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Transport of the Sick Infant

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Emerging Topics and Controversies in Neonatology
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Abstract

The centralisation of neonatal care worldwide has necessitated the development of neonatal transport. This is evolving as a subspecialty in its own right with implications for education and governance. The goal is to ensure that the right babies are cared for in the right place at the right time and moved safely with the right team by the right mode of transport. This chapter describes the risks of transport and use of technology and service design strategies that may mitigate these.

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References

  1. Gale C, Santhakumaran N, Statnikov M. Impact of manages clinical networks on NHS specialist neonatal services in England: a population based study. BMJ. 2012;344:e2105.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Orr RA, Felmet KA, Han Y, et al. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics. 2009;124:40–8.

    Article  PubMed  Google Scholar 

  3. Bowman E, Doyle LW, Murton LJ. Increased mortality of preterm infants transferred between tertiary perinatal centres. BMJ. 1988;297(6656):1098–100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Harding JE, Morton SM. Adverse effects of neonatal transport between level 3 centres. J Pediatr Child Health. 1993;29:146–9.

    Article  CAS  Google Scholar 

  5. Harding JE, Morton SM. Outcome of neonates transported between level 3 centres depends upon centre of care. J Pediatr Child Health. 1994;30:389–92.

    Article  CAS  Google Scholar 

  6. Mohamed MA, Aly H. Transport of premature infants is associated with increased risk for intraventricular haemorrhage. Arch Dis Child Fetal Neonatal Ed. 2010;95(6):F403–7.

    Article  PubMed  Google Scholar 

  7. Marlow N, Bennett C, Draper E. Perinatal outcomes for extremely preterm babies in relation to place of birth in England: the EPICure 2 study. Arch Dis Child Fetal Neonatal Ed. 2014;99:F181–8.

    Article  CAS  PubMed  Google Scholar 

  8. Silverman WA, Fertig JW, Berger AP. The influence of the thermal environment upon the survival of the newly born premature infant. Pediatrics. 1958;22:876–86. 13600915.

    CAS  PubMed  Google Scholar 

  9. Leslie A, Stephenson TJ. Audit of neonatal intensive care transport. Arch Dis Child. 1994;71:F61–6.

    Article  CAS  Google Scholar 

  10. Bartels DB, Kreienbrock L, Dammann O, et al. Population based study on the outcome of small for gestational age newborns. Arch Dis Child Fetal Neonatal Ed. 2005;90:F53–9. 15613577.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Fassassi M, Michel F, Thomachot L, et al. Airway humidification with heat and moisture exchanger in mechanically ventilated neonates. Intensive Care Med. 2007;33:336–43. 17165022.

    Article  PubMed  Google Scholar 

  12. Leslie A, Stephenson TJ. Audit of neonatal intensive care transport—closing the loop. Acta Paediatr. 1997;86:1253–6.

    Article  CAS  PubMed  Google Scholar 

  13. Blaxter L, Yeo M, McNally D, Crowe J, Henry C, Hill S, Mansfield N, Leslie A, Sharkey D. Neonatal head and torso vibration exposure during inter-hospital transfer. Proc Inst Mech Eng H. 2017;231(2):99–113.

    Article  PubMed  PubMed Central  Google Scholar 

  14. EU Directive 2002/44/EC-vibration. www.osha.europa.eu/en/legislation/directives/19.

  15. Auerbach PS, Morris JA Jr, Phillips JB, et al. An analysis of ambulance accidents in Tennessee. JAMA. 1987;258:487–90.

    Article  Google Scholar 

  16. Fenton AC, Leslie A, Skeoch CH. Optimising neonatal transfer. Arch Dis Child Fetal Neonatal Ed. 2004;89:F215–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hunt RC, Brown LH, et al. Is ambulance transport time with lights and siren faster than that without? Ann Emerg Med. 1995;25(4):507–11.

    Article  CAS  PubMed  Google Scholar 

  18. Magnavita V, Arslan E, Benini F. Noise exposure in the neonatal intensive care units. Acta Otorhinolarygol Ital. 1994;14:489–51.

