Recommendations on the skills profile and standards of the neonatal transport system in Spain

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Componentes del sistema de incubadora de transporte (TIS): 1.1: incubadora; 1.2: bomba de jeringa; 1.3: ventilador; 1.4: monitor. Sistema de anclaje: 2.1: pernos; 2.2: raíles; 3: interfaz a utilizar si los raíles no se pueden sujetar directamente al sistema de la camilla. Si la interfaz se debe sujetar al chasis, se deberían utilizar los puntos de sujeción originales del chasis; 4: sistema de la camilla (camilla/chasis/soporte de la camilla, etc.)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Raquel Jordán Lucas, Hector Boix, Laura Sánchez García, María Cernada, Isabel de las Cuevas, María L. 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=> "gr1.jpeg" "Alto" => 2730 "Ancho" => 3000 "Tamanyo" => 1035076 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "(A) Electrocardiogram recorded in the PICU at 24 h from admission. Narrow complex bradycardia with suspected high-grade atrioventricular block with 2:1 conduction. Blocked P waves “buried” in the T wave of the preceding heartbeat are difficult to discern. (B) Electrocardiogram with oesophageal probe (lead V1) recorded immediately following the one shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A. Features consistent with high-grade 2:1 atrioventricular (AV) block. Atria (arrows) and ventricular activity seem dissociated, as the AV interval changes from beat to beat. Note: Since neonatal oesophageal electrodes were not available, we fitted an oesophageal lead as follows: we inserted a gastric tube previously rinsed with physiological saline, which served as the conductor, and without entirely removing the guide wire we connected it to the ECG lead and to the monitor. We slowly pulled the tube up towards the oesophagus while watching the ECG tracings to the point that atrial activity was detectable with the highest possible amplitude. The oesophageal tracings allow observation of amplified atrial activity and to analyse it independently from the QRS complex. This is very useful in the diagnosis of certain forms of supraventricular tachycardia or in case of conduction disorders when the AV conduction ratio is not clear in the surface ECG." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ignacio Oulego-Erroz, Pilar de Castro-Vecino, Carlos Ocaña-Alcober, Soraya Gutiérrez-Marqués, Juan Pablo Martínez-Badás, Miriam Centeno-Jiménez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Oulego-Erroz" ] 1 => array:2 [ "nombre" => "Pilar" "apellidos" => "de Castro-Vecino" ] 2 => array:2 [ "nombre" => "Carlos" "apellidos" => "Ocaña-Alcober" ] 3 => array:2 [ "nombre" => "Soraya" "apellidos" => "Gutiérrez-Marqués" ] 4 => array:2 [ "nombre" => "Juan Pablo" "apellidos" => "Martínez-Badás" ] 5 => array:2 [ "nombre" => "Miriam" "apellidos" => "Centeno-Jiménez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403320302149" "doi" => "10.1016/j.anpedi.2020.06.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403320302149?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287921000521?idApp=UINPBA00005H" "url" => "/23412879/0000009400000006/v1_202106030800/S2341287921000521/v1_202106030800/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Spanish Association of Paediatrics" "titulo" => "Recommendations on the skills profile and standards of the neonatal transport system in Spain" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "420.e1" "paginaFinal" => "420.e11" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Raquel Jordán Lucas, Hector Boix, Laura Sánchez García, María Cernada, Isabel de las Cuevas, Maria L. Couce" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Raquel" "apellidos" => "Jordán Lucas" "email" => array:1 [ 0 => "rjordan@vhebron.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Hector" "apellidos" => "Boix" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Laura" "apellidos" => "Sánchez García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "María" "apellidos" => "Cernada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Isabel de las" "apellidos" => "Cuevas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Maria L." "apellidos" => "Couce" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 6 => array:2 [ "colaborador" => "en representación de las Comisiones de Estándares y Transporte Neonatal, Sociedad Española de Neonatología" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "1" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Servicio de Neonatología, Hospital Universitari Vall d’Hebron, Comisión de Transporte Neonatal, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neonatología, Hospital Universitari Vall d’Hebron, Comisión de Estándares, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Neonatología, Hospital Universitario La Paz, Comisión de Transporte Neonatal, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Comisión de Estándares, Valencia, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Hospital Universitario Marqués de Valdecilla, Departamento de Ciencias Médicas y Quirúrgicas Universidad de Cantabria, Comisión de Transporte Neonatal, Santander, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Neonatología, Hospital Clínico Universitario de Santiago, IDIS, Universidad de Santiago de Compostela, Comisión de Estándares, Santiago de Compostela, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recomendaciones sobre el perfil de competencias y estándares del sistema de traslado neonatal en España" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1739 "Ancho" => 2500 "Tamanyo" => 130848 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Transport incubator system fixed to the frame of the vehicle (UNE-EN 13976-1). Components of the transport incubator system (TIS): 1.1: incubator; 1.2: syringe pump; 1.3: ventilator; 1.4: monitor. Fixation system: 2.1: track studs; 2.2: track rails; 3: Interface to be used if track rails cannot be fixed directly to the stretcher system. If the interface is to be attached to undercarriage, original fixation points on the undercarriage should be used; 4: Stretcher system (stretcher/undercarriage/stretcher support, etc)." ] ] ] "textoCompleto" => "IntroductionThe delivery and the first hours of life of newborn (NB) infants that are vulnerable on account of prematurity or illness largely determine their long-term outcomes. This is why these infants should be born in facilities that are ready to care for them and, if this is not the case, be transported to such facilities safely and efficiently.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> Neonatal transport (TN) requires meticulous organization involving the coordination of different resources, patient stabilization in the sending hospital (SH) and subsequent transport and admission to the receiving hospital (RH) where the NB infant can receive the required care. It is essential that the comprehensive and specialised care required by these patients is offered both before and during transport.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The specific training of the NT team and their experience in neonatal care must guarantee adequate care with the maximum safety for the patient, achieving a decrease in perinatal morbidity and mortality, optimising the use of neonatal intensive care unit (NICU) resources and increasing the satisfaction of parents, families and health care professionals.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> An established and specific NT system is an essential resource in the development of the neonatal care system.The aim of this document is to define the standards required in human and material resources to organise and manage the transport of critical NBs optimally and safely.Organization of a neonatal transport systemFor NT to meet the efficacy, efficiency and care quality objectives, it is essential that the transport system be organised taking into account the particular needs of each autonomous community in terms of the number of transports of critical NBs and the complexity of neonatal units based on the levels of care offered.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> The support of policymakers and the availability of resources are the elements that have the greatest impact in NT planning.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Coordination and communicationCoordination and communication are essential for the proper functioning of the NT system.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Within the public health system, emergency care coordinating teams play a key role, managing the demands of SH and the transport to the RH through the following responsibilities<a class="elsevierStyleCrossRef" href="#bib0020">4</a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1Coordinating health care services based on the emergency triage.</li><li class="elsevierStyleListItem" id="lsti0010">2Having up-to-date information on the capacity and available services for each facility.</li><li class="elsevierStyleListItem" id="lsti0015">3Obtain and transfer patient medical records.</li><li class="elsevierStyleListItem" id="lsti0020">4Establish protocols for the classification of the critical NB.</li><li class="elsevierStyleListItem" id="lsti0025">5Establish NT pathways based on this classification.</li><li class="elsevierStyleListItem" id="lsti0030">6Guaranteeing availability of beds at the RH.</li><li class="elsevierStyleListItem" id="lsti0035">7Allocating, managing and optimising human and material resources.</li><li class="elsevierStyleListItem" id="lsti0040">8Facilitate communication between the parties involved in NT to reduce transport times.</li></ul>Types of neonatal transportThe main indication for NT involves the impossibility of managing the disorder manifesting in certain infants at the SH based on complexity and diagnostic and therapeutic needs, for instance, the need of surgical intervention, high-frequency oscillatory ventilation or extracorporeal membrane oxygenation (ECMO). Thus, there are different types of NT based on the details of the transport.Intrauterine transport: transport of a pregnant woman from one labour and delivery unit to another one of higher complexity that can offer the mother or neonate the care they require or due to maternal and/or foetal compromise. Prenatal diagnosis and correct planning of the birth in the right facility allows perinatal transport under the best possible conditions. Intrauterine transport is the gold standard for mothers and infants whenever possible and has been proven to reduce perinatal morbidity and mortality compared to postnatal transport.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Some of the aspects that need to be considered in deciding the timing of transport are the risk of imminent birth, the obstetric history, potential complications during transport, correct planning of delivery in a facility with the appropriate level of care for the circumstances, the distance between the hospitals and the availability of beds in the RH<a class="elsevierStyleCrossRef" href="#bib0030">6</a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). There are tools available to facilitate decision-making, such as the Malinas score,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> which assesses the stage of labour and cervical dilation to estimate the risk of imminent birth, or the foetal fibronectin test, which combined with the cervical length allows estimating the risk of preterm birth within 7 days.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> While the different tools can be useful, there is no prevailing preference for any of them. At presence, one of the key interventions available is the education of pregnant women on how to identify the early signs and symptoms of preterm birth.<a class="elsevierStyleCrossRefs" href="#bib0010">2,8</a><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Neonatal transport: optimal NT depends on the correct classification of neonatal units by level of care and the regional organization of health care systems. Thus, the sending or receiving role of each hospital is clearly defined based on their capacity and services. Many newborn infants are transported from one hospital to another during the “golden hours” that are key in neonatal morbidity and mortality and therefore require particularly rigorous care. The outcomes of extremely preterm NBs are poorer in those transported in the first 48 h post birth compared to those delivered in tertiary care hospitals, so it is recommended that efforts be made to ensure delivery of these infants in a setting offering tertiary neonatal care, considering prenatal over postnatal transport a priority as long as it is safe.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>It is of vital importance that NT be organised, planned and executed by appropriately trained staff equipped with the necessary resources. Current technology and knowledge allow for an increasing number of urgent interventions, such as nitric oxide, hypothermia or even ECMO, to be implemented during transport. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarises the main indications for neonatal transfer.<a class="elsevierStyleCrossRef" href="#bib0030">6</a><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Return transport: from the facility where intensive care was delivered to the SH or the hospital closest to the family home once the condition that motivated the transfer to or delivery in the RH. It allows optimising the availability of beds in different care settings, regrouping families so they can be closer to the hospitalised children, promoting the interpersonal relationship between professionals and reducing health care costs.Family and transportThe transport of a highly vulnerable patient, such as a critical NB, is a negative and stressful experience for families that may interfere with bonding and hinder participation of parents in infant caregiving activities. To minimise these negative repercussions, providers must inform parents about every aspect related to the transport of their child and, in adherence with European guidelines, at least one of the parents should be allowed to accompany the infant during transport.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> It is also important to ensure accurate identification of the patient before proceeding with the transfer. Sending hospitals should have a protocol developed in cooperation with the department of obstetrics to facilitate the transfer of mothers that could not be transported with their infants.Human resources and skills of the neonatal transport teamIdeally, the NT team will include a paediatrician specialised in neonatology, paediatric nursing staff and an emergency medical technician (EMT-driver or pilot). The entire team must be knowledgeable of the most frequent neonatal problems, be trained in transport and basic and advanced life support (neonatal and paediatric) and support teamwork and leadership. The competence of transport team members in these areas will contribute to the optimal outcome of transport (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The required competencies include:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0045">1Theoretical knowledge and clinical skills<a class="elsevierStyleCrossRefs" href="#bib0030">6,9–13</a></li><li class="elsevierStyleListItem" id="lsti0050">2Technical skills<a class="elsevierStyleCrossRefs" href="#bib0030">6,9–12</a></li><li class="elsevierStyleListItem" id="lsti0055">3Communication and social skills<a class="elsevierStyleCrossRefs" href="#bib0030">6,9</a></li><li class="elsevierStyleListItem" id="lsti0060">4Skills related to the means of transport<a class="elsevierStyleCrossRef" href="#bib0070">14</a></li><li class="elsevierStyleListItem" id="lsti0065">5Continuing education.