Protecting preemies during a critical journey

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Neonatal transport challenges and practices

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).

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Transport program in Traunstein

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.

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:

  • Light
  • Sound
  • Vibration
  • Temperature

In order to optimize transport and minimize discomfort to the infant, the effects of these factors have to be reduced as much as possible.

Dr. Hilary White on Transport

The Sick Kids Hospital in Canada has become a drop-in center for people who want to learn and receive advanced training for transport. Dr. Hilary White discusses her experience and the highly sophisticated team at Sick Kids. She also acknowledges the challenges and limitations that still exist when it comes to neonatal transport. 

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

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