Dropped baby (neonate)



▶️• 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


▶️• Perform: ➡️• continuous ECG

➡️• saturation monitoring

➡️• neurological examination: − hourly for first 12 hr, then − 2-hrly for 24 hr


▶️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


• Complete incident form

• Consider possibility of non-accidental injury


• If CT abnormal discuss with neurosurgical centre • If CT normal/not indicated observe baby on NNU for ≥24 hr