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10,12,15</a></li></ul><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Medical and nursing staffExpertise in transport is acquired naturally if the staff is actively and regularly involved in specialised transport teams and in neonatal and paediatric intensive and emergency care units. The connection to these units is essential to maintain the necessary clinical and technical skills to carry out NT. During transport, health care decisions ultimately rest with the physician. The tasks are allocated to different members of the staff, but there are some tasks that any of the team members should be able to perform in a critical juncture.Emergency medical technicianThe duties of EMT extend beyond the mere operation of the vehicle and include a series of tasks that are part of the team’s work. The EMT plays an important role in ensuring the safety of the patient and all other riders (transport team and family members) and the maintenance of the transport unit and its equipment. It has to adapt the handling of the vehicle to the characteristics of the patient so it has the least possible impact on the clinical condition of the infant. The participation of EMTs in health care and educational activities allows contemplating a future in which specialization would be accredited, and we advocate for the establishment of the role of paediatric EMT.Material resources for neonatal transportWhether transport is urgent or scheduled, the vehicle and equipment must fulfil the requirements of a mobile intensive care unit for the effective transfer of newborn infants of varying maturity and requiring different levels of care and interventions. Interchangeability and interoperability in different settings and scenarios using different transport vehicles must be ensured. <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> summarises the material resources that are recommended for NT.<a class="elsevierStyleCrossRefs" href="#bib0010">2,16,17</a><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0070">aTransport vehicles:<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> compares the different types of transport vehicles.<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0075">1Ground transport: availability of a vehicle exclusively dedicated to NT is recommended, along with specific maintenance and cleaning protocols.</li><li class="elsevierStyleListItem" id="lsti0080">2Air transport: an air ambulance is an aircraft designed, equipped and dedicated to the transport of patients that may require medical care in transit, such as ambulance service airplanes or helicopters. The vehicle triage should be based on the urgency of the condition (considering time-dependent outcomes) and the transport distance and duration. When the isochrone map (showing the time required to travel from a certain point to a certain hospital) shows a time greater than 1 h or the distance exceeds 150 km, use of a helicopter is recommended, and in case of longer travel, use of an airplane, taking into account the available resources and the experience of the transport team.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Air transport involves greater specialisation of the staff and is subject to limitations based on geography, weather conditions and night travel that are not standardised across Spain.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Health care devices and products must function safely under local temperature and humidity conditions, the vibration and shock caused by movement of the air ambulance, air pressure variations and electromagnetic interference as established in the UNE EN 13718-1:2014 and EN 13718-2:2015 standards.<a class="elsevierStyleCrossRefs" href="#bib0095">19,20</a></li></ul><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0085">bTransport incubator system (TIS) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>)<elsevierMultimedia ident="fig0005"></elsevierMultimedia></li></ul><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>The TIS is comprised of a portable incubator combined with the rest of the equipment. It is important to control its weight and bulk to ensure the safety of vehicle occupants.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> The total mass of the system should not exceed 140 kg and should not affect the stability or manoeuvrability of the ambulance.To ensure the power supply, the total usage of the TIS should not exceed 1200 W connected to a 230 V alternating current source, 720 W connected to a 24 V direct current (DC) source or 360 W connected to a 12 V DC source. The incubator must have a rechargeable battery serving as a portable power supply capable of maintaining the temperature for at least 90 min. The TIS must be equipped with oxygen and medical gas, and it is essential to calculate the necessary supply of gases for transport, especially when covering long distances (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). All the components must be safely secured so they cannot move during transit, in adherence with the EN 1789:2007 + A2:2014 standards for ground ambulances and the EN 13718-1:2014 and EN 13718-2:2015 standards for air ambulances.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>The requirements for TISs in regards to suspension/shock absorption, temperature conditions, vibration, mechanical integrity, electromagnetic compatibility, mass, electricity, fixation of component parts and interface conditions during incubator transport are established in the UNE-EN 13976-1:2018<a class="elsevierStyleCrossRef" href="#bib0110">22</a> and EN 13976-2:2018 standards.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> No system is completely effective in attenuating mechanical vibration, and gel mattresses in incubators are only partially effective in reducing its transmission.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> Caution must be exerted to avoid obstructing air inlets and vent holes with blankets, which can cause an increase in temperature above safe levels. The noise level inside the incubator should not exceed 60 dB during regular use or 80 dB when an alarm is sounding. Use ear defenders is recommended in every transport, although these devices only reduce noise by a maximum of 7 dB. New systems for NT must be develop that reduce noise exposure.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> Exposure to the highest intensity of light occurs during vehicle loading and unloading. This exposure should be minimised or prevented using eye covers, light-reducing cot covers or tinting of the transport cot to reduce the illuminance without compromising the ability to observe the neonate during transport.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>Pretransport stabilizationTransport causes noise, vibration, acceleration and deceleration forces and temperature fluctuations in addition to detracting from the quality of care due to limited space and restricted mobility. The transport team must stabilise the infant before transport to be able to face a risk situation that will be compounded by the effects of transport under the best possible conditions.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>Leaving aside the available equipment and technology, the guiding principles of neonatal care are improving safety through the standardization of procedures and eradicating preventable adverse events, which entails controlling body temperature, securing the airway and ventilatory support, placement of catheters for intravenous access and drainage, haemodynamic stabilization with maintenance of glucose levels in the normal rage and family support (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The stabilization of the critical NB must adhere to the ABCDE protocol and the staff should be constantly re-evaluating the support and care provided to the infant. The breathing of the patient should be evaluated to determine whether it is possible to transport the infant under noninvasive ventilation applying appropriate selection criteria<a class="elsevierStyleCrossRef" href="#bib0135">27</a> (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>); administration of surfactant and/or inhaled nitric oxide or placement of a chest tube may be necessary before transport. If available, high-frequency oscillatory ventilation may be indicated for stabilization of the most critically ill infants.<a class="elsevierStyleCrossRef" href="#bib0140">28</a><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia>Providers must be acquainted with the ventilator and the selected modality of support and should be capable of making adjustments as required by environmental and clinical changes during transport. The difficulty of assessing chest wall motion and performing lung auscultation during transport due to mechanical vibration and background noise must be taken into account. Adequate stocking of batteries and gas canisters is important to ensure the supply of power and medical gases during transfers and ambulance transport.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> The use of checklists during intubation and other procedures can shorten the execution time and improve success rates.<a class="elsevierStyleCrossRef" href="#bib0145">29</a>Depending on the timing and means of transport, there may be important fluctuations in body temperature. In the case of transported NBs with hypoxic-ischaemic encephalopathy, active hypothermia is key to achieve the target temperature on arrival to the RH and minimises the risk of overcooling compared to passive hypothermia. Portable devices to monitor brain function may allow assessment of the patient during stabilization in units lacking equipment, although they cannot be used to monitor the patient and consider changes in management during transport due to vibration artifacts.<a class="elsevierStyleCrossRef" href="#bib0140">28</a>The concept of time-dependent outcome is relevant in NBs requiring immediate surgical intervention or urgent advanced life support that can only be provided in an intensive care setting. An ongoing re-evaluation of the care plan, the anticipation of complications, technical skills and care team cohesiveness are key factors in the successful stabilization of the patient.Neonatal transport and COVID-19Despite the apparent rarity of vertical transmission of SARS-CoV-2, the transport group of the Società Italiana di Neonatologia recommends approaching each possible case as confirmed, even if the SH defines it as suspected. The only additional equipment required is personal protective equipment, although fitting specific filters in the valves of the ventilator. The partition between the cab and the patient compartment should be kept closed.<a class="elsevierStyleCrossRef" href="#bib0150">30</a>The European Society of Paediatric and Neonatal Intensive Care (ESPNIC) has recommended handling incubator transports as if they were open stretcher transports as regards the use of personal protective equipment.<a class="elsevierStyleCrossRefs" href="#bib0155">31,32</a> It also recommended placing the NB in a suitably sized plastic bag to reduce the need for heating or humidification as well using port hole covers to minimise air leaks. Although it is not aligned with the principles of family-centred care, transporting infants without the parents, whether symptomatic or not, is also recommended to protect the transport team.ConclusionsThe first hours of life of an ill or preterm newborn infant are crucial to the outcome of the patient, and therefore delivery should take place in a hospital with the necessary resources to manage the corresponding level of complexity. When this is not the case, the neonate must be provided with optimal, professional transport to a facility that can offer the required care. The training and coordination of the neonatal transport team and the resources at its disposal are key to guarantee transport under adequate conditions. Each transport team must perform data collection and documentation of any incidents during transport to allow quality assessment and identification of opportunities for improvement in order to increase patient safety throughout the transport process.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1519738" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1378099" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1519739" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1378098" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Organization of a neonatal transport system" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Coordination and communication" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Types of neonatal transport" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Family and transport" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Human resources and skills of the neonatal transport team" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Medical and nursing staff" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Emergency medical technician" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Material resources for neonatal transport" ] 8 => array:3 [ "identificador" => "sec0050" "titulo" => "Pretransport stabilization" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Neonatal transport and COVID-19" ] ] ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-11-02" "fechaAceptado" => "2021-02-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1378099" "palabras" => array:4 [ 0 => "Neonatal transport" 1 => "In utero transport" 2 => "Newborn" 3 => "High risk newborn" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1378098" "palabras" => array:4 [ 0 => "Transporte neonatal" 1 => "Transporte intraútero" 2 => "Recién nacido" 3 => "Recién nacido de alto riesgo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The first hours of life of a sick or premature newborn are crucial for its prognosis and therefore delivery should take place in a center prepared for that degree of complexity. When this condition is not met, the newborn must be transferred in an optimal and safe way to the center that can offer the necessary care. The training, staffing, organization and coordination of the neonatal transport team are essential to guarantee a safe transfer. Being aware of the interest and the advances that are currently taking place in this area of pediatrics, the Standards Commission and the Neonatal Transport Commission of the Spanish Society of Neonatology have prepared this document. In it, both the provision of human and material resources necessary as well as the bases of clinical stabilization in transport to carry out the neonatal transfer in a safe way and proportionate to the needs of the critical newborn have been exhaustively reviewed and detailed." