record the newborn’s vital signs, administered medications, and any medical incidents during transport.
• The nurse may contact the neonatal unit for consultation or assistance.
• Upon arrival at the receiving facility, the nurse hands over the newborn to the responsible physician and provides all relevant documents, signing the referral form and noting the time and condition of arrival.

3. Role of the Receiving Neonatal Unit Nurse:

• Prepare for the newborn’s arrival.
• Ensure a disinfected incubator is ready and functional.
• Warm the incubator at least ten minutes before arrival.
• Adjust the incubator temperature according to the newborn’s weight and gestational age.
• Prepare resuscitation equipment.
• Check oxygen source and ventilation devices.
• Assess vital signs, perform initial tests, and ensure stability.
• Complete admission and medical documentation.

Responsible Personnel:

• Physicians
• Nursing staff
• Support staff