Triaging sick newborn babies

Dear friends, On this webinar, we will learn about triaging sick newborn babies and the essential components of neonatal transport..
The word “triage” means sorting. Triage is the process of rapidly screening sick neonates when they arrive at the hospital and categorizing them in one of the groups depending on the urgency of the care needed. The site at the facility where a neonate is first brought to the hospital such as a emergency area or the reception and resuscitation corner in the casualty should be the triaging area. All the staff involved should be trained in the triaging process. The most experienced doctor present who is trained in neonatal care should undertake the responsibility of emergency treatment and management of the neonate.
By triaging, we classify the babies into the following three categories: Those needing emergency care. These babies require urgent intervention and emergency treatment and need to be admitted in the SNCU. Those needing priority care. These babies need immediate assessment and priority treatment and need to be admitted in the SNCU. Those neonates whose underlying medical conditions do not merit immediate management or are “non urgent”
Some of the examples of babies needing emergency care include babies with moderate to severe hypothermia (temp<36 degree celcius), apnea or gasping respiration, Severe respiratory distress, Central cyanosis, Shock, Coma, convulsions or encephalopathy. Babies with priority signs include tiny babies (<1800 gms), babies in cold stress (temp 36.4 degree celcius - 36 degree celcius), babies with Respiratory distress, those who are Irritable/restless/jittery, babies presenting with Refusal to feed, Abdominal distension, those with Severe jaundice or Severe pallor or Bleeding from any sites, and babies with Major congenital malformations. All cases not categorized as Emergency or Priority such as those with superficial infections, minor trauma, neuro developmental delayetc would be examples of non urgent cases.
Having assessed the vital signs…In the emergency treatment we need to firstly. Manage temperature: If the baby’s temperature is less than 34 degree celcius, then do rapid re-warmimg till temperature of 34 degree celcius is reached. Subsequently, maintain the baby’s temperature between 36.5 degree celcius - 37.5 degree celcius. Keep the baby dry and the head, hands and feet covered. To Maintain the airway; Place the child in sniffing position, Place a shoulder roll under the shoulder to position the child. Clear the airway of secretions by suctioning if indicated.
Its important to recognize that Baby may have more than one underlying condition to treat, so we need to look for all underlying conditions and treat them.
  • Introduction...
  • 1. Triaging...
  • 2. Categorizing th...
  • 3. Examples of gro...
  • 4. Process of tria...
  • 5. Emergency manag...
  • 6. Emergency manag...
  • 7. Triaging: Other...
 

Introduction

DR. COL K. VENKATNARAYAN
MD, DNB, MNAMS, DM (Neonatology)

Head & Associate Professor
Command Hospital
Pune

1. Triaging

► Definition
      ♦ The word “triage” means sorting
      ♦ Process of rapidly screening sick neonates

► Place of triaging
      ♦ The reception and resuscitation area/ casualty

► Staff
      ♦ Trained staff and most experienced doctor

2. Categorizing the groups

► Emergency cases
      ♦ Require urgent intervention and emergency treatment
      ♦ Need to be admitted in the SNCU

► Priority cases
      ♦ Need immediate assessment and priority treatment
      ♦ Need to be admitted in the SNCU

► Non-urgent cases
      ♦ Need assessment

3. Examples of groups of triaging

4. Process of triaging: Assessment for emergency signs

► Temperature
      ♦ Assess, if baby has hypothermia

► Airway and breathing
      ♦ Apnea/ gasping respiration
      ♦ Respiratory distress (RR> 60/min, retractions, grunting)
      ♦ Central cyanosis

► Circulation
      ♦ CFT > 3 sec
      ♦ Tachycardia and weak pulse

► Sensorium
      ♦ Assess response to stimulus
      ♦ Look for convulsions

5. Emergency management: Triaging

► Manage temperature
      ♦ Re warm the baby
      ♦ Maintain temperature: 36.50C - 37.50C
      ♦ Keep the baby dry and the head, hands and feet covered

► Maintain airway
      ♦ Place shoulder roll: Baby in “sniffing” position
      ♦ Clear secretions, if required

6. Emergency management: Triaging-01

► Assist breathing
      ♦ Start with 1-2 L/min by nasal cannula or 5-6 L/ min by
         hood, if baby is distressed
      ♦ Give PPV, if baby is gasping or apneic
      ♦ Connect to pulse oximeter

► Support circulation
      ♦ Give bolus of NS 10 ml/kg over 30 min
      ♦ Repeat, if response is poor
      ♦ Blood transfusion, if bleeding is the cause
      ♦ Start inotropes, if poor response

7. Triaging: Other key issues



Baby may have more than one underlying
condition to treat, so look for all
conditions and treat them