PrePre--HospitalHospital

NeonatalNeonatal Intensive Care:Intensive Care:

a a possiblepossible challengechallenge??

Dr. Angelo Giusto, MDDr. Angelo Giusto, MD

NeonatalNeonatal Intensive CareIntensive Care

Giannina Giannina GasliniGaslini Children’Children’s Hospital, s Hospital, GenoaGenoa

SeptemberSeptember 11 11 –– 15, 200615, 2006

FocusedFocused historyhistory

�� In In italyitaly the the prepre--hospitalhospital EMS EMS startedstarted in in 19921992

�� Some Some institutionsinstitutions startedstarted immediatlyimmediatly, , otherother startedstarted in 2004!in 2004!

�� ThereThere are no are no schoolsschools forfor physicianphysician, , forfortraining in training in emergencyemergency medicinemedicine

�� At At presentpresent, in , in ItalyItaly: BLS, ACLS, ATLS, : BLS, ACLS, ATLS, PHTLS, PBLS, PALS, PTC and, in the PHTLS, PBLS, PALS, PTC and, in the lastlastyearyear, the PEPP , the PEPP coursecourse

NumbersNumbers -- 11

PediatricsPediatrics emergenciesemergencies: :

lessless the 3% of the the 3% of the entireentire numbernumber of of callcall

adults

childs

NumbersNumbers -- 22

NeonatalNeonatal emergenciesemergencies: : whatwhat percentagepercentage??

adults

childs??

What’What’s new s new aroundaround

�� StatisticsStatistics show the show the needneed forfor of a “full of a “full focusfocus” ” aboutabout pediatricspediatrics and and newbornnewborn carecare

�� StatisticsStatistics show show thatthat manymany newbornnewborn are are treatedtreated byby prepre--hospitalhospital emergencyemergencyservicesservices

�� FromFrom thesethese twotwo stepssteps, , prepre--hospitalhospitalprofessionalsprofessionals mustmust knowknow the “the “newbornnewborn & & neonatalneonatal entityentity” and the ” and the treatementstreatements thatthattheythey maymay requirerequire

PresentPresent situationsituation

�� NotNot allall the the prepre--hospitalhospital professionalsprofessionals havehave

the the samesame training and the training and the samesame “cursus “cursus

studiorumstudiorum”;”;

�� NotNot allall prepre--hospitalhospital professionalsprofessionals are are wellwell--

trainedtrained;;

�� PediatricPediatric emergenciesemergencies and and expeciallyexpecially

neonatalneonatal stabilizationstabilization are are uncommonuncommon

featuresfeatures

ObjectivesObjectives, , expectationsexpectations

�� EachEach physicianphysician mustmust knowknow the the uniqueunique, , particularparticular featuresfeatures of of newbornsnewborns, , includingincluding::�� PhysiopatologyPhysiopatology of of pregnancypregnancy

�� PhysiopatologyPhysiopatology of of laborlabor and deliveryand delivery

�� AnatomicAnatomic featuresfeatures of of newbornsnewborns

�� PhysiologicPhysiologic featuresfeatures of of newbornsnewborns

�� FoundationsFoundations of of neonatalneonatal stabilizationstabilization and and resuscitationresuscitation

�� EachEach phisycianphisycian, in the , in the prepre--hospitalhospitalemergencyemergency serviceservice, , mustmust bebe ableable toto treattreatanan illill newbornnewborn

ThereThere isis onlyonly a a questionquestion::

Are Are wewe readyready??

At the moment, At the moment,

therethere isis onlyonly anan answeranswer::

NO!NO!

WhatWhat can (or can (or mustmust) ) wewe do?do?

Training!Training!

Training!Training!Training!Training!

Training!Training!

Training!Training!

Training!Training!Training!Training!

HowHow??

1)1) TestingTesting the the locallocal resourcesresources, , checkingchecking the the

prepre--hospitalhospital professionalsprofessionals preparationpreparation, ,

accordingaccording toto needsneeds;;

2)2) DevelopeDevelope a training program, common a training program, common toto

allall phisycianphisycian, in , in orderorder toto obtainobtain a a

standard in the standard in the serviceservice;;

3)3) ReferRefer toto hospital hospital professionalsprofessionals and, and,

moreovermoreover makemake useuse of of children’children’s hospital s hospital

training training programsprograms;;

4)4) AcquireAcquire the the conceptconcept thatthat a a childrenchildren are are

notnot a a smallsmall adultadult!!!!!!

WhyWhy??

……forfor themthem, , itit isis mostmost importantimportant!!

QuestionsQuestions??

PrePre--HospitalHospital

NeonatalNeonatal Intensive Care:Intensive Care:

a a possiblepossible challengechallenge??

Dr. Angelo Giusto, MDDr. Angelo Giusto, MD

NeonatalNeonatal Intensive CareIntensive Care

Giannina Giannina GasliniGaslini Children’Children’s Hospital, s Hospital, GenoaGenoa

SeptemberSeptember 11 11 –– 15, 200615, 2006