Neonatal Transport Research Articles

Noise exposure exceeded safe limits during neonatal care and road transport but was reduced by active noise cancelling.

Noise levels above 45 dB in a neonatal intensive care unit (NICU) and 60 dB during neonatal transport are recognised hazards, but protective equipment is not standard. We measured noise levels in both settings, with and without noise protection. Peak sound and equivalent continuous sound levels were measured in a NICU and during road transport, at a mannequin's ear and inside and outside the incubator. Recordings were made without protective earwear, with noise protecting earmuffs and with active noise cancelling headphones. In the NICU, the peak levels at the ear, and inside and outside the incubator, were 61, 68 and 76 dB. The equivalent continuous sound levels were 45, 54 and 59 dB. During road transport, the respective levels were 70, 77 and 83 dB and 54, 62 and 68 dB. In the NICU, 80% of environmental peak noise reached the ear and this was reduced to 78% with earmuffs and 75% with active noise cancelling. The respective figures during transport were 87% without protection and 72% with active noise cancelling, with an unexpected increase for ear muffs. Noise levels exceeded safe limits in the NICU and during transport, but active noise cancelling reduced exposure.

Treating Specialty Patients on the Western Frontier

The Kite Flight specialty transport program provides neonatal, pediatric, and obstetric transports across West Texas and Eastern New Mexico. Supplementing local ground and air medical services in the region, Kite Flight has grown services by over 500% in under 3 years. Providing enhanced services to the patients in the region, through provider education and transport, our goal is to improve outcomes for our vulnerable patient populations.

Compliance with the Golden Hour bundle in deliveries attended by a specialized neonatal transport team compared with staff at non-tertiary centres.

Preterm infants born at <32 weeks gestational age (GA) have increased morbidity if they are born outside tertiary centres (outborn). Stabilization and resuscitation after birth consistent with the neonatal Golden Hour practices (NGHP) are required to optimize outcomes. To evaluate physiological outcomes of hypothermia and hypoglycaemia, and compliance with NGHP by neonatal transport team (NTT) compared with referral hospital team (RHT) during the stabilization of infants born at <32 weeks GA. A retrospective case-control study of infants born at <32 weeks GA during 2016-2019 at non-tertiary perinatal centres where the NTT attended the delivery (cases) were matched to infants where the RHT team attended the delivery (controls). During the 4-year period, NTT team received 437 requests to attend deliveries at <32 weeks GA and attended 76 (17%) prior to delivery. These cases were matched 1:1 with controls composed of deliveries attended by the RHT. The rate of hypothermia was 15% versus 29% in the NTT and RHT groups, respectively (P = 0.01). The rate of hypoglycaemia (<2.2 mmol/L) was 5% versus 12% in the NTT and RHT groups, respectively (P = 0.64). For compliance with the NGHP, use of fluid boluses was 8% versus 33%, use of thermoregulation practices, that is, plastic bag, was 76% versus 21%, and establishment of intravenous access was 20 min versus 47 min, in the NTT and RHT groups, respectively. High-risk preterm deliveries attended by the NTT compared with the RHT had increased compliance and earlier implementation of the NGHP elements, associated with improved physiological stability and lower hypothermia rates. Outreach education for RHT should ensure that these key elements are included during the training in the stabilization of high-risk preterm deliveries.

Structured Referral Call Handling Process Improves Neonatal Transport Dispatch Times.

In 2019 the Southern Alberta Neonatal Transport Service adopted a transport call handling process change to expedite transport team mobilization. This study compares the impact of this change on neonatal transport decision to dispatch and mobilization times. This retrospective cohort study was conducted using a historical cohort of neonates referred for transportation between January 2017 and December 2021. The "dispatch time" (DT) was the time from the start of consultation to the time a decision to dispatch the transport team was made, whereas "mobilization time" (MT) referred to the time from start of consultation to the time the team departed the home base. In 2019, a DT target of <3 minutes was implemented to meet a target MT of <15 and <30 minutes for emergent and urgent high-risk transport referral calls, respectively. In 2021 use of the "Situation" component of the SBAR (Situation, Background, Assessment, Recommendation) communication tool was introduced with the transport team asking five questions to determine need for mobilization. Data between 2017 and 2018 represented the preintervention period, 2019, the "washout" period for implementation, and 2020 to 2021, the postintervention period. Data were analyzed to determine trends in DT and MT. The DT was reduced from a median of 5 to 3 minutes following intervention (p < 0.001). DT target goal of 3 minutes was achieved in 67.08% of calls compared with 26.24% in the preintervention period, (p < 0.001). The team achieved MT target goals in 42.71% of urgent and emergent transfers compared with 18.05% prior to intervention (p < 0.001). Introduction of a time-sensitive referral call handling process improved dispatch and mobilization time of the neonatal transport team. · Time-sensitive triaging of neonatal transport referrals improves dispatch and mobilization time.. · A structured referral call handling process improves the efficiency of neonatal transport decision-making.. · Dedicated neonatal transport vehicles are likely to improve neonatal transport mobilization time..

