Abstract

Current practices for monitoring the haemodynamics of critically ill newborns whilst in transport to tertiary care are poorly validated. These include arterial blood pressure monitoring, capillary return and urine output. Clinician performed ultrasound (CPU) has been validated in the NICU and is currently being trialled in transport. This case based discussion describes the retrieval of four newborn infants utilising CPU assessment of the newborn systemic blood flow and investigation of intracranial blood flow and pathology. Case one describes a baby with subgaleal haemorrhage who was pre arrest where the CPU (cardiac) allowed the treating team to effectively change the inotropes and alter the clinical course. Case two is a baby with the classical diagnostic dilemma of persistent pulmonary hypertension of the newborn (PPHN) versus cyanotic congenital heart disease (CCHD) – the screening CPU (cardiac) was able to define CCHD and the transport was re-directed to tertiary paediatric cardiac services. The CPU (cardiac) in case three, a baby born at 25 weeks, also assisted in the choice of therapeutic options for the treating team. Both case three and four were born at 25 week gestation and the CPU (cranial) provided information prior to transport that aided in the counselling of the parents.

Keywords: Systemic blood flow, cardiac output, clinician performed ultrasound, inotropes, transport