Podcast
Questions and Answers
What is the primary purpose of transportation during maternal fetal transport?
Which hazard is NOT associated with the transport of a surgical baby?
Which piece of equipment is essential for a skilled transport team working with surgical neonates?
What is one component of medical treatment that should be instituted during transport of a critically ill baby?
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What is a critical complication that a skilled transport team aims to prevent during the transport of a surgical baby?
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Which condition is NOT indicated for transport due to respiratory distress?
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What is the primary reason the two-way transport system is considered more reliable?
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Which of the following is considered a surgical condition that requires transport due to respiratory distress?
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What is the recommended dosage of vitamin K for newborn infants if not already administered?
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In developed countries, what form of transport plays a major role in neonatal emergencies?
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What is the appropriate positioning for an infant with esophageal atresia with tracheo-esophageal fistula?
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Which intervention should NOT be performed during the transport of an infant with diaphragmatic hernia?
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What should be done to cover an omphalocele or gastroschisis during transport?
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Which of the following is a key recommendation for managing infants with diaphragmatic hernia if respiratory status deteriorates?
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What is a critical consideration during the transport of a newborn with esophageal atresia?
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Study Notes
Transport of Surgical Baby
- The best transport incubator for a baby is the mother's uterus, known as maternal fetal transport.
- For critically ill babies, a portable incubator is used during transport.
Hazards during Transport
- Hypothermia
- Peritoneal contamination
- Shock
- Hypoxia
- Gangrene of the gastrointestinal tract (GIT)
- Aspiration
- Metabolic acidosis
- Dehydration
Rationale of Transport
- Prevent cold injury (hypothermia).
- Ensure adequate ventilation.
- Administer medical treatment (antibiotics, IV fluids).
- Deflate a distended stomach.
- Inform the surgical team about the incoming patient.
Skilled Transport Team
- A skilled transport team can reduce neonatal surgical complications.
- Team should have:
- Transport incubator, preferably with a ventilator and oxygen source
- Disposable nasogastric tubes (sizes FG 5, 6, 8, 10)
- Disposable IV administration sets (butterfly 21, 23, 25 + IV cannulas)
- IV solutions (Glucose 10% in 1/2 normal saline i.e., D10 1/2 NS)
- Suction apparatus
- Oxygen mask and AMBU-bag
- Laryngoscope and endotracheal tubes (size 0, 2.5)
- Resuscitation drugs: atropine, epinephrine, sodium bicarbonate
- Plastic sheaths, Aluminum foil, Sterile sponges and towels
Types of Transport
- One-way transport: community hospital to paediatric surgical center
- Two-way transport: community hospital to center to community hospital
- Two-way transport is generally favored due to center personnel's familiarity with neonatal emergencies.
- Ambulance transport is most common in Egypt.
- Air transport (Helicopter) is prevalent in developed countries.
- Altitude in air transportation impacts:
- Infusion rates
- Pneumothorax management
On Arrival at the Centre
- Intensive care personnel, surgeon, anesthesiologist, and operating room team should be prepared for pediatric surgical management.
- Vitamin K (1 mg) should be administered intramuscularly to all newborn infants if not already given.
Surgical Considerations for Transport
-
Respiratory Distress due to Surgical Conditions:
- Esophageal atresia with tracheo-oesophageal fistula
- Diaphragmatic hernia
- Congenital lobar emphysema
- Massive cystic hygroma in the neck or face
- Massive cystic hygroma in the neck or face (causing respiratory distress)
-
Neonatal Intestinal Obstruction:
- Atresias: duodenal, jejunal, ileal, colonic, or rectal
- Malrotation + volvulus
- Meconium plug syndrome
- Meconium ileus
- Meconium peritonitis
- Hirschsprung's disease
- Anorectal malformations
-
Anterior Abdominal Wall Defects:
- Omphalocele (Exomphalos major and minor)
- Gastroschisis
- Vesico-intestinal fissure (Extrophy of cloaca)
- Bleeding per rectum
- Palpable abdominal masses
Practical Examples During Transport
Esophageal Atresia with Tracheo-esophageal Fistula
- Position the infant semi-upright to prevent reflux into the trachea.
- Perform thorough suction in the proximal pouch.
- Avoid pressure on the abdomen during examination.
- Do not use radiographic contrast material.
- Administer antibiotics.
Diaphragmatic Hernia
- Position the infant semi-sitting with the affected side down.
- Perform frequent nasogastric tube aspiration.
- Do not administer positive pressure oxygen via a mask.
- Intubate only if the infant's condition deteriorates.
- Hyperventilate with low inspiratory pressure.
- Be aware of the risk of pneumothorax on both sides.
- Have an intercostal tube ready (under water seal system).
- Administer IV fluids (D10 1/2 NS) to stabilize vital signs.
- Administer antibiotics (Ampicillin 25 mg/kg, Gentamycin 2 mg/kg).
Omphalocele, Gastroschisis & Neonatal Intestinal Obstruction
- Cover omphalocele or gastroschisis with warmed normal saline-soaked gauze.
- Wrap the abdomen with a plastic sheath and aluminum foil.
- Support the bowel to prevent venous obstruction, kinking, and gangrene.
- Perform nasogastric suction.
- Administer IV fluids (D10 1/2 NS).
- Administer antibiotics.
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Description
This quiz covers the essential aspects of neonatal transport, particularly for critically ill surgical babies. It discusses the best transport methods, potential hazards during transport, and the rationale behind effective transportation. A skilled transport team's role and the necessary equipment are also highlighted.
