Why do we need Neonatal Transport?
When fragile neonates need to be moved to another facility, that move becomes the most important journey of the baby’s life. For the smallest and most critically ill newborns, reduced transport time between facilities leads to improved outcomes.
In utero transfer has better clinical outcomes for mother and infant than transfer after birth. However, in utero transfer is not always possible due to a number of reasons:
- accelerated birth due to baby’s clinical condition
need for treatment at a specialized hospital (for example ECMO)
→ extracorporeal membrane oxygenation
- risk that could not be detected before birth
- problems right after birth (for example respiratory distress syndrome)
In these instances, the critically ill newborns then rely on the hospital team and technology to provide the best possible environment for them during transportation. Depending on the region, hospital and situation, transfers can be done by ambulance or aircraft (fixed wing or helicopter).
What challenges does the team face when transporting a neonate?
The Baby needs to be protected from factors such as thermal change and vibrations, the caregiver needs fast access to the baby and life-supporting devices, and the transport team needs a transport system that is easy to move.
Transferring these infants at such a critical state poses many challenges to the clinicians and potential risks to the infant due to external factors including:
In order to optimize transport and minimize discomfort to the infant, the effects of these factors have to be reduced as much as possible.
What is needed for transport?
Transportation requires skilled personnel and specialized equipment that is designed to meet the needs of neonates. The team set up varies from region to region and hospital to hospital. Equipment requirements also vary according to each situation but generally speaking the device needs the following:
- Incubator with good access to the neonate
- Vital signs monitor to observe oxygen saturation, ECG, respiration, C02 elimination, etc.
- Ventilator to provide respiratory support
- Infusion pumps to administer medication
Dr. Hilary Whyte
As mentioned before the best incubator is the mother so there is no question that in utero transfers are the best.
Dr. Whyte, working at the Sick Kids Hospital in Toronto, Canada is sharing her thoughts in view of neonatal transport. Dr. Whyte and her team have experienced many challenges and problems over the years when it comes to transport.
The Sick Kids Hospital has become a drop-in center for people who want to learn and participate in transport training. Over the years they have trained many people and provided them with the opportunity to utilize their skills at the cutting edge of medicine of intensive care. They go out on transport refreshing or even improving their skills. “That is what attracts people to work here at Sick Kids. It is often perceived as jewel in the crown of the neonatology program “, says Dr. Whyte.
The Traunstein program
Dr. Gerhard Wolf and Dr. Tobias Trips explain the challenges of Neonatal Transport along with the team involved, equipment requirements and how the program is conducted at the Children’s Hospital Traunstein Germany.
The above is a brief overview of all transport topics however we would like to refer you to reliable and qualitative supplementary information which might help you further.
You will find more information and statistics below:
- Transport of the Critically Ill Newborn
- Neonatal post-resuscitation stabilization and preparation for transport
- Vibration and noise in pediatric emergency transport vehicles: a potential cause of morbidity?
Macnab A, Chen Y, Gagnon F, Bora B, Laszlo C.
- Sound and vibration: effects on infants' heart rate and heart rate variability during neonatal transport.
Karlsson BM, Lindkvist M, Lindkvist M, Karlsson M, Lundström R, Håkansson S, Wiklund U, van den Berg J.
- Physical stressors during neonatal transport: helicopter compared with ground ambulance.
Bouchut JC, Van Lancker E, Chritin V, Gueugniaud PY.