Neonatal Transport Team Research Articles

Endotracheal tube length for neonatal intubation

In the newborn infant, accurate endotracheal tube (ETT) placement is essential for adequate ventilation and surfactant delivery. This study aimed to determine the relationship between gestation, weight and endotracheal tube length, and to evaluate the promotion of gestation-based guidelines for ETT length. A prospective audit of endotracheal tube placement, followed by an education drive to 24 hospitals, and a subsequent repeat audit. Neonatal intensive care transfer service. Infants referred for inter-hospital transfer between 33 neonatal units. Education drive to local hospitals to encourage use of standardised guidelines for ETT length based on gestation. Endotracheal tube length, radiological position with respect to thoracic vertebral bodies and radiological complications were assessed by neonatal transport team staff. The association between satisfactory ETT length and gestation was linear, whereas the relationship with weight was non-linear. In participating centres, use of gestation-based guidelines were associated with a reduction in tubes needing repositioning (8% vs. 53%, p<0.01) and in the incidence of uneven lung expansion (3% vs.17%, p<0.05). As use of gestation guidelines increased from 18% to only 32% overall, the intervention did not produce statistically significant changes in the entire patient population. Use of gestation-based guidelines on ETT length for neonatal intubation was associated with a reduction in tube malposition and uneven lung expansion. A table of ETT length against gestation and weight is provided to assist those carrying out this procedure, which could be incorporated into neonatal resuscitation training.

Interfacility Transport of the Critically Ill Pediatric Patient

Care of the critically ill and injured child has evolved over the last 20 years, with growth of regional pediatric critical care services, attendant subspecialties, and the proliferation of pediatric critical care training programs nationally. Concurrent with this evolution has been recognition of the need for specialty care of the critically ill child during air or ground transport to a regional pediatric center. The American Academy of Pediatrics Section on Transport Medicine has provided standards that have been adopted by many neonatal and pediatric transport teams. Team composition varies, but all share the mission of specialized transport for critically ill and injured children in a safe and expeditious process while ultimately improving patient outcome. Specialized pediatric transport teams are costly to maintain. Declining reimbursement for specialized care and reduced profit margins have resulted in extended roles for transport team members within children's hospitals. More stringent budgetary constraints have created challenges for pediatric transport teams in our constantly changing medical environment.

Passive cooling to initiate hypothermia for transported encephalopathic newborns

Two newborns at high risk for severe encephalopathy were passively cooled by discontinuing the supplied heat from a radiant warmer. Cooling was attempted in both babies (successfully in one) before the arrival of the neonatal transport team. Both infants had core temperatures of approximately 34 degrees C on arrival at the NICU. Passive cooling may be an effective method to initiate cooling very early in the course of encephalopathy.

A population based 10‐year study of neonatal air transport in North Norway

This study audits the activity of the neonatal air transport team in Norway's two northernmost counties. Data on all air transports to or from the regional Neonatal Intensive Care (NICU) Unit within a 10-year period were collected. Two hundred and thirty-eight acute transports were conducted during the study period; 169 referrals to the NICU and 69 transfers to national surgical and cardiac centres. Only 13 very low birth weight infants were transported; the in utero transport rate was 95% for this patient population. The adjusted risk of death and/or intracranial haemorrhage for outborn very low birth weight infants was five-fold increased compared to those not transported postnatally. Babies with congenital heart disease comprised the one-fourth of all transports. The long-term mortality was 14% for the whole study population, and 29% for infants with congenital heart disease. Only seven deaths (3.2%) were defined as being transport-related; death during or within 24 h after transport. However, preventable complications like temperature instability, hypoglycaemia and hypo-/hypercapnia occurred in 10-20% of all transports. The transport related mortality was low in this study, however very low birth weight infants and infants with major congenital heart disease showed a relatively poor outcome.