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Las primeras horas de vida de un recién nacido enfermo o prematuro son cruciales para su pronóstico y por lo tanto el parto debería acontecer en un centro preparado para ese grado de complejidad. Cuando no se cumple esta condición, el recién nacido debe ser trasladado de un modo óptimo y seguro al centro que pueda ofrecerle los cuidados necesarios. La formación, dotación, organización y coordinación del equipo de transporte neonatal son indispensables para garantizar un traslado en condiciones. Siendo conscientes del interés y los avances que en la actualidad se están produciendo en esta área de la pediatría, la Comisión de Estándares y la Comisión de Transporte Neonatal de la Sociedad Española de Neonatología han elaborado el presente documento. En él, se ha revisado y detallado de forma exhaustiva tanto la dotación de recursos humanos y materiales necesarios como las bases de la estabilización clínica en transporte para llevar a cabo el traslado neonatal de forma segura y proporcionada a las necesidades del recién nacido crítico." ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Jordán Lucas R, Boix H, Sánchez García L, Cernada M, de las Cuevas I, Couce ML. Recomendaciones sobre el perfil de competencias y estándares del sistema de traslado neonatal en España. An Pediatr (Barc). 2021;94:420." ] 1 => array:3 [ "etiqueta" => "1" "nota" => "Appendix <a class="elsevierStyleCrossRef" href="#sec0070">A</a>lists the members of the Neonatal Transport Committee of the Sociedad Española de Neonatología (seNeo) and the Standards Committee of the SENeo." "identificador" => "fn0005" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The members of the Neonatal Transport Committee of the Sociedad Española de Neonatología (SENeo) are Olalla Rodríguez Losada, Laura Sánchez García, Teresa Esclapés Giménez, Rafael Gómez Zafra, Miguel Ángel Cortajarena Altuna, Marta Costa Romero, Miguel Ángel García Cabezas, Beatriz Curto Simón, Natalia Mandiá Rodríguez, Félix Morales Luengo, Javier Díez-Delgado Rubio, Marta Sardá Sánchez, Luis Pérez Baena, Isabel Sanz Ruiz, Isabel de las Cuevas Terán and Raquel Jordán Lucas. The members of the Standards Committee of the SENeo are María L. Couce Pico, Héctor Boix Alonso, María Cernada Badía, María Gracia Espinosa Fernández, Noelia González Pacheco, Alejandro Pérez Muñuzuri, M. Dolores Sánchez-Redondo Sánchez-Gabriel and Ana Martín Ancel." "etiqueta" => "Appendix A" "titulo" => "Committee Members" "identificador" => "sec0070" ] ] ] ] "multimedia" => array:9 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1739 "Ancho" => 2500 "Tamanyo" => 130848 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Transport incubator system fixed to the frame of the vehicle (UNE-EN 13976-1). Components of the transport incubator system (TIS): 1.1: incubator; 1.2: syringe pump; 1.3: ventilator; 1.4: monitor. Fixation system: 2.1: track studs; 2.2: track rails; 3: Interface to be used if track rails cannot be fixed directly to the stretcher system. If the interface is to be attached to undercarriage, original fixation points on the undercarriage should be used; 4: Stretcher system (stretcher/undercarriage/stretcher support, etc)." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 333 "Ancho" => 1667 "Tamanyo" => 64848 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Calculation of the medical gas supply needed in transport. Formula A (time in minutes of medical gas autonomy delivering a constant flow with a flowmeter). Formula B (time in minutes autonomy in patient connected to mechanical ventilation). FiO2, inspired fraction of oxygen; IRV, inspiratory reserve volume." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2440 "Ancho" => 3333 "Tamanyo" => 947583 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Pretransport stabilization. ECG, electrocardiogram; EtCO2, end-tidal carbon dioxide; ETT, endotracheal tube; GT, gastric tube; HR, heart rate; IBP, invasive (intra-arterial) blood pressure; IMV, invasive mechanical ventilation; IV, intravenous; NB, newborn; NIBP, noninvasive blood pressure; NIRS, near infrared spectroscopy; NIV, noninvasive ventilation; RR, respiratory rate; Rx, X-ray; SpO2, oxygen saturation; temp, temperature." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "HELLP, haemolysis, elevated liver enzymes, low platelet count; IUGR, intrauterine growth restriction.Adapted from Moreno et al.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indications \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Contraindications \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Risk of preterm birth before 32 weeks’ gestation with or without premature rupture of membranes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Placental abruption \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple birth before 34 weeks’ gestation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Significant bleeding \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe IUGR < 34 weeks’ gestation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Imminent birth \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Congenital anomalies requiring immediate treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical instability or maternal need of intensive care that can be delivered at the sending hospital \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe blood type incompatibility \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nonreassuring foetal status \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hydrops fetalis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cord prolapse or breech presentation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polyhydramnios or severe oligoamnios \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe preeclampsia or HELLP syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prenatal diagnosis of metabolic disease requiring immediate management \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe maternal disease or complications of pregnancy (heart disease, insulin-dependent diabetes, infection) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2609796.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main indications and contraindications of intrauterine transport to a tertiary care hospital." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "ECMO, extracorporeal membrane oxygenation; HFOV, high frequency oscillatory ventilation.Adapted from Moreno et al.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preterm birth or low birth weight \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Frequent episodes of apnoea or bradycardia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Congenital anomalies, especially those that compromise the stability of the infant (diaphragmatic hernia, oesophageal atresia, airway malformations) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate-severe respiratory distress that cannot be managed in sending hospital \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe pulmonary hypertension \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Congenital heart defects \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiovascular disorders (cardiac arrest, arrhythmia, heart failure) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurologic disorders (moderate-severe perinatal asphyxia, hypoxic-ischaemic encephalopathy, neonatal seizures) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Metabolic disorders (persistent hypoglycaemia, severe metabolic acidosis, fluid and electrolyte disorders, hydrops fetalis, haemodynamically significant dehydration, kidney failure) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Infectious disease (septic shock, meningitis or encephalitis) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gastrointestinal disorders (intestinal obstruction, necrotising enterocolitis, acute abdomen) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haematological disorders (thrombocytopenia, haemolytic disease, acute neonatal anaemia) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neonatal surgical disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Any condition or disease requiring intensive care or complex treatment that is not available in the sending hospital (peritoneal dialysis, ventricular, chest or abdominal drainage, ECMO, pericardiocentesis, total or partial exchange transfusion, veno-venous haemofiltration, HFOV) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Insidious neonatal disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lack of beds in sending hospital \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2609793.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main indications for neonatal transfer." ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "ABB, acid-base balance; ALS, advanced life support; BLS, basic life support; CA, cardiac arrest; CPR, cardiopulmonary resuscitation; CRM, crew resource management; CVP, central venous pressure; EMT, emergency medical technician; ETT, endotracheal tube; HFOV, high frequency oscillatory ventilation; HR, heart rate; IBP, invasive blood pressure; IMV, invasive mechanical ventilation; iNO, inhaled nitric oxide; MECC, Medical Emergency Coordination Centre; NB, newborn; NIBP, noninvasive blood pressure; NICU, neonatal intensive care unit; NIV, noninvasive ventilation; OI, oxygenation index; RH, receiving hospital; RR, respiratory rate; SH, sending hospital; SpO2, oxygen saturation; Temp, temperature." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Physician/paediatrician \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nursing staff \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Emergency medical technician \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="11" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Theoretical knowledge and practical skills</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Knowledge of the foundations and essential components of teamwork</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Knowledge of the stages of neonatal transport and their particularities</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Knowledge of available electronic medical devices, their setup and use</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Recording and analysis of quality indicators to improve outcomes and ensure a high-quality transport system</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Knowledge of neonatal pathophysiology and the following in particular:</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Basic neonatal diseases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Disease severity scores (Apgar, Silverman, Sarnat, etc) and normal vital signs for gestational age</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Techniques to handle vehicle under adverse conditions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Clinical signs of respiratory, haemodynamic and neurologic impairment</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neonatal basic life support \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Diagnosis and treatment of the most frequent neonatal diseases, including those in preterm infants</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Identification of equipment and drugs for advanced life support \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Pain assessment scale, nonpharmacological and pharmacological analgesia and sedation</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vehicle maintenance and equipment maintenance \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Developmental care approach</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Calculation of required medical gas supply \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Communication between intervention setting and MECC \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="19" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Technical skills</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory monitoring (pulse oximetry, capnography and ABB) and haemodynamic monitoring (HR, RR, ECG, NIBP, IBP, CVP, preductal and postductal SpO2, OI)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Methods to control body temp. Eligibility criteria and performance of therapeutic hypothermia</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In regards to the specific supplies/equipment used in transport, knowledge of:</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Operating incubators, ventilators, monitors, infusion pumps and child restraint systems (harness, support pillow</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Most frequent serious complications that may occur during transport (extubation, loss of IV access, CA)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Transferring patients to/from different health care vehicles and in hospital</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Keeping inventory and restocking supplies to ensure availability</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Respiratory: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Respiratory: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Adapt vehicle operation to patient condition \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Securing airway: intubation (including very preterm NBs), management of difficult airway (laryngeal mask airway) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Help with intubation, surfactant administration, management of NIV and interfaces, IMV or HFOT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Deliver BLS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Neonatal IMV/HFOT and NIV and interfaces \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Use of iNO in ventilation systems \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Help medical and nursing staff deliver ALS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Use of iNO in ventilation systems \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Help with insertion and maintenance of pleural drainage line and suction devices \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Verify basic functioning of medical equipment and auxiliary systems in the transport vehicle \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Thoracocentesis and pleural drainage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2. Haemodynamic: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Assembly and setup of electronic medical devices (ventilator, iNO, monitors, infusion pumps etc) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Surfactant administration techniques \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Establishment of vascular access: peripheral venous, umbilical, peripheral central venous access, arterial, intraosseous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Maintain vehicle and equipment in good working order \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2. Haemodynamic: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Help establish central vascular access \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Establishment of vascular access: umbilical (venous or arterial), central (femoral, jugular), arterial, intraosseous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Interpretation