DROPPED BABY (NEONATE)
● ASSESSMENT
• Ensure baby placed on a safe surface, ideally resuscitaire
• Assess: 
• heart rate • respiratory rate • responsiveness
• If urgent clinical concerns call neonatal crash team, otherwise request medical review by neonatal middle grade
• Take full history and examine baby
• detailed documentation of all injuries
• review vitamin K history/administration
• Record occipital frontal circumference
• Update parents
• Move baby to NNU/special care baby unit and admit for ≥24 hr for observations
MONITOR
• Perform: • continuous ECG
• saturation monitoring
• neurological examination: − hourly for first 12 hr, then − 2-hrly for 24 hr
INVESTIGATIONS
Cranial ultrasound scan
• Perform cranial ultrasound scan unless CT indicated within 1 hr
• If cranial ultrasound not available senior clinician to make decision as to whether a CT scan is indicated
• If cranial ultrasound normal continue to monitor baby and to review for indications for CT scan
CT head scan
• If baby sustained head injury and clinical concerns of skull fracture or cranial ultrasound abnormalities, arrange urgent CT scan of head
• Provisional written radiology report should be made available within 1 hr of scan
Vomiting is not a reliable sign in infants
• If any of the following risk factors, CT head scan within ≤1 hr
• suspicion of non-accidental injury
• seizure
• altered state of consciousness on initial assessment or at 2 hr after injury
• suspected open/depressed skull fracture
• tense fontanelle
• any sign of basal skull fracture 
− haemotympanum − ‘panda’ eyes − cerebrospinal fluid leakage from ear or nose − Battle’s sign (bruising over mastoid process)
• focal neurological deficit
• bruise, swelling or laceration >5 cm on head
• recurrent vomiting
DOCUMENTATION
• Complete incident form
• Consider possibility of non-accidental injury
SUBSEQUENT MANAGEMENT
• If CT abnormal discuss with neurosurgical centre • If CT normal/not indicated observe baby on NNU for ≥24 hr