Pediatric and Neonatal Transport Teams With and Without a Physician

To determine whether a transport team composed of advanced practice nurses could function as effectively as a physician-nurse team, as measured by patient outcome. Observational cohort study. The interfacility transport team at a tertiary care children's hospital. Fourteen transport nurses and 539 patients. A transport team was studied during a previously planned change in composition from a physician-nurse team to a nurse-nurse team. Data were recorded by transport nurses and by subsequent review of the medical record during two 4-month periods, 1 before and 1 after the team change. Pediatric risk of mortality scores (a marker for degree of illness) were assigned for the periods before, during, and after transport. Transport time intervals, demographic data, and patient outcomes were also recorded. Data were assessed using frequency tables for discrete variables, as well as mean and standard deviation for continuous variables. For identification of group differences, chi test was used. Mortality, transport-related morbidity, overall transport times and interval times, and outcome of procedures performed by transport nurses. Five hundred thirty-nine data sheets were received: 228 before (group 1) and 311 after (group 2) the team change. Physicians attended 128 (56.1%) group 1 transports and 15 (4.82%) group 2 transports. There were no significant differences in mean pediatric risk of mortality scores between group 1 and group 2 patients. Mortality was equivalent. Group 2 transport times were significantly shorter than group 1 times. Transport nurses performed 8 intubations; all were successful. Outcomes for the 2 types of teams were equivalent. Nonphysician teams responded more quickly and spent less time at the referring facility.

Dedicated Neonatal Retrieval Teams Improve Delivery Room Resuscitation of Outborn Premature Infants

Morbidity related to ineffective resuscitation and stabilization of premature infants is increased when delivery occurs outside tertiary perinatal centers. The regional neonatal transport team received extensive training to expand their scope of practice to include delivery room resuscitation allowing them to attend high-risk deliveries in community hospitals when maternal transfer was not possible. Compare the resuscitation and stabilization of premature infants when a specialized neonatal retrieval team (SNRT) is in attendance at delivery with immediate resuscitation and stabilization performed by the referral hospital team (RHT). We assessed the impact of a specially trained neonatal transport team by comparing the initial resuscitation process, airway and vascular access skills, illness severity and patient stabilization in both groups. Neonates resuscitated by the RHT were more likely to receive oxygen, mask CPAP, bag and mask ventilation and cardiac compressions for a significantly longer time period. Neonates resuscitated by the SNRT were intubated more promptly (8.5 minutes {1 to 22} vs 16 minutes {1 to 90}, p=0.035) following a fewer number of attempts. The endotracheal tube was correctly positioned on radiological assessment in 72% of cases in the SNRT group vs 38.1% in the RHT group (p<0.001). Many neonates had no vascular access (31%) and were profoundly hypothermic (38.5%) on arrival of the SNRT. Although there was no significant difference in maximum FiO(2) or oxygenation index, babies with respiratory distress syndrome resuscitated by the RHT were less likely to receive surfactant therapy (76.6 vs 34.4%, p=0.001). There was no difference in transport-related mortality between the groups The presence of a highly skilled transport team at a high-risk preterm delivery improves the quality of neonatal resuscitation by increasing intubation success rates and achieving earlier vascular access. Neonates resuscitated by dedicated neonatal retrieval teams were less likely to become significantly hypothermic. Although the severity of RDS was similar neonates in the RHT were less likely to receive surfactant.

