STABLE Programme

Course Description

Is an educational program designed to provide guidelines for pre-transport neonatal stabilisation. The purpose of the STABLE program is to help community based hospitals organize the care of the sick infant following resuscitation with a focus on Sugar, Temperature, Artificial breathing, Blood pressure, Lab work and Emotional support. Initially developed as a complement to NRP in a format that optimises the candidate's retention and to be used as a guide.

First introduced in the United States in May 1996, this program has rapidly grown in popularity with over 20,000 Learner participants worldwide to date.
Other countries where STABLE has been taught include Canada, the Bahamas, Guam, Cuba, Japan and Puerto Rico. The European premiere of this course was held in UCC in June 2000. Almost a dozen courses have been held since, in Cork Dublin Tralee, Sligo and Kilkenny. The first STABLE couse in Northern Ireland took place in June 2002 and the first in the UK was held in Middlesborough on 28th May, 2003.

The second component of newborn emergency care, which we introduced into Ireland, was the STABLE Programme. This programme, originally developed by Kristin Karlsen, in Salt Lake city, Utah, was the first neonatal outreach education program to focus exclusively on the post-resuscitation/pre transport stabilization care of sick newborns. This mnemonic-based resource, served as a concise guideline to organize the myriad of details and interventions necessary for stabilizing a sick infant. STABLE is an educational mnemonic that stands for Sugar, Temperature, Airway, Breathing, Laboratory and Emotional Support.

The program involves an eight-hour interactive didactic presentation by an expert in neonatal nursing or medicine. The Sugar module reviews the importance of establishing IV access when an infant is sick, infants at risk for hypoglycenia, the IV treatment of hypoglycemia, and the initial intravenous (IV) fluid therapy for sick infants. Indications for umbilical catheters and their safe use are included. The Temperature module addresses the special temperature needs of infants and the detrimental effects of cold stress on infants. Artificial Breathing deals with respiratory distress in the newborn, the indication for intubation and ventilation, assisting with intubation and securing the endotracheal tube. The Blood pressure section: this module reviews risk factors for the three major causes of shock in infants: hypovolemic, cardiogenic and septic shock, and how to assess and treat shock. The Laboratory modue focuses primarily on neonatal infection and includes maternal and neonatal risk factors, signs of infection, interpretation of the complete blood count (CBC) and the initial antibiotic treatment for suspected infection. In the Emotional Support module,  we deal with the family's needs and reactions to the crisis surrounding the birth of a sick infant.

Sugar
Initial IV therapy
Fluid rates and calculations
Glucose monitoring
Hypoglycemia assessment and interventions
Umbilical catheters Candidates for placement and safe use

Temperature
The detrimental effects of cold stress
Vulnerable infants
How body heat is lost
Pulmonary vasoconstriction and shunting
Warming severely hypothermic infants

Artificial Breathing
Evaluating respiratory distress
Indications for positive pressure ventilation and endotracheal intubation
Assisting with intubation
ET tube sizes
Securing tubes
Location on chest x-ray
Evaluating for pneumothorax

Blood Pressure
Types and signs of shock
Treatment of shock
Hypovolaemic
Cardiogenic
Septic
Dopamine infusion Calculations and safe use

Lab works
Pre-transport lab evaluation
Clinical signs of sepsis
CBC interpretation
ANC, I/T ratio, and platelet evaluation
Antibiotic therapy

Emotional Support
Understand how the family may react during the crisis of a neonatal transport
Understand ways community caregivers can support families of sick or transported infants