Triaging and stabilising a neonatal transport request — OSCE

Station brief (8–10 minutes)

A referring hospital calls about a 2-hour-old 34-week infant with worsening respiratory distress, an oxygen requirement, a temperature of 35.7 degrees and a glucose of 2.0 mmol per litre. You are the registrar receiving the call. Take the referral in a structured way, triage the urgency, describe the STABLE stabilisation you would perform, and state what must be corrected before the vehicle moves. Halfway through, the examiner reveals that the infant has also become progressively and then profoundly cyanotic and poorly responsive to oxygen — adjust the plan. State your thresholds and name the source. [2] [5]

Tasks for the candidate

1. Take the referral using SBAR and a structured call-back, capturing the information needed to act. [2]
2. Triage the urgency and justify why the infant is not yet fit to move. [3]
3. Outline the STABLE pretransport stabilisation and name the temperature and glucose targets. [3] [5]
4. When the cyanosis and oxygen non-responsiveness are revealed, state the likely diagnosis and the immediate pretransfer management, including a drug and dose. [6]
5. State why a specialist neonatal transport team is preferred and how the receiving cot is secured. [5]

Expected performance

Must hit. Takes the call with SBAR (situation, background, assessment, recommendation) and reads it back; classifies the request as urgent (not yet time-critical) but identifies that the temperature (35.7 degrees) and glucose (2.0 mmol per litre) must be corrected before movement; runs STABLE — Sugar (dextrose bolus and maintenance infusion), Temperature (rewarm to 36.5 to 37.5 with a pre-warmed incubator, hat and warm blankets), Airway (assess and secure, intubate if the work of breathing is excessive), Blood pressure (measure and support), Lab work (blood gas, septic screen, chest radiograph; speak to the parents) and Equipment (checked, with a trained escort); when cyanosis unresponsive to oxygen appears, recognises a duct-dependent congenital heart lesion and starts prostaglandin E1 at 0.01 to 0.03 micrograms per kilogram per minute with a plan for apnoea; states that a specialist team reduces transport-related adverse events and that the receiving cot is booked before departure. [2] [3] [6]

Merit. Explains the stabilise-first principle physiologically (the sick newborn is borderline; transport adds cold, vibration and acceleration); distinguishes antenatal from postnatal transfer and notes in-utero transfer is preferable when risk is identified early; identifies that the cyanotic lesion is a time-critical upgrade of the request; names capnography for any ventilated baby; and addresses family communication and culturally safe care. [5]

Fail. Advises moving the infant immediately without correcting temperature and glucose (scoop-and-run); cannot state the STABLE components or the temperature and glucose targets; misses the duct-dependent lesion or fails to start prostaglandin E1; quotes the wrong prostaglandin dose or route; does not book the receiving cot; or cannot explain why a specialist team is preferred. [3] [6]

Sample candidate structure

"I'd take this call using SBAR — gestation, age, weight, the respiratory picture, current observations, airway and access, what's been given, and what the baby needs — and read it back. This is an urgent retrieval, but the baby isn't fit to move yet: the temperature is 35.7 and the glucose is 2.0, both below safe thresholds. I'd run STABLE — correct the glucose with dextrose and start a maintenance infusion, actively rewarm to hold 36.5 to 37.5, assess and secure the airway, support the blood pressure, take a gas and septic screen and speak to the parents, and check the equipment and escort. Only when stable do we package and move, with a specialist team and the receiving cot booked. If the baby becomes cyanotic and unresponsive to oxygen, that's a duct-dependent lesion as the ductus closes — I'd start prostaglandin E1 at 0.01 to 0.03 micrograms per kilogram per minute, plan for the apnoea, upgrade this to a time-critical cardiac retrieval, and transfer to a cardiac centre." [2] [6]