of paediatric arrhythmias \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Emergency pericardiocentesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Drug dilution and administration, drug interactions and use of infusion pumps \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Diagnosis and treatment of paediatric arrhythmias \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3. Point-of-care ultrasound: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Use of ultrasound to guide catheter insertion, assess lungs, heart and brain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="5" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Communication and interpersonal skills</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ability of professionals to coordinate actions under stressful circumstances: decision-making. Fluid and collaborative communication between SH, RH, MECC and transport team</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Effective teamwork: task allocation, constant communication</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Management of NONMEDICAL incidents during transport</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Provision of family-centred care: adequate communication, explaining the situation and procedures to be performed. Facilitate parents accompanying the NB</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Document interventions during transport (neonatal transport form) and facilitate transfer of information between SH and RH (physical and verbal transfer)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="9" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Competencies related to means of transport</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Identification of “time-dependent” diseases: adequate assessment of “time” as a necessary resource in patient stabilization and transport based on the presenting problem, treatment and transport conditions</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ability to work in small and noisy environments with limited resources</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anticipation and prevention:</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Incidents and complications derived from moving the patient</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Most frequent adverse events involving the airway, ventilation and haemodynamic support during transport (fixation of ETT, drains, vascular access lines etc)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Equipment-related complications: ventilators, infusion pumps, monitors, incubators, other</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Knowledge of the effects of transport on the patient’s condition (acceleration and deceleration, effect of altitude on air density and oxygenation)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Appropriate prioritization and performance of procedures to guarantee the safety of the patient and crew</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Knowledge of safety measures in transport vehicles (ground/air), roads, airports, heliports and helipads</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="6" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Training</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Training or rotation in a transport unit and NICU</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Specific training and continuing education in neonatology and neonatal transport \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Regular refresher training in:</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Regular refresher training in: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Neonatal ALS</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Neonatal BLS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• IMV and NIV during transport</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Safety in health care transport \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Safety in health care transport</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Continuing education with high-fidelity simulation and crisis management during transport (CRM) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Continuing education with high-fidelity simulation and crisis management during transport (CRM)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2609791.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Human resources and competencies in neonatal transport." ] ] 6 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CPR, cardiopulmonary resuscitation; ECG, electrocardiogram; EtCO2, capnography; ETT, endotracheal tube; HR, heart rate; IBP, invasive blood pressure; iNO, inhaled nitric oxide; NB, newborn; NIBP, noninvasive blood pressure; RR, respiratory rate; PEEP, positive end-expiratory pressure; PtCO2, transcutaneous carbon dioxide pressure; SpO2, oxygen saturation; temp, temperature.Source: Jourdain et al,<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Lee et al,<a class="elsevierStyleCrossRef" href="#bib0080">16</a> British Columbia Transfer Record.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Transport incubator with a cabinet for the NB, with a certified fixation system and clear sections that allow observation of the infant and provide a safe, protected and temperature-controlled environment. It must allow medical intervention in transit. It must meet the basic safety and function standards established by the UNE-EN 60601-2-20:2010, 2018 revision \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Vital signs monitor including at minimum the HR, RR, ECG, NIBP, IBP, CVP, SpO2 and body temperature. Point-of-care blood testing and glucose meter. Point monitoring of EtCO2 (verification of ETT placement after intubation and in CPR) and PtCO2 are desirable. Visual alarms are preferable over audio alarms \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Disposable supplies for vascular access and intravenous infusion, necessary drugs and fluids. Large volume pumps and continuous infusion pumps \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Refrigerator for drugs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Supplies for enteral nutrition. Human milk storage system \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Supplies for airway management. Neonatal self-inflating bag with PEEP valve. Portable suction system. Transport ventilator with assist-control mode. Humidifier. Noninvasive ventilatory support. If available, high-frequency oscillatory ventilation and high-flow oxygen therapy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Portable oxygen, medical air and iNO canisters with quick connect adapters, sufficient supply to cover double the longest expected duration \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Supplies for CPR, defibrillator \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Urinary drainage system, catheters and bags \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Servo-controlled active cooling system \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Point-of-care ultrasound system: desirable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• System to load and unload the incubator without lifting \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Light for diagnosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Seats for at least 3 providers/family members. At least 450 mm distance between seats and incubator to allow easy access to the NB. A certified restraint system must be used for the safety of the patient and the crew \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Dependable power supply to power medical equipment in the vehicle without using the battery of the incubator. The electric system must be designed so that the vehicle will not use the power of the transport incubator or its interface system \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Communication systems for communication between the medical team and vehicle operators and between the medical team and the unit’s base location \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2609792.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Equipment and supplies for neonatal transport." ] ] 7 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Road ambulance \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rotary aircraft (helicopter) ambulance \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fixed wing aircraft (plane) ambulance \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Transport distance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Short \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Long \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Very long (between autonomous communities and international \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time to departure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Excellent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Excellent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor to acceptable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time to arrival \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acceptable to poor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Excellent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Transport duration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Excellent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acceptable to excellent \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Access to patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor (limited space) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acceptable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meteorological aspects \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Excellent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weather restrictions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acceptable to good (flight over bad weather) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Deleterious effects of travel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Infrequent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increased noise and vibration Effect of altitude on patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Decreased impact of altitude (cabin pressurization) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maintenance cost \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2609795.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of the advantages and disadvantages of the different vehicles used in neonatal transport." ] ] 8 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "ABB, acid-base balance; BE, base excess; CPAP, continuous positive airway pressure; ECG, electrocardiogram; EtCO2, end-tidal carbon dioxide; FiO2, fraction of inspired oxygen; HFNC, high flow nasal cannula; HFOT, high-flow oxygen therapy; HR, heart rate; IBP, invasive (intra-arterial) blood pressure; iNO, inhaled nitric oxide; MAP, mean airway pressure; NIBP, noninvasive blood pressure; NIPPV, nasal intermittent positive pressure ventilation; NIV, noninvasive ventilation; PaCO2, partial pressure of carbon dioxide; PEEP, positive end-expiratory pressure; PIP, peak inspiratory pressure; PtcO2 transcutaneous oximetry; RR, respiratory rate; SpO2, peripheral oxygen saturation.Adapted from Null et al.<a class="elsevierStyleCrossRef" href="#bib0140">28</a>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inclusion criteria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory distress or chronic pulmonary disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stable with NIV > 2 h \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chest radiograph for adequate lung expansion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FiO2 < 0.5 or decreasing and PaCO2 < 60 mmHg and stable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pH > 7.3 and table \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Transport team comfortable with patient status \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Exclusion criteria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulmonary hypertension unresponsive to iNO \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poor lung expansion on upper levels of NIV support \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HFOT ≥ 6 Lpm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CPAP ≥ 8 cmH2O \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NIPPV with RR ≥ 20 bpm or PIP ≥ 20 cmH2O or PEEP ≥ 7 cmH2O \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HFNC with MAP ≥ 8 cmH2O \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Persistent apnoea \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sepsis with poor cardiac output \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgical problems: diaphragmatic hernia, trachea-oesophageal fistula, intestinal obstruction, necrotising enterocolitis, gastroschisis, omphalocele \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Significant acidosis: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory: pH < 7.25 or PaCO2 > 60 mmHg \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Metabolic: pH < 7.20 and BE > 10 mEq/L \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Transport team uncomfortable moving patient on NIV \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pretransport assessment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Breath sounds, RR, depth of respiration, retractions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positions of palpable edge of liver at right costal margin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Recovery of SpO2 after brief loss of NIV support \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stability of patient during repositioning, suctioning, and examining \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">If changing NIV technique: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wait minimum of 30 min to access stability \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Obtain chest radiograph to assess lung expansion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Measure blood gas before departure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monitoring during transport \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HR, ECG, RR, NIBP, IBP, preductal and postductal SpO2, EtCO2, PtcO2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peripheral(x2) or central vascular access \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blood: ABB, glucose, electrolytes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Physical examination before and during transport \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2609794.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Criteria for considering non-invasive mechanical ventilation during transport." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hacia el pleno desarrollo del transporte pediátrico en España [Towards the full development of paediatric transport in Spain]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. 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Recommendations on the skills profile and standards of the neonatal transport system in Spain

