4: Infant Transport

I. GENERAL PRINCIPLES

A seamless transport of infants from a referring hospital to a higher level neonatal intensive care unit (NICU) enables each patient to benefit from the regionalization and specialization of critical care personnel and services. Clear guidelines and a transport algorithm must be established regarding transport procedures, personnel, and necessary equipment. The goals of an infant transport are:

1. Provide early stabilization and initiation of advanced care at a referring institution.

2. Continue critical care therapies and monitoring during transport to ensure safety and a positive neonatal outcome.

II. PREDEPARTURE ASSESSMENT AND PREPARATION

1. Procedures. Policies and procedures reflect the unique characteristics of each region (size, geography, and level 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. On receiving a request for a transport, an intake record should be completed, documenting the referring physician and hospital contact information and patient information. A predeparture assessment of the patient may determine transport team composition and guide the referring hospital with management.

2. 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 regarding issues and equipment specific to transport and have the ability to contact the medical command at any time during transport.

3. Equipment. Each transport team should be self-sufficient (ie, be a mobile NICU). Special emphasis is placed on having the necessary equipment to enable maximal stabilization of the infant at the referring hospital to facilitate an uneventful transport. Medications and equipment can be chosen according to published lists. Well-calibrated monitoring equipment is necessary given the added noise and vibration during transport, which often compromise auditory and visual monitoring. An instant camera is an important consideration to provide pictures of the infant to the family.

4. Transport mode. Clear guidelines should be established regarding the indications for air versus ground transport based on distance, time of day, geography, weather, location of landing sites, and severity and stability of the patient's condition. The most critical factor in determining mode of transport is the safety of the team and patient. Decisions regarding flight safety should be made according to weather and other flight conditions and not be influenced by patient status. Follow instructions from the flight crew regarding loading and unloading of the aircraft. Transport personnel should be restrained in safety harnesses throughout every transport.

III. PATIENT ASSESSMENT AND STABILIZATION AT THE REFERRING HOSPITAL

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. Team members should conduct themselves as professional representatives of the NICU, avoiding situations ...