Consideration of Regional Differences While using Kangaroo Mother Care During Neonatal Transport

Consideration of Regional Differences While using Kangaroo Mother Care During Neonatal Transport

Long-distance transfer of unwell neonates: A case series.

The Northern Territory Neonatal Emergency Transport Service (NETS NT) pilot was created in April 2018 to expedite the transfer of critically unwell neonates to specialised interstate centres. The aim of this paper is to describe long-distance retrievals undertaken during the first 3 years of operation of the service. A case series is described comprising neonates requiring long-distance aeromedical transfer (>2500 km) by NETS NT between April 2018 and June 2021. Data were obtained from hospital and transport service documentation. This was supplemented by four semi-structured interviews with transport staff. Thirty neonates were transferred via NETS NT during the investigation period, including 19 transfers >2500 km. Of these, 18/19 (94.7%) required respiratory support, 8/19 (42.1%) were intubated and 4/19 (21.1%) required inotropic support. The average length of transport was 7.5 h (5.6-8.9). Twelve patients had in-flight documentation available. Eight required increased oxygen administration 8/12 (66.6%). The median change in FiO2 was an increase of 0.02 (-0.05 to 0.45). The NETS NT has been successfully established to transport high-risk neonates to interstate quaternary health services when required. Future recommendations for the service include ongoing implementation of systems and processes to strengthen all aspects of governance and operations using suitably adapted resources from established Australian retrievals services.

Social and Structural Determinants and Health Outcomes in Neonatal Transport

Social and Structural Determinants and Health Outcomes in Neonatal Transport

The Go Sheet: Evaluation and Implementation of a Tool for Mass Neonatal Transport

The Go Sheet: Evaluation and Implementation of a Tool for Mass Neonatal Transport

Evacuating Premature and Critically Ill Neonates When Hospitals are Endangered by Disasters: A Case Study of the PANDA Team Evacuation of a Neonatal Intensive Care Unit During Severe Wildfires in Oregon, USA

Introduction:In September 2020, severe wildfires in Oregon (USA) came dangerously close to Hospital A. The entire county was under evacuation orders. The Neonatal Intensive Care Unit (NICU) at Hospital A needed to evacuate patients to other areas for safety, however the characteristics of premature and critically ill neonates required a specialized transport team. This presentation outlines a case study of how the Pediatric and Neonatal Transport team (PANDA), based at Oregon Health and Science University (Portland, Oregon, USA), responded to evacuate neonatal and infant patients to other metro area NICUs during the wildfires.Method:Case study.Results:During a six-hour period, both PANDA transport teams on shift were activated to complete back-to-back transports of neonates and infants by ground ambulance to fire safe locations. Each patient was transported by a PANDA Registered Nurse and PANDA Respiratory Therapist, with an Emergency Medical Technician who drove the ambulance and Medical Control available by phone. The PANDA team normally operates in non-disaster settings. This was the first time PANDA was activated to evacuate patients from a hospital during a disaster. This presentation will discuss lessons learned and implications for future practice.Conclusion:Wildfire frequency and severity is predicted to increase due to climate change. Evacuation of premature and critically ill neonates requires a specialized transport team due to patient size, weight, and other considerations. Specialized transport teams should develop disaster evacuation workflows and resources, and regularly practice for these events. There is also a need for trauma-informed care in the post-evacuation setting to transport staff and parents of patients who were unable to travel with their child during transport. A full team pre-transport risk assessment is crucial in these circumstances.

