Neonatal transport

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Authors

Jourdain G, Simeoni U, Schlembach D, Bernloehr A, Cetin I, Gente M, Grosek S, Leslie A, Ratnavel N, Roth-Kleiner M

Click on the image to read the standard in brief.

Target group

Infants and parents

User group

Healthcare professionals, neonatal units, hospitals, health services, and regional neonatal transport services

Statement of standard

Infants are transferred by a dedicated, specialised medical service that offers a quality of care similar to that promoted in a NICU.

Rationale

The regional organisation of perinatal care based on primary, secondary and tertiary care (see Birth & transfer) mandates the provision of infant transport services to facilitate the flow of patients through the system when antenatal transfer is impossible. (1) Neonatal transport is a critical phase of perinatal care, with specific needs for a specialised team and equipment to ensure maximal safety and efficiency. (2–5) Consensus guidelines and recommendations are proposed by healthcare professionals on paediatric and neonatal inter-facility transport. (1) Efficiency of specialised paediatric and neonatal transport has been evaluated in several studies. (6–15) When an infant no longer needs higher levels of care, a transfer to a hospital closer to the family’s home is recommended. This also optimises the use of available cots for all levels of care and allows the local hospital staff to familiarise themselves with the patient who will be followed up locally.

A standard detailing facilities and capabilities of transport services in the special environment of an ambulance, helicopter or fixed wing aircraft is thus needed throughout Europe.

Inter-hospital communication and regulation of transfers are complex and time consuming tasks that need to be managed by a dedicated call handling/regulation centre at the regional level, covering a sufficiently large area to reach a critical volume of activity.

Intra-hospital neonatal transfer, in particular in situations where the delivery room and the NICU are not adjacent, is also critical and warrants the same standard.

Benefits

Short-term benefits

Improved medical care and outcomes for infants needing transfer (6–15)
Improved transfer conditions (consensus)
Optimised use of NICU and perinatal centres resources (consensus)

Long-term benefits

Improved outcomes for infants and families (consensus)
Improved overall performance of regional organisation of perinatal care and reduction of healthcare costs (consensus)

Components of the standard

Component

Grading of evidence

Indicator of meeting the standard

For parents and family

Parents and family are informed about all aspects of the transfer of the infant by healthcare professionals.

B (High quality)

Parent feedback, patient information sheet¹

Parents/one parent are able to accompany the infant during transfer.

B (High quality)

Parent feedback, patient information sheet¹

For healthcare professionals

A unit guideline on neonatal transport is adhered to by all responsible healthcare professionals.

B (High quality)

Guideline

Education and training, including medical simulation training and continuous education/training, are attended by members of the transport team and for other neonatal and obstetric healthcare professionals involved in neonatal transport. (16) (see TEG Education & training)

A (Moderate quality)
B (High quality)

Guideline, training documentation

For neonatal unit and hospital

A unit guideline on intra-hospital neonatal transport, including transport of newborn infants in critical conditions, as part of the hospital organisation is available and regularly updated.

B (High quality)

Guideline

Trained and experienced healthcare professionals as well as equipment resources needed for intra-hospital neonatal transport are provided.

B (High quality)

Audit report², training documentation

Education and training, including medical simulation training and continuous education/training, are attended by members of the transport team and other neonatal and obstetric healthcare professionals involved in neonatal transport. (16) (see TEG Education & training)

A (Moderate quality)
B (High quality)

Guideline, training documentation

For health service and regional neonatal transport service

A regional/national guideline on inter-hospital neonatal transport is available and regularly updated.

B (High quality)

Guideline

Health service is responsible for the provision of a regional neonatal transport service allowing complete preservation of life functions, such as body temperature maintenance, haemodynamic, respiratory, neurologic, metabolic functions and sepsis management (see description).

B (Moderate quality)

Audit report²

Nurse or midwife assisted neonatal transport of newborn infants who do not need medical assistance (e.g. transfer of newborn infants for step down care) is available.

B (Moderate quality)

Guideline

A unique regional call and transfer regulation center is organised and continuously available, with a dedicated call number and real time information on the available cots in primary, secondary and tertiary centres.

B (Low quality)

Audit report²

¹The indicator “patient information sheet” is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.

²The indicator “audit report” can also be defined as a benchmarking report.

Where to go

Further development

Grading of evidence

For parents and family

Parents are involved in the monitoring of quality of organisation of perinatal care and neonatal transport.

B (Low quality)

For healthcare professionals

Ensure that neonatal transport healthcare professionals are trained, using real conditions and medical simulation. (17,18)

A (Low quality)

For neonatal unit

Ensure the availability of a trained and experienced dedicated team for intra-hospital neonatal transport and for participation in regional transport.

B (High quality)

For hospital

N/A

For health service

Provide stringent quality improvement programmes including parental satisfaction.

B (Low quality)

Getting started

Initial steps

For parents and family

Parents are verbally informed by healthcare professionals about the transport of their infant.

For healthcare professionals

Attend continuous training on neonatal transfer.

For neonatal unit

Develop and implement a unit guideline on neonatal transport.
Develop information material on neonatal transport for parents.
Equip and staff each neonatal unit for intra-hospital transport and eventual participation to inter-facility transport.

For tertiary level hospital

Support healthcare professionals to participate in training on neonatal transport.
Coordinate specialised inter-hospital transport service.

For health service and regional neonatal transport service

Develop and implement a national guideline and/or a policy statement on neonatal transport.
Support the development of information material on neonatal transport for parents.
Provide and structure regional perinatal transport services, including quality control.

Staff and equipment for neonatal transfers

Staff and equipment should be dedicated to undertaking neonatal transport.