The Ottawa Model of Research Use

To improve performance of a neonatal transport team by implementing a research-based family assessment instrument. Objectives included providing a structure for evaluating families and fostering the healthcare relationship. Neonatal transports are associated with family crises. Transport teams require a comprehensive framework to accurately assess family responses to adversity and tools to guide their practice toward parental mastery of the event. Currently, there are no assessment tools that merge family nursing expertise with neonatal transport. A family assessment tool grounded in contemporary family nursing theory and research was developed by a clinical nurse specialist. The Ottawa Model of Research Use guided the process of piloting the innovation with members of a transport team. Focus groups, interviews, and surveys were conducted to create profiles of barriers and facilitators to research use by team members. Tailored research transfer strategies were enacted based on the profile results. Formative evaluations demonstrated improvements in team members' perceptions of their knowledge, family centeredness, and ability to assess and intervene with families. The family assessment tool is currently being incorporated into Clinical Practice Guidelines for Transport and thus will be considered standard care. Use of a family assessment tool is an effective way of appraising families and addressing suffering. The Ottawa Model of Research Use provided a framework for implementing the clinical innovation. A key role of the clinical nurse specialist is to influence nursing practice by fostering research use by practitioners. When developing and implementing a clinical innovation, input from end users and consumers is pivotal. Incorporating the innovation into a practice guideline provides a structure to imbed research evidence into practice.

81 Evaluation of the Impact of the S.T.A.B.L.E. Program on the Pre-Transport Care of the Neonate in Nova Scotia

The S.T.A.B.L.E. Program is a standardized educational program focusing on the stabilization of the critically ill neonate prior to transport. The S.T.A.B.L.E. Program was implemented over 13 months in all referring centers (12) providing obstetrical services in Nova Scotia in 1999. The program has been widely implemented in the United States but has not been previously evaluated. To assess if the S.T.A.B.L.E. Program increases regional healthcare provider perceived confidence in pre-transport stabilization; to determine if the S.T.A.B.L.E. Program guidelines are incorporated into healthcare provider clinical practice; and to assess if the pre-transport management of neonates has improved. A retrospective chart review of all Nova Scotia neonates transported to the NICU at the IWK Health Centre in two time periods (pre- and post-S.T.A.B.L.E. implementation). Information obtained included birthweight, gestation and time spent at the referring center by the Neonatal Transport Team. An analysis of interventions based on S.T.A.B.L.E. guidelines begun by the referring Centre in the two time periods was performed. A questionnaire utilizing a Likert scale was sent to all healthcare providers in Nova Scotia who had participated in the S.T.A.B.L.E. Program during the initial 13 months, to evaluate participant satisfaction, self-perceived confidence and change in practice. 64/124 (52%) questionnaires were completed. Nearly all participants (96%) indicated the course was relevant and useful. 90% indicated that they felt more confident in neonatal pre-transport stabilization, and 86.5% indicated that they had adopted principles of the S.T.A.B.L.E. Program into their practice. 127 charts of infants transported to the NICU were reviewed: 80 pre-S.T.A.B.L.E., 47 post-S.T.A.B.L.E. There were no differences in birth-weight or gestation between the two groups. There were no differences found between the two groups for: improved glucose, thermoregulation, BP stability, increased intubation if needed or for stabilization time required on arrival of the Neonatal Transport Team. Although this study did not find an improvement in clinical outcome, it highlights the increase in provider confidence since the S.T.A.B.L.E. Program was implemented. As this study was carried out in a region with a well established regionalized healthcare system with strong prenatal referral patterns for premature infants, further evaluation of the S.T.A.B.L.E. Program in regions with higher rates of outborn deliveries is warranted.