Recomendaciones sobre el perfil de competencias y estándares del sistema de traslado neonatal en España

Raquel Jordán Lucasa,

Corresponding author

rjordan@vhebron.net

Corresponding author.

, Hector Boixb, Laura Sánchez Garcíac, María Cernadad, Isabel de las Cuevase, Maria L. Coucef, en representación de las Comisiones de Estándares y Transporte Neonatal, Sociedad Española de Neonatología 1

a Servicio de Neonatología, Hospital Universitari Vall d’Hebron, Comisión de Transporte Neonatal, Barcelona, Spain

b Servicio de Neonatología, Hospital Universitari Vall d’Hebron, Comisión de Estándares, Barcelona, Spain

c Servicio de Neonatología, Hospital Universitario La Paz, Comisión de Transporte Neonatal, Madrid, Spain

d Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Comisión de Estándares, Valencia, Spain

e Hospital Universitario Marqués de Valdecilla, Departamento de Ciencias Médicas y Quirúrgicas Universidad de Cantabria, Comisión de Transporte Neonatal, Santander, Spain

f Servicio de Neonatología, Hospital Clínico Universitario de Santiago, IDIS, Universidad de Santiago de Compostela, Comisión de Estándares, Santiago de Compostela, Spain

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            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Electrocardiogram recorded in the PICU at 24&#8239;h from admission&#46; Narrow complex bradycardia with suspected high-grade atrioventricular block with 2&#58;1 conduction&#46; Blocked P waves &#8220;buried&#8221; in the T wave of the preceding heartbeat are difficult to discern&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;B&#41; Electrocardiogram with oesophageal probe &#40;lead V1&#41; recorded immediately following the one shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#46; Features consistent with high-grade 2&#58;1 atrioventricular &#40;AV&#41; block&#46; Atria &#40;arrows&#41; and ventricular activity seem dissociated&#44; as the AV interval changes from beat to beat&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Note&#58; Since neonatal oesophageal electrodes were not available&#44; we fitted an oesophageal lead as follows&#58; we inserted a gastric tube previously rinsed with physiological saline&#44; which served as the conductor&#44; and without entirely removing the guide wire we connected it to the ECG lead and to the monitor&#46; We slowly pulled the tube up towards the oesophagus while watching the ECG tracings to the point that atrial activity was detectable with the highest possible amplitude&#46; The oesophageal tracings allow observation of amplified atrial activity and to analyse it independently from the QRS complex&#46; This is very useful in the diagnosis of certain forms of supraventricular tachycardia or in case of conduction disorders when the AV conduction ratio is not clear in the surface ECG&#46;</p>"
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It is essential that the comprehensive and specialised care required by these patients is offered both before and during transport&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The specific training of the NT team and their experience in neonatal care must guarantee adequate care with the maximum safety for the patient&#44; achieving a decrease in perinatal morbidity and mortality&#44; optimising the use of neonatal intensive care unit &#40;NICU&#41; resources and increasing the satisfaction of parents&#44; families and health care professionals&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> An established and specific NT system is an essential resource in the development of the neonatal care system&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this document is to define the standards required in human and material resources to organise and manage the transport of critical NBs optimally and safely&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Organization of a neonatal transport system</span><p id="par0015" class="elsevierStylePara elsevierViewall">For NT to meet the efficacy&#44; efficiency and care quality objectives&#44; it is essential that the transport system be organised taking into account the particular needs of each autonomous community in terms of the number of transports of critical NBs and the complexity of neonatal units based on the levels of care offered&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The support of policymakers and the availability of resources are the elements that have the greatest impact in NT planning&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Coordination and communication</span><p id="par0020" class="elsevierStylePara elsevierViewall">Coordination and communication are essential for the proper functioning of the NT system&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Within the public health system&#44; emergency care coordinating teams play a key role&#44; managing the demands of SH and the transport to the RH through the following responsibilities<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0025" class="elsevierStylePara elsevierViewall">Coordinating health care services based on the emergency triage&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0030" class="elsevierStylePara elsevierViewall">Having up-to-date information on the capacity and available services for each facility&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0035" class="elsevierStylePara elsevierViewall">Obtain and transfer patient medical records&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4</span><p id="par0040" class="elsevierStylePara elsevierViewall">Establish protocols for the classification of the critical NB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5</span><p id="par0045" class="elsevierStylePara elsevierViewall">Establish NT pathways based on this classification&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6</span><p id="par0050" class="elsevierStylePara elsevierViewall">Guaranteeing availability of beds at the RH&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7</span><p id="par0055" class="elsevierStylePara elsevierViewall">Allocating&#44; managing and optimising human and material resources&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8</span><p id="par0060" class="elsevierStylePara elsevierViewall">Facilitate communication between the parties involved in NT to reduce transport times&#46;</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Types of neonatal transport</span><p id="par0065" class="elsevierStylePara elsevierViewall">The main indication for NT involves the impossibility of managing the disorder manifesting in certain infants at the SH based on complexity and diagnostic and therapeutic needs&#44; for instance&#44; the need of surgical intervention&#44; high-frequency oscillatory ventilation or extracorporeal membrane oxygenation &#40;ECMO&#41;&#46; Thus&#44; there are different types of NT based on the details of the transport&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Intrauterine transport&#58;</span> transport of a pregnant woman from one labour and delivery unit to another one of higher complexity that can offer the mother or neonate the care they require or due to maternal and&#47;or foetal compromise&#46; Prenatal diagnosis and correct planning of the birth in the right facility allows perinatal transport under the best possible conditions&#46; Intrauterine transport is the gold standard for mothers and infants whenever possible and has been proven to reduce perinatal morbidity and mortality compared to postnatal transport&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Some of the aspects that need to be considered in deciding the timing of transport are the risk of imminent birth&#44; the obstetric history&#44; potential complications during transport&#44; correct planning of delivery in a facility with the appropriate level of care for the circumstances&#44; the distance between the hospitals and the availability of beds in the RH<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; There are tools available to facilitate decision-making&#44; such as the Malinas score&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> which assesses the stage of labour and cervical dilation to estimate the risk of imminent birth&#44; or the foetal fibronectin test&#44; which combined with the cervical length allows estimating the risk of preterm birth within 7 days&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> While the different tools can be useful&#44; there is no prevailing preference for any of them&#46; At presence&#44; one of the key interventions available is the education of pregnant women on how to identify the early signs and symptoms of preterm birth&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Neonatal transport&#58;</span> optimal NT depends on the correct classification of neonatal units by level of care and the regional organization of health care systems&#46; Thus&#44; the sending or receiving role of each hospital is clearly defined based on their capacity and services&#46; Many newborn infants are transported from one hospital to another during the &#8220;golden hours&#8221; that are key in neonatal morbidity and mortality and therefore require particularly rigorous care&#46; The outcomes of extremely preterm NBs are poorer in those transported in the first 48&#160;h post birth compared to those delivered in tertiary care hospitals&#44; so it is recommended that efforts be made to ensure delivery of these infants in a setting offering tertiary neonatal care&#44; considering prenatal over postnatal transport a priority as long as it is safe&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">It is of vital importance that NT be organised&#44; planned and executed by appropriately trained staff equipped with the necessary resources&#46; Current technology and knowledge allow for an increasing number of urgent interventions&#44; such as nitric oxide&#44; hypothermia or even ECMO&#44; to be implemented during transport&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarises the main indications for neonatal transfer&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Return transport&#58;</span> from the facility where intensive care was delivered to the SH or the hospital closest to the family home once the condition that motivated the transfer to or delivery in the RH&#46; It allows optimising the availability of beds in different care settings&#44; regrouping families so they can be closer to the hospitalised children&#44; promoting the interpersonal relationship between professionals and reducing health care costs&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Family and transport</span><p id="par0095" class="elsevierStylePara elsevierViewall">The transport of a highly vulnerable patient&#44; such as a critical NB&#44; is a negative and stressful experience for families that may interfere with bonding and hinder participation of parents in infant caregiving activities&#46; To minimise these negative repercussions&#44; providers must inform parents about every aspect related to the transport of their child and&#44; in adherence with European guidelines&#44; at least one of the parents should be allowed to accompany the infant during transport&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is also important to ensure accurate identification of the patient before proceeding with the transfer&#46; Sending hospitals should have a protocol developed in cooperation with the department of obstetrics to facilitate the transfer of mothers that could not be transported with their infants&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Human resources and skills of the neonatal transport team</span><p id="par0100" class="elsevierStylePara elsevierViewall">Ideally&#44; the NT team will include a paediatrician specialised in neonatology&#44; paediatric nursing staff and an emergency medical technician &#40;EMT-driver or pilot&#41;&#46; The entire team must be knowledgeable of the most frequent neonatal problems&#44; be trained in transport and basic and advanced life support &#40;neonatal and paediatric&#41; and support teamwork and leadership&#46; The competence of transport team members in these areas will contribute to the optimal outcome of transport &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The required competencies include&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">1</span><p id="par0105" class="elsevierStylePara elsevierViewall">Theoretical knowledge and clinical skills<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;9&#8211;13</span></a></p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">2</span><p id="par0110" class="elsevierStylePara elsevierViewall">Technical skills<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;9&#8211;12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">3</span><p id="par0115" class="elsevierStylePara elsevierViewall">Communication and social skills<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;9</span></a></p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">4</span><p id="par0120" class="elsevierStylePara elsevierViewall">Skills related to the means of transport<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">5</span><p id="par0125" class="elsevierStylePara elsevierViewall">Continuing education&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10&#44;12&#44;15</span></a></p></li></ul></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Medical and nursing staff</span><p id="par0130" class="elsevierStylePara elsevierViewall">Expertise in transport is acquired naturally if the staff is actively and regularly involved in specialised transport teams and in neonatal and paediatric intensive and emergency care units&#46; The connection to these units is essential to maintain the necessary clinical and technical skills to carry out NT&#46; During transport&#44; health care decisions ultimately rest with the physician&#46; The tasks are allocated to different members of the staff&#44; but there are some tasks that any of the team members should be able to perform in a critical juncture&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Emergency medical technician</span><p id="par0135" class="elsevierStylePara elsevierViewall">The duties of EMT extend beyond the mere operation of the vehicle and include a series of tasks that are part of the team&#8217;s work&#46; The EMT plays an important role in ensuring the safety of the patient and all other riders &#40;transport team and family members&#41; and the maintenance of the transport unit and its equipment&#46; It has to adapt the handling of the vehicle to the characteristics of the patient so it has the least possible impact on the clinical condition of the infant&#46; The participation of EMTs in health care and educational activities allows contemplating a future in which specialization would be accredited&#44; and we advocate for the establishment of the role of paediatric EMT&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Material resources for neonatal transport</span><p id="par0140" class="elsevierStylePara elsevierViewall">Whether transport is urgent or scheduled&#44; the vehicle and equipment must fulfil the requirements of a mobile intensive care unit for the effective transfer of newborn infants of varying maturity and requiring different levels of care and interventions&#46; Interchangeability and