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The goal of an infant transport is to provide early stabilization and initiation of advanced care at a referring institution with continuation of critical care therapies and monitoring during transport to ensure safety and a positive neonatal outcome. Transport of infants who need a higher level of care from a referring hospital to a level III neonatal intensive care unit (NICU) enables each patient to benefit from the regionalization and specialization of critical care personnel, capabilities, and services. A great deal of planning must take place for a specialized transport team to function effectively, and clear guidelines must be established regarding personnel, procedures, and equipment needed. A preplanned transport algorithm is essential to organize a smooth transition of care. Ideally, the mother would be transferred to the level III center before delivery of a high-risk infant, but this is not always possible.

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  1. Transport team

      1. Personnel. The team may include physicians, nurses, neonatal nurse practitioners or advanced practice nurses, respiratory therapists, and perhaps emergency medical technicians. Limited research supports similar outcomes from transport teams with and without the direct presence of a transport physician. Team members should have received special training in the care of sick infants and have the ability to contact the attending neonatologist at any time during transport. Appropriate insurance coverage is necessary for team members, and questions of liability must be worked out with legal consultation among hospitals, ambulance services, and aircraft services.

      1. Procedures. Policies and procedures reflect the unique characteristics of each region (size, geography, economics, and sophistication of medical services). Lines of communication must always be open between the referring hospital and the NICU at all levels (ie, administrators, physicians, nurses) and with ambulance or air services. At the referring hospital, team members should conduct themselves as professional representatives of the NICU, avoiding situations of conflict or criticism with the staff.

  2. Equipment. Each transport team should be self-sufficient. Special emphasis is placed on having all of the necessary equipment to enable stabilization of the infant at the referring hospital to optimize an uneventful transport instead of a "swoop and scoop" mentality. Medications and equipment can be chosen according to published lists. Special considerations are maintaining thermal neutrality (eg, plastic swaddling or heated, humidified inspired air mixtures) and noise and vibration, which often compromise auditory and visual monitoring. Well-calibrated blood pressure and transcutaneous monitors may be useful. An instant camera is a "must" because pictures of the infant may be the mother's only psychological support for days.

  3. Protocol for stabilization and transfer. The mobile environment has risks and limitations that can be balanced by pretransport stabilization, qualified professionals, and equipment and monitoring devices adapted for use during transport.

      1. General procedures. Unless active resuscitation is underway, the team's first task at the referring hospital is to listen to the history and assessment of the infant's status. The vital signs are then obtained. A complete physical assessment should be performed as well as review of all laboratory values and radiographic studies. Obtain ...

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