Neonatal Transport: Current Trends and Practices

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Key points

  • Program accreditation-transport programs are beginning to embrace the concept of accreditation to assure competency and compliance with transport standards and explore avenues for accreditation.

  • Transport team training simulation-based training that addresses clinical competence for low-volume high-risk procedures in conjunction with leadership and communication skills minimizes adverse event occurrences.

  • The ability to provide active versus passive cooling for transported neonates with HIE

Introduction and the necessity and process of neonatal transport

The transport of newborns has been a necessity for many decades when it became clinically apparent that not all hospitals could provide the level of care required by a premature or critically ill neonate. Derived from the Latin words of portare, meaning to carry and trans, meaning across, the transportation of neonates at risk for morbidities and mortality took hold.1 This realization of the need existed even before the advent of modern-day neonatal intensive care units (NICUs). Despite best

History/current statistics

In the United States, there are 68,979 neonates transported annually or approximately 188 transports undertaken daily.6 Admission rates to NICUs have been increasing related to overall population growth in the United States. Prior to the twentieth century, most births occurred in the home, with neonatal morbidity or mortality a relatively common occurrence given the novel status of neonatal medicine at that time.1, 2 The fundamental desire to provide for the care of premature and critically ill

Accreditation requirements

Regulations governing transport have been sparse historically but continue to evolve, and when enacted, impact neonatal transport delivery on a national and/or state level. Risks need to be considered and managed effectively to ensure the safety of all involved. All neonatal team members need to be knowledgeable of alterations in neonatal physiology that occur during ambulance or helicopter transport of a critically ill neonate related to weather conditions, temperature extremes, equipment

Simulation-based training/skills assessment

As neonatal transport became a professionally acknowledged subspecialty, the most effective manner in which to train the transport team personnel was debated among educators and clinicians. Given that transport team composition varies in the United States and each provider is functioning within his or her individual scope of practice, the educational process is challenging. In 2011, Karlsen completed a national survey of neonatal transport teams in the United States and found that 44.3% of

Evolving transport therapies/active cooling for neuroprotective hypothermia

Perinatal hypoxic ischemic encephalopathy (HIE) can lead to severe neurodevelopmental outcome and death. In the early to mid-2000s, studies were conducted to evaluate the neuroprotective efficacy of hypothermia for the treatment of HIE. The studies involved 2 types of therapies: whole-body cooling or selective head cooling.18 As the studies progressed and positive outcomes were demonstrated for neonates undergoing neuroprotective hypothermia, this therapy became standard of care. However, the

Evolving transport therapies/high-frequency ventilation

High-frequency ventilation (HFV) has been integrated into neonatal care for essentially 2 plus decades. The use of HFV in the transport environment was limited until commercially manufactured transport ventilators became available. For clinical situations such as respiratory failure, significant air leak syndrome, and failure of conventional mechanical ventilation (CMV), the use of HFV can facilitate a more optimal transport for the neonate.21 This is the case if neonates in level 3 centers

Quality metrics

Neonatal transport is recognized as a high-risk activity with considerable threat of adverse events because of its inherent dynamic nature. Committing the proper resources and personnel in conjunction with tracking outcome metrics cannot be overemphasized. Ratnavel indicates that national bench marking as an evaluative component is essential to follow trends in patient acuity and measures the ability to comply with predesignated service standards.3 Despite the sheer number of neonates

Summary/future of transport

Tremendous advances have taken place since the inception of an organized neonatal transport program in the 1940s to present day. From rudimentary incubators/isolettes to high-frequency ventilators and commercially available active cooling systems, the NICU is becoming more mobile in every sense of the word. The fundamentals of neonatal care have remained constant: temperature control, airway and respiratory management, glucose and blood pressure homeostasis, and support of the family,

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References (24)

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    Disclosure: The author has nothing to disclose.

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