121 A “Stay and Play” Philosophy of Stabilization Leads to Safe and Effective Paediatric Transport

The likelihood of physiological deterioration or adverse events during the retrieval of critically ill children is reduced by dedicated paediatric transport teams. Recently the neonatal transport team based at the Hospital for Sick Children (HSC) has expanded its mandate to retrieve children up to 2 years of age. The Acute Care Transport Services (ACTS) team has translated its neonatal stabilization philosophy of “stay and play” into paediatric critical care transports. However other teams consider a “scoop and run” philosophy to be the most effective and safest means of transporting critically ill children. To investigate if “stay and play” stabilization of critically ill children is associated with physiological deterioration or an increased likelihood of adverse events on transport. Data was prospectively collected on all paediatric transports by ACTS from Nov 2002 to Nov 2003. Details recorded included patient demographics, referral problem, transport mobilization & stabilization times and adverse events during transport. A physiology score based on a modified PRISM score was used as an index of illness severity and recorded on arrival and following departure of the team from the referral hospital. The effectiveness of transport stabilization was assessed by comparing pre-and post-stabilization physiology scores. An intervention score was constructed to assess details of the stabilization process. The relationship between intervention scores and stabilization times was examined using linear regression methods. 35 children were retrieved during the study time-period. The average age at referral was 5.7 months (Range 1.5–24). The referring diagnosis included CNS disease (37%), respiratory failure (34%), septicaemic shock (14%), cardiac disease (8.6%) and others (6.4%). Patients were referred from an emergency department (60%) or paediatric ward (31.4%). The average mobilization and stabilization times for ACTS were 33.4 mins (Range 5–315) and 140 mins (Range 40–320) respectively. 94.3% patients demonstrated improvement or plateau in their physiology score with a significant reduction in physiologic score over the stabilization period from 4.17 to 2.88 (1.875 2.2, p=0.002). There was a positive relationship between the length of stabilization and the calculated intervention score (r=0.61, p<0.001). There were no critical incidents or adverse patient or equipment events during transport. 88.6% patients were admitted to the critical care unit at HSC. This study demonstrates that the physiologic condition of critically ill children is improved and the likelihood of adverse events is reduced following aggressive stabilization by a dedicated “mobile ICU” team.

Transport of the mechanically ventilated pediatric patient.

Children deserve quality care when they are critically ill or injured. Specialized pediatric services may be limited outside major medical centers. Transport by specialized pediatric and neonatal transport teams may be required to deliver patients to tertiary pediatric medical centers. In addition, in the past decade a cost-effective, organized, systematic approach to health care management has assumed greater importance, leading to the concept of the so-called medical home. In this model, a child with a complex medical problem is cared for in the environment in which he or she will receive the best care, with emphasis on providing rehabilitative and long-term care near the child's home. It is likely, then, that the field of pediatric transport medicine will assume greater importance in the coming decade.

P EDIATRIC C RITICAL C ARE T RANSPORT —T HE S AFETY OF THE J OURNEY : A F IVE-YEAR R EVIEW OF V EHICULAR C OLLISIONS I NVOLVING P EDIATRIC AND N EONATAL T RANSPORT T EAMS

Objective. To determine the frequency and consequences of vehicular crashes among dedicated pediatric and neonatal transport teams. Methods. A three-page questionnaire was sent to the transport teams of National Association of Children's Hospitals and Related Institutions (NACHRI) member hospitals. The survey instrument consisted of three sections. The first section requested demographic information about the team and asked the team to report any vehicular collisions or incidents in the previous five years. The second section was directed at teams that did not report collisions or incidents and asked the team to identify potential reasons for their safety record. The third section was directed to those teams reporting collisions or incidents and asked about the causes and consequences of these events. Results. Ninety of 153 (59%) surveys were returned. Thirty-eight of the 90 teams (42%) reported at least one collision in the previous five years. A total of 66 collisions were reported (nine aircraft crashes and 57 ambulance collisions). The number of collisions was not related to the total number of transports performed by the team. Most teams attributed the collisions to errors on the part of a team member or to the actions of a third party. Collisions resulted in eight deaths, ten cases of moderate to severe injury, and 28 minor injuries to patients, health care workers, and/or the ambulance crew. All deaths resulted from aircraft crashes. Additionally, there were operational impacts upon the teams. These included missed workdays and disability on the part of team members and changes in team practices. Collision-free teams attributed their safety record to specific policies of the team and/or the vehicle owner or vendor and to luck. Conclusions. Collisions/crashes among pediatric transport teams are unusual. However, they have resulted in deaths, injuries, and disability. Collisions/crashes appear to be caused by the actions of a team member and/or those of third parties. Specific safety policies on the part of the team and/or vehicle owner or provider may prevent or decrease collisions/crashes.

