Management of Neonatal Movement

• 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