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SCOPE

DISEASE/CONDITION(S)

Neonatal transport.

GUIDELINE OBJECTIVE(S)

To provide an overview of important aspects of transporting neonates between healthcare facilities or to home.

BRIEF BACKGROUND

Ideally, babies should be delivered at healthcare facilities equipped with the staff and resources required for their care. Nevertheless, even in today’s era of advanced antenatal fetal surveillance, neonates are occasionally born in healthcare facilities unable to care for them and require transfer to a higher-level facility. Neonatal transports may urgent or non-urgent. Urgent neonatal transport usually occurs in the first few days of life in a newborn infant with a congenital anomaly or neonatal disease resulting from failure of adaptation to extrauterine life. Occasionally, urgent transfer is needed when a hospitalized preterm neonate develops a disease state (e.g., necrotizing enterocolitis) that requires subspecialty services at a tertiary care center. In situations where the infant is clinically unstable, rapidity of transfer to a center with the appropriate resources is critical for survival. Planning for such events will increase the likelihood of a favorable patient outcome, decrease family stress, and allow for efficient transports.

Program Considerations

All hospitals that have maternity facilities, Levels I and II neonatal intensive care units (NICUs), and emergency rooms should have agreements with regional tertiary care centers about where they should transfer patients who they are unable to care for. Policies and guidelines should delineate criteria for consultation, neonatal transfer, and methods of stabilizing neonates prior to transfer. All relevant contact information and written guidelines and protocols should be easily accessible and reviewed periodically to ensure they are current. Legal counsel should be sought to ensure that the program and hospital comply with all local, state, and federal laws.

Neonatal Transport Teams

Regional neonatal transport teams should have a medical director who works with hospital administration to oversee and ensure efficient functioning of the transport team, develop guidelines and protocols for neonatal transfer, and monitor the quality of neonatal transport services.

Depending on the frequency of transports, transport teams may be unit based, where personnel (nurses, respiratory therapists, neonatal nurse practitioners, and physicians) are deployed when necessary, or dedicated, where selected personnel have the sole responsibility for neonatal transport. Dedicated teams often are responsible for transporting patients of a wide age range, in addition to neonates. A major advantage of dedicated teams is that they can respond rapidly when needed, as opposed to unit-based teams who are required to hand over clinical responsibilities to colleagues for the duration of the transport and for some time afterward. Regardless of the type of team, all team members should be covered by appropriate malpractice insurance for care rendered during transport.

Modes of Transport

The mode of transport chosen by the transport team will depend ...

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