Air transport of the sick newborn infant: audit from a sparsely populated county in Norway.

The aim of this study was to describe principal problems and to analyse transport times, stabilizing procedures, adverse events during transfer, outcome, effectiveness and the care of infants transferred by air from district general hospitals and maternity homes to a central hospital. Transfer times, equipment adverse events and clinical deterioration were recorded as they occurred. Data regarding clinical problems, diagnoses and outcome were collected retrospectively from hospital records. During the study period (1984-95) 275 infants (267 transports) were transferred by fixed-wing aircraft (233) or helicopter (34). Median time from request of transfer to arrival of the transport team (usually a neonatal nurse and a paediatrician) was 120 min, median stabilizing time 60 min. Ninety-six infants (35%) were intubated, 62 (22.5%) by the transport team. During 34 transports (12.7%), equipment-related adverse events occurred making six infants worse. Ten more infants deteriorated during transit. A significant correlation between birthweight and after-transfer temperature was recorded. After-transfer temperature for very low birthweight (<1500 g, VLBW) infants was significantly higher when the transport team attended the delivery than when they did not (35.9 degrees C vs 34.7 degrees C). All nine infants (3.2%) with after-transfer temperature <34.0 degrees C died, 15 infants (5.5%) died within 24 h after transfer and 20 (7.3%) died later. Adjusted OR for death among transported versus in utero transferred VLBW infants was 3.8 (1.4-10.4). Every effort should be taken to transfer VLBW infants in utero. If preterm deliveries at 26-28 weeks of gestation at district general hospitals is unavoidable, an early request for the neonatal transport team to be there at delivery is advisable. Transport of very immature infants <26 weeks gestational age is not recommended. An outreach educational program ("Team Pink Newborn") has been created. Staff training to combat hypothermia and regular inspection and control of the transport equipment by three neonatal intensive care nurses has now been implemented.

Air transport of the sick newborn infant: audit from a sparsely populated county in Norway

The aim of this study was to describe principal problems and to analyse transport times, stabilizing procedures, adverse events during transfer, outcome, effectiveness and the care of infants transferred by air from district general hospitals and maternity homes to a central hospital. Transfer times, equipment adverse events and clinical deterioration were recorded as they occurred. Data regarding clinical problems, diagnoses and outcome were collected retrospectively from hospital records. During the study period (1984‐95) 275 infants (267 transports) were transferred by fixed‐wing aircraft (233) or helicopter (34). Median time from request of transfer to arrival of the transport team (usually a neonatal nurse and a paediatrician) was 120 min, median stabilizing time 60min. Ninety‐six infants (35%) were intubated, 62 (22.5%) by the transport team. During 34 transports (12.7%), equipment‐related adverse events occurred making six infants worse. Ten more infants deteriorated during transit. A significant correlation between birthweight and after‐transfer temperature was recorded. After‐transfer temperature for very low birthweight (&lt;1500g, VLBW) infants was significantly higher when the transport team attended the delivery than when they did not (35.9 °C vs 34.7 °C). All nine infants (3.2%) with after‐transfer temperature &lt;34.0°C died, 15 infants (5.5%) died within 24 h after transfer and 20 (7.3%) died later. Adjusted OR for death among transported versus in utero transferred VLBW infants was 3.8 (1.4‐10.4). Every effort should be taken to transfer VLBW infants in utero. If preterm deliveries at 26‐28 weeks of gestation at district general hospitals is unavoidable, an early request for the neonatal transport team to be there at delivery is advisable. Transport of very immature infants &lt;26 weeks gestational age is not recommended. An outreach educational program (“Team Pink Newborn”) has been created. Staff training to combat hypothermia and regular inspection and control of the transport equipment by three neonatal intensive care nurses has now been implemented.

Very low birthweight infants: outcome in a sub-Arctic population.