Vehicle for road transfer

A dedicated vehicle should be reserved for neonatal transport
Vehicles to be used for neonatal transport should conform to European Standard EN 1789 (16)
In addition, vehicles should have
- Seating for at least three staff/family
- No-lifting loading & unloading of incubator equipment
- Supplies of compressed medical gases sufficient for double the longest anticipated transfer.
- Secure power supply such that medical equipment may be powered from the vehicle without using incubator batteries.
- Fridge for drugs conservation

Air transport (helicopter or fixed wing)

Neonatal transport service must have a structured access to air transport service and facilities.

Equipment

The neonatal equipment used should conform to European Standards EN 13976-1 and EN 13976-2. (18)
Equipment used for neonatal transport in air ambulances should additionally conform to EN 13718 – Medical vehicles and their equipment. Air ambulances. Requirements for medical devices used in air ambulances. (17)
Equipment should be configured such that transported infants
- Are kept in the thermoneutral temperature zone.
- Receive the necessary respiratory support.
- Receive the necessary fluid and drug infusions.
- Have their vital signs monitored appropriately.
- Who become critically unstable in transit can receive emergency care (airway, breathing, circulation).

Staff for transfer

For ground transfers the drivers of vehicles should hold relevant training for driving emergency vehicles.
The clinical team should include nurse, advanced clinical practitioner, doctor or paramedic depending on the clinical needs of the patient. Healthy infant transfers may be conducted by a nurse alone.
The clinical team should have received neonatal transport-specific training and be supported by continuing education for transport.
The work of the clinical team should be supported by transport-specific clinical guidelines.
Where air transport is anticipated all the staff involved should have received air transport training and preparation and this should be refreshed annually.

Woodward GA, Insoft RM, Pearson-Shaver AL, Jaimovich D, Orr RA, Chambliss R, et al. The state of pediatric interfacility transport: consensus of the second National Pediatric and Neonatal Interfacility Transport Medicine Leadership Conference. Pediatr Emerg Care. 2002 Feb;18(1):38–43.
Bellingan G, Olivier T, Batson S, Webb A. Comparison of a specialist retrieval team with current United Kingdom practice for the transport of critically ill patients. Intensive Care Med. 2000 Jun;26(6):740–4.
King BR, King TM, Foster RL, McCans KM. Pediatric and neonatal transport teams with and without a physician: a comparison of outcomes and interventions. Pediatr Emerg Care. 2007 Feb;23(2):77–82.
Orr RA, Felmet KA, Han Y, McCloskey KA, Dragotta MA, Bills DM, et al. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics. 2009 Jul;124(1):40–8.
Stroud MH, Prodhan P, Moss MM, Anand KJS. Redefining the golden hour in pediatric transport. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2008 Jul;9(4):435–7.
Ramnarayan P, Thiru K, Parslow RC, Harrison DA, Draper ES, Rowan KM. Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study. Lancet Lond Engl. 2010 Aug 28;376(9742):698–704.
Ramnarayan P, Polke E. The state of paediatric intensive care retrieval in Britain. Arch Dis Child. 2012 Feb;97(2):145–9.
Borrows EL, Lutman DH, Montgomery MA, Petros AJ, Ramnarayan P. Effect of patient- and team-related factors on stabilization time during pediatric intensive care transport. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2010 Jul;11(4):451–6.
Ramnarayan P. Measuring the performance of an inter-hospital transport service. Arch Dis Child. 2009 Jun;94(6):414–6.
Vos GD, Nissen AC, H M Nieman F, Meurs MMB, van Waardenburg DA, Ramsay G, et al. Comparison of interhospital pediatric intensive care transport accompanied by a referring specialist or a specialist retrieval team. Intensive Care Med. 2004 Feb;30(2):302–8.
Longhini F, Jourdain G, Ammar F, Mokthari M, Boithias C, Romain O, et al. Outcomes of Preterm Neonates Transferred Between Tertiary Perinatal Centers. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2015 Oct;16(8):733–8.
Stroud MH, Prodhan P, Moss M, Fiser R, Schexnayder S, Anand K. Enhanced monitoring improves pediatric transport outcomes: a randomized controlled trial. Pediatrics. 2011 Jan;127(1):42–8.
Broughton SJ, Berry A, Jacobe S, Cheeseman P, Tarnow-Mordi WO, Greenough A, et al. The mortality index for neonatal transportation score: a new mortality prediction model for retrieved neonates. Pediatrics. 2004 Oct;114(4):e424-428.
Stroud MH, Trautman MS, Meyer K, Moss MM, Schwartz HP, Bigham MT, et al. Pediatric and neonatal interfacility transport: results from a national consensus conference. Pediatrics. 2013 Aug;132(2):359–66.
Stroud MH, Sanders RC, Moss MM, Sullivan JE, Prodhan P, Melguizo-Castro M, et al. Goal-Directed Resuscitative Interventions During Pediatric Interfacility Transport. Crit Care Med. 2015 Aug;43(8):1692–8.
Mickells GE, Goodman DM, Rozenfeld RA. Education of pediatric subspecialty fellows in transport medicine: a national survey. BMC Pediatr. 2017 13;17(1):13.
Akula VP, Joe P, Thusu 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 Apr;166(4):856-861.e1-2.
Barsuk JH, Cohen ER, Wayne DB, Siddall VJ, McGaghie WC. Developing a Simulation-Based Mastery Learning Curriculum: Lessons From 11 Years of Advanced Cardiac Life Support. Simul Healthc J Soc Simul Healthc. 2016 Feb;11(1):52–9.