    CAS  Google Scholar 

  19. Statement AP. Noise: a hazard for the fetus and newborn. Pediatrics. 1997;100:724–7.

    Article  Google Scholar 

  20. Buckland L, Austin N, Jackson A, et al. Excessive exposure of sick neonates to sound during transport. Arch Dis Child Fetal Neonatal Ed. 2003;88:F513–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Skeoch CH, Jackson L, Wilson AM, Booth P. Fit to fly: practical challenges in neonatal transfers by air. Arch Dis Child Fetal Neonatal Ed. 2005;90:F456–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Carmo K. The history of ultrasound and its use at point of care: neonatal ultrasound in transport. Curr Treat Options Pediatr. 2017;3(4):305–12. https://doi.org/10.1007/s40746-017-0101-0.

    Article  Google Scholar 

  23. Senthilkumar R, Corpuz N, Ratnavel N, Sinha A, Mohinuddin S. Adverse events during emergency transfer of neonates performed by a regionalised dedicated transfer service. Arch Dis Child. 2011;96:A91. https://doi.org/10.1136/adc.2011.212562.211.

    Article  Google Scholar 

  24. EN 13976-1:2018. Rescue systems—transportation of incubators—part 1: interface requirements.

    Google Scholar 

  25. EN 13976-2:2018. Rescue systems—transportation of incubators—part 2: system requirements.

    Google Scholar 

  26. Boyle MA, Dhar A, Chaudhary R, Kent S, O’Hare S, Dassios T, Broster S. Introducing high-flow nasal cannula to the transport environment. Acta Paediatr. 2017;106(3):509–12.

    Article  PubMed  Google Scholar 

  27. O’Connor TA, Grueber R. transcutaneous measurement of carbon dioxide tension during long distance transport of neonates receiving mechanical ventilation. J Perinatol. 1998;18(3):189–92.

    PubMed  Google Scholar 

  28. Lilley CD, Stewart M, Morley CJ. Respiratory function monitoring during neonatal emergency transport. Arch Dis Child Fetal Neonatal Ed. 2005;90:F82–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Klingenberg C, Wheeler KI, MaCallion N, Morley CJ, Davis PG. Volume-targeted versus pressure limited ventilation in neonates. Cochrane Database Syst Rev. 2017;10:CD003666. https://doi.org/10.1002/14651858.

    Article  CAS  PubMed  Google Scholar 

  30. Goldsmith J, Karotkin E. Assisted ventilation of the neonate. 5th ed. New York: Elsevier Saunders; 2011.

    Google Scholar 

  31. Bhat P, Dhar A, Chaudhary R, O'Hare S, Kent S, Broster S, Curley A. Monitoring respiratory function parameters in ventilated infants during inter-hospital emergency neonatal transport. Arch Dis Child. 2015;100.

    Article  Google Scholar 

  32. Barry P, Leslie A, editor. Paediatric and neonatal critical care transport.

    Google Scholar 

  33. Extracorporeal Life Support Organization. http://www.elso.org.

  34. UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation. UK Collaborative ECMO Trial Group. Lancet. 1996;348(9020):75–82.

    Google Scholar 

  35. Bennet CC, Johnson A, Field DJ, Elbourne D. UK collaborative ECMO trial group. UK collaborative randomised controlled trial of neonatal extracorporeal membrane oxygenation: follow-up to age 4 years. Lancet. 2001;357(9262):1094–6.

    Article  Google Scholar 

  36. Robinson S, Peek G. The role of ECMO in neonatal and paediatric patients. Paediatr Child Health. 2015;25(5):222–7.

    Article  Google Scholar 

  37. Azzopardi D, Brocklehurst P, Edwards D, Halliday H, Levene M, Thorensen M, et al. The TOBY Study. Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: a randomised controlled trial. BMC Pediatr. 2008;8:17.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Gluckman PD, Wyatt JS, Azzopardi D, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet. 2005;365(9460):663–70.

    Article  PubMed  Google Scholar 

  39. Thorensen M, tooley J, Liu X, jary S, Fleming P, Luyt K, et al. Time is brain: starting therapeutic hypothermia within three hours after birth improves motor outcome in asphyxiated newborns. Neonatology. 2013;104(3):228–33.

    Article  Google Scholar 

  40. UK TOBY cooling register clinicians handbook. Version 4. 2010. https://www.npeu.ox.ac.uk/downloads/files/tobyregister/Regis-Clinicians-Handbook1-v4-07-06-10.pdf

  41. Jacobs S, Morley CJ, Inder TE, et al. Whole-body hypothermia for term and near-term newborns with hypoxic ischaemic encephalopathy. A randomized controlled trial. Arch Pediatr Adolesc Med. 2011;165(8):692–700.

