| | Factors | Transfer measures |
| | S (sugar and safe care) | 1. Assess for risk factors for hypoglycaemia: e.g., prematurity, less than gestational age, greater than gestational age, diabetic mother, stress (especially history of perinatal stress), respiratory distress, asphyxia, shock, hypothermia, sepsis, etc.
2. Target blood glucose monitoring: blood was collected from the child’s heel and monitored by a rapid blood glucose meter, ensure that the child’s blood glucose was maintained at 2.6–7.0 mmol/L.
3. Individual assessment according to the week of pregnancy and the cause of the hypoglycaemia.
4. The critically ill newborn shall be fasted temporarily, the venous access shall be opened, and glucose intravenous drip shall be performed according to the doctor’s advice when necessary, and the drip rate shall be adjusted according to blood glucose. During infusion, monitor blood glucose every 15–30 minutes, and closely observe and keep the venous channel unblocked during infusion. |
| | T (temperature) | 1. Assess for risk factors for hypothermia: e.g., prematurity, small for gestational age, hypoxia, prolonged resuscitation, co-infections, cardiac, neurological, and endocrine problems, neonates with hypotonia, etc.
2. Target body temperature: try to maintain the body temperature at 36.5–37.2°C.
3. The temperature of delivery room (emergency room) shall be increased to 25–28°C (recommended by the World Health Organization). And preheat the warm box.
4. All articles contacting the body shall be preheated first, the wet towel shall be removed in time, and the baby shall wear a hat; <1500 g premature infants are wrapped in polyethylene (food grade plastic) from chin to foot.
5. Keep warm during all operations and rescue. Reduce the shielding of far-infrared radiation heater during rescue to ensure the good function of temperature sensor.
6. The warming box shall be used for rewarming of hypothermia newborns, and the rewarming speed shall not exceed 0.5°C per hour.
7. Transfer of critically ill and/or premature babies by preheated warming boxes. |
| | A (airway) | 1. Ensure a clear airway and remove secretions from the respiratory tract.
2. Assessment of respiration: respiratory rate and work done, shortness of breath (>60 breaths/min), aspiration concavity, distress, moaning, apnoea, pneumothorax, and assessment of heart rate and oxygen saturation. Administer oxygen as required and specify the concentration of inhaled oxygen and the method of administration. Oxygen saturation needs to be measured before and after the catheter and adjusted carefully to maintain oxygen saturation at 88%–95%. Assisted tracheal intubation with clear pre- and postintubation assistant roles and tasks to maintain effective ventilation, effective fixation of the tracheal tube, and placement of a gastric tube.
3. The insertion depth of sputum suction tube shall be determined by measurement method. It shall not be inserted too deep. The action during sputum suction shall be gentle and accurate. In case of vomiting and severe gastroesophageal reflux, indwelling a gastric tube to extract the contents of the stomach, and place in left lying position.
4. Assist with X-rays and early administration of PS (pulmonary surface active substance) for premature babies in respiratory distress as prescribed by the doctor and take care of them. |
| | B (blood pressure) | 1. Assess the cause of shock: e.g., hypovolemic, cardiogenic, and infectious.
2. Connect a cardiac monitor to monitor blood pressure, heart rate, and oxygen saturation.
3. Follow medical advice for volume expansion and pressure boosting.
4. Master the indications, configuration methods, and safe use principles of dopamine. |
| | L (lab work) | 1. Learn about the tests that need to be done after resuscitation and before transfer of the newborn, and the various laboratory indicators. Routine 4B tests include blood count, blood culture, blood glucose, blood gases.
2. Correctly collect arterial samples to understand and evaluate blood gas, oxygenation, and acid-base balance. |
| | E (emotional support) | 1. Make the family members of newborns aware of the need for newborns to be transferred to the NICU ward and the crisis they experience.
2. Provide support for newborn parents.
3. Neonatal paediatric nurse introduce families to ways in which parent-child communication can be facilitated in the NICU. |
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