To evaluate the outcome for very low birthweight (VLBW) infants in northern Norway. All live born infants (n = 536) with birthweight < or = 1500 g born during 1978-89 to women residing in the northern health region of Norway were studied retrospectively. Data were from the Medical Birth Registry (MBR), hospital records and from follow-up recordings to 4 y of age at maternal and child health centres. Stillborn infants (n = 269) with birthweight < or = 1500 g during the same period were also registered. The annual incidence of live born VLBW infants (7.1/1000 live births) did not change, but the proportion of infants born alive before 26 weeks' gestation increased and the stillborn part decreased significantly. The Caesarean section (CS) rate, antenatal transfer and the use of a neonatal transport team increased significantly. Four hundred and seventy-five infants (89%) were considered viable at birth, 347 (65%) survived to 1 y and 343 (64%) to 4 y. The likelihood of survival was independently related to female gender. The trend for survival to 4 y of age did not increase significantly. Thirty children suffered from cerebral palsy (8.7% of survivors, 5.6% of live births) and the cerebral palsy rate for infants with birthweight 751-1000 g decreased. The proportion of survivors considered to be normal or mild disabled increased and the part suffering from moderate or severe disability decreased significantly. In spite of long distances and unfavourable climatic conditions VLBW infants can be adequately cared for in this sparsely populated region of Norway.

Very low birthweight infants: outcome in a sub‐Arctic population

Objective: To evaluate the outcome for very low birthweight (VLBW) infants in northern Norway. Subjects and methods: All live born infants (n = 536) with birthweight ≤1500g born during 1978–89 to women residing in the northern health region of Norway were studied retrospectively. Data were from the Medical Birth Registry (MBR), hospital records and from follow‐up recordings to 4 y of age at maternal and child health centres. Stillborn infants (n= 269) with birthweight ≤1500g during the same period were also registered. Results: The annual incidence of live born VLBW infants (7.1/1000 live births) did not change, but the proportion of infants born alive before 26 weeks’gestation increased and the stillborn part decreased significantly. The Caesarean section (CS) rate, antenatal transfer and the use of a neonatal transport team increased significantly. Four hundred and seventy‐five infants (89%) were considered viable at birth, 347 (65%) survived to 1 y and 343 (64%) to 4y. The likelihood of survival was independently related to female gender. The trend for survival to 4y of age did not increase significantly. Thirty children suffered from cerebral palsy (8.7% of survivors, 5.6% of live births) and the cerebral palsy rate for infants with birthweight 751‐1000 g decreased. The proportion of survivors considered to be normal or mild disabled increased and the part suffering from moderate or severe disability decreased significantly. Conclusions: In spite of long distances and unfavourable climatic conditions VLBW infants can be adequately cared for in this sparsely populated region of Norway.

Babygard infant transport.

Historically in Australia, neonatal transport teams consisted of a physician training in pediatrics and a retrieval nurse. Even though nurse practitioners (NP) are used more commonly in retrieval services internationally, there is limited information about the effectiveness of the NP model of care in the neonatal emergency retrieval setting. In response to a key strategic goal by the management team, our regional pediatric emergency transport service introduced a retrieval NP into our neonatal emergency service team. This study evaluated the outcomes and satisfaction levels of an NP model of neonatal emergency retrieval.

Changes in management of severe respiratory failure in mature and near mature newborns during stabilization for emergency neonatal transport : 1991-1996. 920

Objective: To document changes in management of severe respiratory failure in mature and near mature newborns during stabilization for transport and respiratory status on admission to the NICU. Design and setting: Retrospective cohort study. A regional NICU in a children's hospital. Population: Newly born neonates (≥ 35 weeks gestation, postnatal age < 48 hours) with severe respiratory failure stabilized by our regional neonatal transport team who required a FiO2 ≥ 0.60 on admission to our NICU. Newborns with congenital anomalies of the heart and lungs were excluded. Outcome measures: The use of several treatment strategies(hyperventilation, sedation with morphine, muscle relaxation, volume expansion, inotropic support, surfactant, sodium bicarbonate) and respiratory status (pH, PCO2, oxygenation index ≥ 25) on admission to our NICU were compared between two prospectively defined periods: 1991-93 (n = 181) vs 1994-96 (n = 139). Table Conclusion: There is no improvement in oxygenation index on admission to our NICU despite less hyperventilation and other changes in management which might enhance oxygenation.