interoperability in different settings and scenarios using different transport vehicles must be ensured&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> summarises the material resources that are recommended for NT&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;16&#44;17</span></a><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">a</span><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Transport vehicles&#58;</span><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> compares the different types of transport vehicles&#46;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">1</span><p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Ground transport&#58;</span> availability of a vehicle exclusively dedicated to NT is recommended&#44; along with specific maintenance and cleaning protocols&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">2</span><p id="par0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Air transport&#58;</span> an air ambulance is an aircraft designed&#44; equipped and dedicated to the transport of patients that may require medical care in transit&#44; such as ambulance service airplanes or helicopters&#46; The vehicle triage should be based on the urgency of the condition &#40;considering time-dependent outcomes&#41; and the transport distance and duration&#46; When the isochrone map &#40;showing the time required to travel from a certain point to a certain hospital&#41; shows a time greater than 1&#160;h or the distance exceeds 150&#160;km&#44; use of a helicopter is recommended&#44; and in case of longer travel&#44; use of an airplane&#44; taking into account the available resources and the experience of the transport team&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Air transport involves greater specialisation of the staff and is subject to limitations based on geography&#44; weather conditions and night travel that are not standardised across Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Health care devices and products must function safely under local temperature and humidity conditions&#44; the vibration and shock caused by movement of the air ambulance&#44; air pressure variations and electromagnetic interference as established in the UNE EN 13718-1&#58;2014 and EN 13718-2&#58;2015 standards&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a></p></li></ul></p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">b</span><p id="par0160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Transport incubator system &#40;TIS&#41;</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></li></ul></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">The TIS is comprised of a portable incubator combined with the rest of the equipment&#46; It is important to control its weight and bulk to ensure the safety of vehicle occupants&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> The total mass of the system should not exceed 140&#160;kg and should not affect the stability or manoeuvrability of the ambulance&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">To ensure the power supply&#44; the total usage of the TIS should not exceed 1200&#160;W connected to a 230&#160;V alternating current source&#44; 720&#160;W connected to a 24&#160;V direct current &#40;DC&#41; source or 360&#160;W connected to a 12&#160;V DC source&#46; The incubator must have a rechargeable battery serving as a portable power supply capable of maintaining the temperature for at least 90&#160;min&#46; The TIS must be equipped with oxygen and medical gas&#44; and it is essential to calculate the necessary supply of gases for transport&#44; especially when covering long distances &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; All the components must be safely secured so they cannot move during transit&#44; in adherence with the EN 1789&#58;2007 &#43; A2&#58;2014 standards for ground ambulances and the EN 13718-1&#58;2014 and EN 13718-2&#58;2015 standards for air ambulances&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">The requirements for TISs in regards to suspension&#47;shock absorption&#44; temperature conditions&#44; vibration&#44; mechanical integrity&#44; electromagnetic compatibility&#44; mass&#44; electricity&#44; fixation of component parts and interface conditions during incubator transport are established in the UNE-EN 13976-1&#58;2018<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> and EN 13976-2&#58;2018 standards&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> No system is completely effective in attenuating mechanical vibration&#44; and gel mattresses in incubators are only partially effective in reducing its transmission&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Caution must be exerted to avoid obstructing air inlets and vent holes with blankets&#44; which can cause an increase in temperature above safe levels&#46; The noise level inside the incubator should not exceed 60&#160;dB during regular use or 80&#160;dB when an alarm is sounding&#46; Use ear defenders is recommended in every transport&#44; although these devices only reduce noise by a maximum of 7&#160;dB&#46; New systems for NT must be develop that reduce noise exposure&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Exposure to the highest intensity of light occurs during vehicle loading and unloading&#46; This exposure should be minimised or prevented using eye covers&#44; light-reducing cot covers or tinting of the transport cot to reduce the illuminance without compromising the ability to observe the neonate during transport&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pretransport stabilization</span><p id="par0180" class="elsevierStylePara elsevierViewall">Transport causes noise&#44; vibration&#44; acceleration and deceleration forces and temperature fluctuations in addition to detracting from the quality of care due to limited space and restricted mobility&#46; The transport team must stabilise the infant before transport to be able to face a risk situation that will be compounded by the effects of transport under the best possible conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Leaving aside the available equipment and technology&#44; the guiding principles of neonatal care are improving safety through the standardization of procedures and eradicating preventable adverse events&#44; which entails controlling body temperature&#44; securing the airway and ventilatory support&#44; placement of catheters for intravenous access and drainage&#44; haemodynamic stabilization with maintenance of glucose levels in the normal rage and family support &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The stabilization of the critical NB must adhere to the ABCDE protocol and the staff should be constantly re-evaluating the support and care provided to the infant&#46; The breathing of the patient should be evaluated to determine whether it is possible to transport the infant under noninvasive ventilation applying appropriate selection criteria<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#59; administration of surfactant and&#47;or inhaled nitric oxide or placement of a chest tube may be necessary before transport&#46; If available&#44; high-frequency oscillatory ventilation may be indicated for stabilization of the most critically ill infants&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">Providers must be acquainted with the ventilator and the selected modality of support and should be capable of making adjustments as required by environmental and clinical changes during transport&#46; The difficulty of assessing chest wall motion and performing lung auscultation during transport due to mechanical vibration and background noise must be taken into account&#46; Adequate stocking of batteries and gas canisters is important to ensure the supply of power and medical gases during transfers and ambulance transport&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> The use of checklists during intubation and other procedures can shorten the execution time and improve success rates&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Depending on the timing and means of transport&#44; there may be important fluctuations in body temperature&#46; In the case of transported NBs with hypoxic-ischaemic encephalopathy&#44; active hypothermia is key to achieve the target temperature on arrival to the RH and minimises the risk of overcooling compared to passive hypothermia&#46; Portable devices to monitor brain function may allow assessment of the patient during stabilization in units lacking equipment&#44; although they cannot be used to monitor the patient and consider changes in management during transport due to vibration artifacts&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">The concept of time-dependent outcome is relevant in NBs requiring immediate surgical intervention or urgent advanced life support that can only be provided in an intensive care setting&#46; An ongoing re-evaluation of the care plan&#44; the anticipation of complications&#44; technical skills and care team cohesiveness are key factors in the successful stabilization of the patient&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Neonatal transport and COVID-19</span><p id="par0205" class="elsevierStylePara elsevierViewall">Despite the apparent rarity of vertical transmission of SARS-CoV-2&#44; the transport group of the Societ&#224; Italiana di Neonatologia recommends approaching each possible case as confirmed&#44; even if the SH defines it as suspected&#46; The only additional equipment required is personal protective equipment&#44; although fitting specific filters in the valves of the ventilator&#46; The partition between the cab and the patient compartment should be kept closed&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">The European Society of Paediatric and Neonatal Intensive Care &#40;ESPNIC&#41; has recommended handling incubator transports as if they were open stretcher transports as regards the use of personal protective equipment&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#44;32</span></a> It also recommended placing the NB in a suitably sized plastic bag to reduce the need for heating or humidification as well using port hole covers to minimise air leaks&#46; Although it is not aligned with the principles of family-centred care&#44; transporting infants without the parents&#44; whether symptomatic or not&#44; is also recommended to protect the transport team&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusions</span><p id="par0215" class="elsevierStylePara elsevierViewall">The first hours of life of an ill or preterm newborn infant are crucial to the outcome of the patient&#44; and therefore delivery should take place in a hospital with the necessary resources to manage the corresponding level of complexity&#46; When this is not the case&#44; the neonate must be provided with optimal&#44; professional transport to a facility that can offer the required care&#46; The training and coordination of the neonatal transport team and the resources at its disposal are key to guarantee transport under adequate conditions&#46; Each transport team must perform data collection and documentation of any incidents during transport to allow quality assessment and identification of opportunities for improvement in order to increase patient safety throughout the transport process&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">The first hours of life of a sick or premature newborn are crucial for its prognosis and therefore delivery should take place in a center prepared for that degree of complexity&#46; When this condition is not met&#44; the newborn must be transferred in an optimal and safe way to the center that can offer the necessary care&#46; The training&#44; staffing&#44; organization and coordination of the neonatal transport team are essential to guarantee a safe transfer&#46; Being aware of the interest and the advances that are currently taking place in this area of &#8203;&#8203;pediatrics&#44; the Standards Commission and the Neonatal Transport Commission of the Spanish Society of Neonatology have prepared this document&#46; In it&#44; both the provision of human and material resources necessary as well as the bases of clinical stabilization in transport to carry out the neonatal transfer in a safe way and proportionate to the needs of the critical newborn have been exhaustively reviewed and detailed&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Las primeras horas de vida de un reci&#233;n nacido enfermo o prematuro son cruciales para su pron&#243;stico y por lo tanto el parto deber&#237;a acontecer en un centro preparado para ese grado de complejidad&#46; Cuando no se cumple esta condici&#243;n&#44; el reci&#233;n nacido debe ser trasladado de un modo &#243;ptimo y seguro al centro que pueda ofrecerle los cuidados necesarios&#46; La formaci&#243;n&#44; dotaci&#243;n&#44; organizaci&#243;n y coordinaci&#243;n del equipo de transporte neonatal son indispensables para garantizar un traslado en condiciones&#46; Siendo conscientes del inter&#233;s y los avances que en la actualidad se est&#225;n produciendo en esta &#225;rea de la pediatr&#237;a&#44; la Comisi&#243;n de Est&#225;ndares y la Comisi&#243;n de Transporte Neonatal de la Sociedad Espa&#241;ola de Neonatolog&#237;a han elaborado el presente documento&#46; En &#233;l&#44; se ha revisado y detallado de forma exhaustiva tanto la dotaci&#243;n de recursos humanos y materiales necesarios como las bases de la estabilizaci&#243;n cl&#237;nica en transporte para llevar a cabo el traslado neonatal de forma segura y proporcionada a las necesidades del reci&#233;n nacido cr&#237;tico&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Jord&#225;n Lucas R&#44; Boix H&#44; S&#225;nchez Garc&#237;a L&#44; Cernada M&#44; de las Cuevas I&#44; Couce ML&#46; Recomendaciones sobre el perfil de competencias y est&#225;ndares del sistema de traslado neonatal en Espa&#241;a&#46; An Pediatr &#40;Barc&#41;&#46; 2021&#59;94&#58;420&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Appendix <a class="elsevierStyleCrossRef" href="#sec0070">A</a>lists the members of the Neonatal Transport Committee of the Sociedad Espa&#241;ola de Neonatolog&#237;a &#40;seNeo&#41; and the Standards Committee of the SENeo&#46;</p>"
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            "apendice" => "<p id="par0225" class="elsevierStylePara elsevierViewall">The members of the Neonatal Transport Committee of the Sociedad Espa&#241;ola de Neonatolog&#237;a &#40;SENeo&#41; are Olalla Rodr&#237;guez Losada&#44; Laura S&#225;nchez Garc&#237;a&#44; Teresa Esclap&#233;s Gim&#233;nez&#44; Rafael G&#243;mez Zafra&#44; Miguel &#193;ngel Cortajarena Altuna&#44; Marta Costa Romero&#44; Miguel &#193;ngel Garc&#237;a Cabezas&#44; Beatriz Curto Sim&#243;n&#44; Natalia Mandi&#225; Rodr&#237;guez&#44; F&#233;lix Morales Luengo&#44; Javier D&#237;ez-Delgado Rubio&#44; Marta Sard&#225; S&#225;nchez&#44; Luis P&#233;rez Baena&#44; Isabel Sanz Ruiz&#44; Isabel de las Cuevas Ter&#225;n and Raquel Jord&#225;n Lucas&#46;</p> <p id="par0230" class="elsevierStylePara elsevierViewall">The members of the Standards Committee of the SENeo are Mar&#237;a L&#46; Couce Pico&#44; H&#233;ctor Boix Alonso&#44; Mar&#237;a Cernada Bad&#237;a&#44; Mar&#237;a Gracia Espinosa Fern&#225;ndez&#44; Noelia Gonz&#225;lez Pacheco&#44; Alejandro P&#233;rez Mu&#241;uzuri&#44; M&#46; Dolores S&#225;nchez-Redondo S&#225;nchez-Gabriel and Ana Mart&#237;n Ancel&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Committee Members"