    Article  PubMed  Google Scholar 

  42. Akula VP, Joe P, Thrusu K, Davis AS, Tamaresis JS, Kim S, et al. A randomized clinical trial of therapeutic hypothermia mode during transport for neonatal encephalopathy. J Pediatr. 2015;166(4):856–861.e2.

    Article  PubMed  Google Scholar 

  43. Goel N, Mohinuddin SM, Ratnavel N, Kempley S, Sinha A. Comparison of passive and servo-controlled active cooling for infants with hypoxic-ischaemic encephalopathy during neonatal transfers. Am J Perinatol. 2017;34(1):19–25.

    PubMed  Google Scholar 

  44. Torre Monmany N, Behrsin J, Leslie A. Servo-controlled cooling during neonatal transport for babies with hypoxic-ischaemic encephalopathy is practical and beneficial: experience from a large UK neonatal transport service. J Paediatr Child Health. May 2019;55(5):518–22.

    Article  PubMed  Google Scholar 

  45. United Kingdom Neonatal Transport Group. https://ukntg.net/.

  46. Stewart MJ, Smith J, Boland RA. Optimizing outcomes in regionalized perinatal care: integrating maternal and neonatal emergency referral, triage and transport. Curr Treat Options Pediatr. 2017;3:313–26.

    Article  Google Scholar 

  47. Boland RA, Davis PG, Dawson JA, Stewart MJ, Smith J, Doyle LW. Very preterm birth before arrival at hospital. Aust N Z J Obstet Gynaecol. 2018;58:197–203.

    Article  PubMed  Google Scholar 

  48. Goh A, Browning Carmo K, Morris J, Berry A, Wall M, Abdel-Latif M. Outcomes of high-risk obstetric transfers in New South Wales and the Australian Capital Territory: the high-risk obstetric transfer study. Aust N Z J Obstet Gynaecol. 2015;55(5):434–9.

    Article  PubMed  Google Scholar 

  49. Hutchinson FH, Davies MW. Time to delivery after maternal transfer to a tertiary perinatal centre. Biomed Res Int. 2014;2014:325919.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Gale C, Hay A, Phillip C, Khan R, Santhakamaran S, Ratnavel N. Inutero transfer is too difficult: results from a prospective study. Early Hum Dev. 2012;88(3):147–50.

    Article  CAS  PubMed  Google Scholar 

  51. McNamara PJ, Mak W, Whyte HE. Dedicated neonatal retrieval teams improve delivery room resuscitation of outborn premature infants. J Perinatol. 2005;25(5):309–14.

    Article  CAS  PubMed  Google Scholar 

  52. Truffert P, Goujard J, Dehan M, Vodovar M, Breart G. Outborn status with a medical neonatal transport service and survival without disability at two years: a population based cohort survey of newborns of less than 33 weeks of gestation. Eur J Obstet Gynaecol Reprod Biol. 1998;79(1):13–8.

    Article  CAS  Google Scholar 

  53. Ratnaval N. Safety and Governance issues for neonatal transport services. Early Hum Dev. 2009;85:483–6.

    Article  Google Scholar 

  54. Davis P, Manktelow B, Bohin S, Field D. Paediatric trainees and the transportation of critically ill neonates: experience, training and confidence. Actapaediatrics. 2001;90:1068–72.

    CAS  Google Scholar 

  55. Resuscitation Council UK. www.resus.org.uk.

  56. US Institute of Medicine. Committee on quality of health care in America; crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.

    Google Scholar 

  57. Ground Air Medical Quality Transport Quality Improvement Collaborative. http://gamutqi.org/.

  58. https://www.bapm.org/resources/categories-care; 2011.

  59. Commission on Accreditation of Medical Transport Systems. http://www.camts.org.

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Correspondence to Joanna Behrsin .

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Behrsin, J., Leslie, A. (2020). Transport of the Sick Infant. In: Boyle, E., Cusack, J. (eds) Emerging Topics and Controversies in Neonatology. Springer, Cham. https://doi.org/10.1007/978-3-030-28829-7_27

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  • DOI: https://doi.org/10.1007/978-3-030-28829-7_27

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