Prise en charge des nouveau-nés maternité par un service de réanimation néonatale

Background. — Although in utero transfer seems actually the safest option when risk factors are identified, specialized transport teams remain important to consider for the neonatal overall management. Subjects. — From January 1988 through December 1992,692 transports of 838 neonates were prospectively studies to determine effectiveness and safety of the Hospital Lenval's neonatal transport team. Results. — Neonatal transport were required respectively for prematurity (46.4%), acute fetal distress (13.8%), respiratory distress (10.1%), intrauterine growth retardation (7.8%), multiple pregnancies (5.2%), perinatal asphyxia (3.1%) and life-threatening congenital abnormalities (2%). Pediatric assistance was unplanned in most of the cases (80%). Assistance with a pediatrician before delivery was performed more frequently (70%) for premature babies (mean gestational age 34.1 ± 3.1 wk) delivered by cesarean section in 66.4% of the cases: in this group, delivery room resuscitation was less aggressive. Assistance was performed after delivery less frequently (30%), approximately in one-half of the cases for neonatal distress: respiratory (33.9%) or neurologic (17.1%); in this group, delivery room resuscitation was more aggressive. In transit, ventilation support via endotracheal intubation was given to 17.9% of the babies. Neither death nor heavy complication occurred during transport. On arrival in the neonatal intensive care unit, hypothermia was noted in 9.6% of the cases, hypotension in 4.3%, hypoglycemia in 13.1% and metabolic acidosis in 10.4%. In our series, the overall mortality rate was 6%, and incidence of neurologic damage 3.3%. Conclusion. — A skilled person in neonatal resuscitation available at every referring maternity and regional high-risk obstetric/neonatal combined centre are two recommendations which could provide improved neonatal management.

Pediatric and neonatal critical care transport: A comparison of therapeutic interventions

To compare the therapeutic interventions provided to newborn and pediatric patients by a dedicated combined neonatal pediatric critical care transport team. From November 1987 through December 1989 we prospectively compared the number of therapeutic interventions performed by the critical care transport team on newborns and pediatric patients. The transport team (critical care physician [PL3 or greater], pediatric respiratory therapist, critical care nurse), recorded all therapeutic interventions, including both procedural and pharmacologic, for 213 newborn and 149 pediatric consecutive transports. Data were analyzed by analysis of variance or chi 2 statistic. All patients were admitted to either the pediatric or the neonatal intensive care unit, and over 80% of both age groups received assisted ventilation. Newborns commonly suffered from respiratory diseases (159/213), while pediatric patients suffered from respiratory (52/149), central nervous system (28/149), and traumatic conditions (37/149). Airway maintenance procedural interventions (intubation, ventilation) were the commonest in both groups, although more frequent in neonates. Neonates received antibiotics and morphine (P < 0.05) while pediatric patients received anticonvulsants and respiratory drugs (P < 0.05) more frequently. Newborns received significantly more interventions than pediatric patients (average 3.56 vs 2.93, P < 0.05). Newborns also received significantly more procedural interventions (2.06 vs 1.36, P = < 0.05) including intubation (34.7% vs 15.4%, P < 0.05) and the initiation of mechanical ventilation (38% vs 22%, P < 0.05). Overall, newborns received more interventions, including intubation, and ventilation from the transport team than did pediatric patients. Our data suggest that combined pediatric neonatal transport teams should be prepared to intervene in a wide range of conditions from preterm respiratory distress to the multiply traumatized adolescent.

Formation of a neonatal transport team.

Formation of a neonatal transport team.