            "identificador" => "sec0070"
          ]
        ]
      ]
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transport incubator system fixed to the frame of the vehicle &#40;UNE-EN 13976-1&#41;&#46; Components of the transport incubator system &#40;TIS&#41;&#58; 1&#46;1&#58; incubator&#59; 1&#46;2&#58; syringe pump&#59; 1&#46;3&#58; ventilator&#59; 1&#46;4&#58; monitor&#46; Fixation system&#58; 2&#46;1&#58; track studs&#59; 2&#46;2&#58; track rails&#59; 3&#58; Interface to be used if track rails cannot be fixed directly to the stretcher system&#46; If the interface is to be attached to undercarriage&#44; original fixation points on the undercarriage should be used&#59; 4&#58; Stretcher system &#40;stretcher&#47;undercarriage&#47;stretcher support&#44; etc&#41;&#46;</p>"
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        "etiqueta" => "Figure 2"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Calculation of the medical gas supply needed in transport&#46; Formula A &#40;time in minutes of medical gas autonomy delivering a constant flow with a flowmeter&#41;&#46; Formula B &#40;time in minutes autonomy in patient connected to mechanical ventilation&#41;&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">FiO<span class="elsevierStyleInf">2</span>&#44; inspired fraction of oxygen&#59; IRV&#44; inspiratory reserve volume&#46;</p>"
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        "figura" => array:1 [
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pretransport stabilization&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ECG&#44; electrocardiogram&#59; EtCO<span class="elsevierStyleInf">2</span>&#44; end-tidal carbon dioxide&#59; ETT&#44; endotracheal tube&#59; GT&#44; gastric tube&#59; HR&#44; heart rate&#59; IBP&#44; invasive &#40;intra-arterial&#41; blood pressure&#59; IMV&#44; invasive mechanical ventilation&#59; IV&#44; intravenous&#59; NB&#44; newborn&#59; NIBP&#44; noninvasive blood pressure&#59; NIRS&#44; near infrared spectroscopy&#59; NIV&#44; noninvasive ventilation&#59; RR&#44; respiratory rate&#59; Rx&#44; X-ray&#59; SpO<span class="elsevierStyleInf">2</span>&#44; oxygen saturation&#59; temp&#44; temperature&#46;</p>"
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">HELLP&#44; haemolysis&#44; elevated liver enzymes&#44; low platelet count&#59; IUGR&#44; intrauterine growth restriction&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Adapted from Moreno et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p>"
          "tablatextoimagen" => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Contraindications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Risk of preterm birth before 32 weeks&#8217; gestation with or without premature rupture of membranes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Placental abruption&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multiple birth before 34 weeks&#8217; gestation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Significant bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe IUGR&#160;&#60;&#160;34 weeks&#8217; gestation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imminent birth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Congenital anomalies requiring immediate treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinical instability or maternal need of intensive care that can be delivered at the sending hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe blood type incompatibility&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nonreassuring foetal status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hydrops fetalis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cord prolapse or breech presentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polyhydramnios or severe oligoamnios&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe preeclampsia or HELLP syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prenatal diagnosis of metabolic disease requiring immediate management&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe maternal disease or complications of pregnancy &#40;heart disease&#44; insulin-dependent diabetes&#44; infection&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Main indications and contraindications of intrauterine transport to a tertiary care hospital&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
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            "identificador" => "at0025"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ECMO&#44; extracorporeal membrane oxygenation&#59; HFOV&#44; high frequency oscillatory ventilation&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Adapted from Moreno et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Preterm birth or low birth weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frequent episodes of apnoea or bradycardia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Congenital anomalies&#44; especially those that compromise the stability of the infant &#40;diaphragmatic hernia&#44; oesophageal atresia&#44; airway malformations&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate-severe respiratory distress that cannot be managed in sending hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe pulmonary hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Congenital heart defects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cardiovascular disorders &#40;cardiac arrest&#44; arrhythmia&#44; heart failure&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neurologic disorders &#40;moderate-severe perinatal asphyxia&#44; hypoxic-ischaemic encephalopathy&#44; neonatal seizures&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metabolic disorders &#40;persistent hypoglycaemia&#44; severe metabolic acidosis&#44; fluid and electrolyte disorders&#44; hydrops fetalis&#44; haemodynamically significant dehydration&#44; kidney failure&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infectious disease &#40;septic shock&#44; meningitis or encephalitis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gastrointestinal disorders &#40;intestinal obstruction&#44; necrotising enterocolitis&#44; acute abdomen&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Haematological disorders &#40;thrombocytopenia&#44; haemolytic disease&#44; acute neonatal anaemia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neonatal surgical disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Any condition or disease requiring intensive care or complex treatment that is not available in the sending hospital &#40;peritoneal dialysis&#44; ventricular&#44; chest or abdominal drainage&#44; ECMO&#44; pericardiocentesis&#44; total or partial exchange transfusion&#44; veno-venous haemofiltration&#44; HFOV&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insidious neonatal disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lack of beds in sending hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Main indications for neonatal transfer&#46;</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ABB&#44; acid-base balance&#59; ALS&#44; advanced life support&#59; BLS&#44; basic life support&#59; CA&#44; cardiac arrest&#59; CPR&#44; cardiopulmonary resuscitation&#59; CRM&#44; crew resource management&#59; CVP&#44; central venous pressure&#59; EMT&#44; emergency medical technician&#59; ETT&#44; endotracheal tube&#59; HFOV&#44; high frequency oscillatory ventilation&#59; HR&#44; heart rate&#59; IBP&#44; invasive blood pressure&#59; IMV&#44; invasive mechanical ventilation&#59; iNO&#44; inhaled nitric oxide&#59; MECC&#44; Medical Emergency Coordination Centre&#59; NB&#44; newborn&#59; NIBP&#44; noninvasive blood pressure&#59; NICU&#44; neonatal intensive care unit&#59; NIV&#44; noninvasive ventilation&#59; OI&#44; oxygenation index&#59; RH&#44; receiving hospital&#59; RR&#44; respiratory rate&#59; SH&#44; sending hospital&#59; SpO<span class="elsevierStyleInf">2</span>&#44; oxygen saturation&#59; Temp&#44; temperature&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Physician&#47;paediatrician&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nursing staff&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Emergency medical technician&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="11" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Theoretical knowledge and practical skills</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Knowledge of the foundations and essential components of teamwork</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Knowledge of the stages of neonatal transport and their particularities</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Knowledge of available electronic medical devices&#44; their setup and use</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Recording and analysis of quality indicators to improve outcomes and ensure a high-quality transport system</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Knowledge of neonatal pathophysiology and the following in particular&#58;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Basic neonatal diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Disease severity scores &#40;Apgar&#44; Silverman&#44; Sarnat&#44; etc&#41; and normal vital signs for gestational age</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Techniques to handle vehicle under adverse conditions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Clinical signs of respiratory&#44; haemodynamic and neurologic impairment</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neonatal basic life support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Diagnosis and treatment of the most frequent neonatal diseases&#44; including those in preterm infants</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Identification of equipment and drugs for advanced life support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Pain assessment scale&#44; nonpharmacological and pharmacological analgesia and sedation</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vehicle maintenance and equipment maintenance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Developmental care approach</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Calculation of required medical gas supply&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Communication between intervention setting and MECC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="19" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Technical skills</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Respiratory monitoring &#40;pulse oximetry&#44; capnography and ABB&#41; and haemodynamic monitoring &#40;HR&#44; RR&#44; ECG&#44; NIBP&#44; IBP&#44; CVP&#44; preductal and postductal SpO<span class="elsevierStyleInf">2</span>&#44; OI&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methods to control body temp&#46; Eligibility criteria and performance of therapeutic hypothermia</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In regards to the specific supplies&#47;equipment used in transport&#44; knowledge of&#58;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Operating incubators&#44; ventilators&#44; monitors&#44; infusion pumps and child restraint systems &#40;harness&#44; support pillow</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Most frequent serious complications that may occur during transport &#40;extubation&#44; loss of IV access&#44; CA&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transferring patients to&#47;from different health care vehicles and in hospital</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Keeping inventory and restocking supplies to ensure availability</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; <span class="elsevierStyleItalic">Respiratory&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; <span class="elsevierStyleItalic">Respiratory&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Adapt vehicle operation to patient condition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Securing airway&#58; intubation &#40;including very preterm NBs&#41;&#44; management of difficult airway &#40;laryngeal mask airway&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Help with intubation&#44; surfactant administration&#44; management of NIV and interfaces&#44; IMV or HFOT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Deliver BLS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-Neonatal IMV&#47;HFOT and NIV and interfaces&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Use of iNO in ventilation systems&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Help medical and nursing staff deliver ALS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Use of iNO in ventilation systems&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Help with insertion and maintenance of pleural drainage line and suction devices&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Verify basic functioning of medical equipment and auxiliary systems in the transport vehicle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Thoracocentesis and pleural drainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46; Haemodynamic&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Assembly and setup of electronic medical devices &#40;ventilator&#44; iNO&#44; monitors&#44; infusion pumps etc&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Surfactant administration techniques&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Establishment of vascular access&#58; peripheral venous&#44; umbilical&#44; peripheral central venous access&#44; arterial&#44; intraosseous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Maintain vehicle and equipment in good working order&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46; <span class="elsevierStyleItalic">Haemodynamic&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Help establish central vascular access&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Establishment of vascular access&#58; umbilical &#40;venous or arterial&#41;&#44; central &#40;femoral&#44; jugular&#41;&#44; arterial&#44; intraosseous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Interpretation of paediatric arrhythmias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Emergency pericardiocentesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Drug dilution and administration&#44; drug interactions and use of infusion pumps&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Diagnosis and treatment of paediatric arrhythmias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46; <span class="elsevierStyleItalic">Point-of-care ultrasound&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Use of ultrasound to guide catheter insertion&#44; assess lungs&#44; heart and brain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Communication and interpersonal skills</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ability of professionals to coordinate actions under stressful circumstances&#58; decision-making&#46; Fluid and collaborative communication between SH&#44; RH&#44; MECC and transport team</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Effective teamwork&#58; task allocation&#44; constant communication</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Management of NONMEDICAL incidents during transport</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Provision of family-centred care&#58; adequate communication&#44; explaining the situation and procedures to be performed&#46; Facilitate parents accompanying the NB</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Document interventions during transport &#40;neonatal transport form&#41; and facilitate transfer of information between SH and RH &#40;physical and verbal transfer&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="9" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Competencies related to means of transport</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Identification of &#8220;time-dependent&#8221; diseases&#58; adequate assessment of &#8220;time&#8221; as a necessary resource in patient stabilization and transport based on the presenting problem&#44; treatment and transport conditions</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ability to work in small and noisy environments with limited resources</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anticipation and prevention&#58;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Incidents and complications derived from moving the patient</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Most frequent adverse events involving the airway&#44; ventilation and haemodynamic support during transport &#40;fixation of ETT&#44; drains&#44; vascular access lines etc&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Equipment-related complications&#58; ventilators&#44; infusion pumps&#44; monitors&#44; incubators&#44; other</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Knowledge of the effects of transport on the patient&#8217;s condition &#40;acceleration and deceleration&#44; effect of altitude on air density and oxygenation&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Appropriate prioritization and performance of procedures to guarantee the safety of the patient and crew</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Knowledge of safety measures in transport vehicles &#40;ground&#47;air&#41;&#44; roads&#44; airports&#44; heliports and helipads</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="6" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Training</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Training or rotation in a transport unit and NICU</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Specific training and continuing education in neonatology and neonatal transport&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Regular refresher training in&#58;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Regular refresher training in&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Neonatal ALS</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Neonatal BLS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; IMV and NIV during transport</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Safety in health care transport&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Safety in health care transport</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Continuing education with high-fidelity simulation and crisis management during transport &#40;CRM&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Continuing education with high-fidelity simulation and crisis management during transport &#40;CRM&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Human resources and competencies in neonatal transport&#46;</p>"
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      6 => array:8 [
        "identificador" => "tbl0020"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CPR&#44; cardiopulmonary resuscitation&#59; ECG&#44; electrocardiogram&#59; EtCO<span class="elsevierStyleInf">2</span>&#44; capnography&#59; ETT&#44; endotracheal tube&#59; HR&#44; heart rate&#59; IBP&#44; invasive blood pressure&#59; iNO&#44; inhaled nitric oxide&#59; NB&#44; newborn&#59; NIBP&#44; noninvasive blood pressure&#59; RR&#44; respiratory rate&#59; PEEP&#44; positive end-expiratory pressure&#59; PtCO<span class="elsevierStyleInf">2</span>&#44; transcutaneous carbon dioxide pressure&#59; SpO<span class="elsevierStyleInf">2</span>&#44; oxygen saturation&#59; temp&#44; temperature&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Jourdain et al&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Lee et al&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> British Columbia Transfer Record&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p>"
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Transport incubator with a cabinet for the NB&#44; with a certified fixation system and clear sections that allow observation of the infant and provide a safe&#44; protected and temperature-controlled environment&#46; It must allow medical intervention in transit&#46; It must meet the basic safety and function standards established by the UNE-EN 60601-2-20&#58;2010&#44; 2018 revision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Vital signs monitor including at minimum the HR&#44; RR&#44; ECG&#44; NIBP&#44; IBP&#44; CVP&#44; SpO<span class="elsevierStyleInf">2</span> and body temperature&#46; Point-of-care blood testing and glucose meter&#46; Point monitoring of EtCO<span class="elsevierStyleInf">2</span> &#40;verification of ETT placement after intubation and in CPR&#41; and PtCO<span class="elsevierStyleInf">2</span> are desirable&#46; Visual alarms are preferable over audio alarms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Disposable supplies for vascular access and intravenous infusion&#44; necessary drugs and fluids&#46; Large volume pumps and continuous infusion pumps&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Refrigerator for drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Supplies for enteral nutrition&#46; Human milk storage system&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Supplies for airway management&#46; Neonatal self-inflating bag with PEEP valve&#46; Portable suction system&#46; Transport ventilator with assist-control mode&#46; Humidifier&#46; Noninvasive ventilatory support&#46; If available&#44; high-frequency oscillatory ventilation and high-flow oxygen therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Portable oxygen&#44; medical air and iNO canisters with quick connect adapters&#44; sufficient supply to cover double the longest expected duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Supplies for CPR&#44; defibrillator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Urinary drainage system&#44; catheters and bags&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Servo-controlled active cooling system&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Point-of-care ultrasound system&#58; desirable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; System to load and unload the incubator without lifting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Light for diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Seats for at least 3 providers&#47;family members&#46; At least 450 mm distance between seats and incubator to allow easy access to the NB&#46; A certified restraint system must be used for the safety of the patient and the crew&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Dependable power supply to power medical equipment in the vehicle without using the battery of the incubator&#46; The electric system must be designed so that the vehicle will not use the power of the transport incubator or its interface system&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Communication systems for communication between the medical team and vehicle operators and between the medical team and the unit&#8217;s base location&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Equipment and supplies for neonatal transport&#46;</p>"
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      7 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0040"
            "detalle" => "Table "
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Road ambulance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rotary aircraft &#40;helicopter&#41; ambulance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fixed wing aircraft &#40;plane&#41; ambulance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transport distance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Short&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Long&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Very long &#40;between autonomous communities and international&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time to departure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excellent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excellent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poor to acceptable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time to arrival&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acceptable to poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excellent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transport duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excellent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acceptable to excellent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Access to patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poor &#40;limited space&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acceptable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Meteorological aspects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excellent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weather restrictions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acceptable to good &#40;flight over bad weather&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deleterious effects of travel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infrequent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increased noise and vibration Effect of altitude on patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Decreased impact of altitude &#40;cabin pressurization&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maintenance cost&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "etiqueta" => "Table 6"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">ABB&#44; acid-base balance&#59; BE&#44; base excess&#59; CPAP&#44; continuous positive airway pressure&#59; ECG&#44; electrocardiogram&#59; EtCO<span class="elsevierStyleInf">2</span>&#44; end-tidal carbon dioxide&#59; FiO<span class="elsevierStyleInf">2</span>&#44; fraction of inspired oxygen&#59; HFNC&#44; high flow nasal cannula&#59; HFOT&#44; high-flow oxygen therapy&#59; HR&#44; heart rate&#59; IBP&#44; invasive &#40;intra-arterial&#41; blood pressure&#59; iNO&#44; inhaled nitric oxide&#59; MAP&#44; mean airway pressure&#59; NIBP&#44; noninvasive blood pressure&#59; NIPPV&#44; nasal intermittent positive pressure ventilation&#59; NIV&#44; noninvasive ventilation&#59; PaCO<span class="elsevierStyleInf">2</span>&#44; partial pressure of carbon dioxide&#59; PEEP&#44; positive end-expiratory pressure&#59; PIP&#44; peak inspiratory pressure&#59; PtcO<span class="elsevierStyleInf">2</span> transcutaneous oximetry&#59; RR&#44; respiratory rate&#59; SpO<span class="elsevierStyleInf">2</span>&#44; peripheral oxygen saturation&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Adapted from Null et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p>"
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Inclusion criteria</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Respiratory distress or chronic pulmonary disease</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Stable with NIV&#160;&#62;</span>&#160;2&#160;h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Chest radiograph for adequate lung expansion</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">FiO<span class="elsevierStyleInf">2</span> &#60; 0&#46;5 or decreasing and PaCO<span class="elsevierStyleInf">2</span> &#60; 60&#160;mmHg and stable</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">pH &#62; 7&#46;3 and table</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Transport team comfortable with patient status</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Exclusion criteria</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pulmonary hypertension unresponsive to iNO</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Poor lung expansion on upper levels of NIV support</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HFOT &#8805; 6 Lpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CPAP &#8805; 8 cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NIPPV with RR&#160;&#8805;&#160;20 bpm or PIP&#160;&#8805;&#160;20 cmH<span class="elsevierStyleInf">2</span>O or PEEP&#160;&#8805;&#160;7 cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HFNC with MAP&#160;&#8805;&#160;8 cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Persistent apnoea</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sepsis with poor cardiac output</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Surgical problems&#58; diaphragmatic hernia&#44; trachea-oesophageal fistula&#44; intestinal obstruction&#44; necrotising enterocolitis&#44; gastroschisis&#44; omphalocele</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Significant acidosis&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Respiratory&#58; pH&#160;&#60;&#160;7&#46;25 or PaCO<span class="elsevierStyleInf">2</span> &#62; 60&#160;mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Metabolic&#58; pH&#160;&#60;&#160;7&#46;20 and BE&#160;&#62;&#160;10 mEq&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Transport team uncomfortable moving patient on NIV</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Pretransport assessment</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Breath sounds&#44; RR&#44; depth of respiration&#44; retractions</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Positions of palpable edge of liver at right costal margin</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Recovery of SpO<span class="elsevierStyleInf">2</span> after brief loss of NIV support</span>&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2021.02.006

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Year/Month	Html	Pdf	Total

2024 October	42	49	91
2024 September	55	42	97
2024 August	78	62	140
2024 July	53	41	94
2024 June	66	24	90
2024 May	47	39	86
2024 April	44	37	81
2024 March	46	37	83
2024 February	86	42	128
2024 January	35	41	76
2023 December	35	48	83
2023 November	31	68	99
2023 October	33	44	77
2023 September	31	44	75
2023 August	29	41	70
2023 July	46	47	93
2023 June	33	44	77
2023 May	64	43	107
2023 April	50	29	79
2023 March	82	51	133
2023 February	55	30	85
2023 January	42	31	73
2022 December	87	49	136
2022 November	76	53	129
2022 October	96	72	168
2022 September	51	45	96
2022 August	57	60	117
2022 July	77	55	132
2022 June	45	46	91
2022 May	60	80	140
2022 April	74	64	138
2022 March	67	88	155
2022 February	87	73	160
2022 January	79	68	147
2021 December	77	66	143
2021 November	66	40	106
2021 October	92	83	175
2021 September	85	78	163
2021 August	74	60	134
2021 July	84	52	136
2021 June	127	121	248
2021 May	42	19	61

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