Interventions for supporting parents of infants requiring neonatal inter‐hospital transport: A systematic review

AbstractBackgroundNeonatal inter‐hospital transport is associated with heightened stress for parents whose needs may remain unmet around this time.AimTo identify interventions which are used to support parents whose infants require neonatal inter‐hospital transport.Study DesignA systematic literature review approach was used. Six online databases (CINAHL, EMBASE, EMCARE, Medline, PsycINFO, Web of Science) were searched up to February 2022. The eligibility criteria included interventional studies published in the English language. Methodological quality was assessed by the Critical Appraisal Skills Programme checklists. Data were extracted using a predefined framework and synthesized narratively because of heterogeneity of reported outcomes.ResultsA total of 671 articles were screened, with five meeting the eligibility criteria. Three interventions were reported within the five studies: a communication‐based intervention before transport represented by 223 parents in one study, Kangaroo Care during transport, which was carried out with 136 infants in three studies, and video calls after transport evaluated by one study in seven parents versus a control group. The effectiveness of the interventions could not be reliably determined. Neonatal nurses were the main providers of all the interventions pre‐, peri‐, and post‐transport.ConclusionsLimited evidence of mixed quality and inconsistent outcome measurements is available. Future research should focus on developing a contemporary intervention, determining the optimum timing for its implementation, and evaluating it using a robust study design.Relevance to Clinical PracticeNeonatal nurses need to be aware of the importance of their role in supporting parents through the distressing time of neonatal transport.

A two-year retrospective study of the neonatal emergency transport service in Northeast Italy

Background Some newborns require acute transport to a Neonatal Intensive Care Unit (NICU) due to unpredicted or unpredictable reasons. Objective To describe the activity of the Neonatal Emergency Transport Service (NETS) in Northeast Italy. Methods An observational retrospective study was performed between 1 January 2018, and 31 December , 2019. Results A total of 133 transports were collected, with a neonatal transport index of 1.4%. Infants ≤2500 grams were more frequently transferred by NETS than those in the normal group (n = 34/563, 6.0% vs. n = 99/8,437, 1.2%; p < .001). The incidence of preterm birth among transferred newborns was 42/133 (31.6%). For the newborns with >2500 grams, there was a low incidence of a cesarean birth compared to vaginal delivery (23.2% versus 63.5%; p = .001), while the percentages were reversed in the group of infants ≤2500 grams (67.7% versus 20.6%) (p = .001). Infant stabilization time was higher in the underweight group compared to those weighed >2500 grams (31.5 versus 23.0 min; p < .001), as well as the median length of stay in NICU (18.0 versus 8.0 days, respectively, p < .001). The group of infants ≤2500 grams received more intravenous therapy (47.1% vs. 26.2%) and invasive ventilation (26.5% vs. 8.1%), compared to the group of infants who weighed >2500 grams. Conclusions This study described a local reality by showing the characteristics of the neonatal transports that took place in a metropolitan area in Northeast Italy. Wider database is necessary to achieve a better knowledge in the field of perinatal outcomes.

Comparing Three Methods of Therapeutic Hypothermia Among Transported Neonates with Hypoxic-Ischemic Encephalopathy.

Hypoxic-ischemic encephalopathy (HIE) and associated multiorgan injury are significant causes of morbidity and mortality in term and near-term neonates. Therapeutic hypothermia (TH) is the current standard of care for neuroprotection in neonates with HIE. In our experience, the majority of babies born with HIE were found in nontertiary care facilities in our region, where effective methods of cooling during transport to tertiary care centers are desirable. Most centers initiate passive TH at referral hospitals, while active cooling is typically initiated during transport. The objective of this study was to evaluate the effectiveness of three methods of cooling during transport of neonates with HIE in southern Alberta. In this prospective cohort study, 186 neonates with HIE were transported between January 2013 and December 2021. Among the 186 neonates, 47 were passively cooled, 36 actively cooled with gel packs, and 103 cooled with a servo-controlled cooling device. The clinical characteristics were comparable for the three groups, with no difference in adverse events. Fifteen neonates (8%) died and 54 neonates (29%) suffered radiologically determined brain injury. Servo-controlled cooling was found to be superior to other methods in maintaining a target temperature without significant fluctuation during transport and with temperature in the target range on arrival at tertiary care facilities. The rate of overcooling was also lower in the servo-controlled group compared with other groups. There were no statistically significant differences between the groups in relation to mortality and brain MRI changes associated with HIE. Adjusting for GA, 10-minute Apgar score, base excess, HIE stage, and need for intubation during transport, passive cooling increased the odds of temperature fluctuation outside the range by 12-fold and gel pack cooling by 13-fold compared with servo-controlled cooling. The use of servo-controlled TH devices should be the preferred practice wherever feasible. (REB17-1334_REN3).

Assessment of neonatal referral infrastructure and clinical characteristics of referred neonates in three first referral hospitals in Nairobi County, Kenya

Background Almost one in five newly born babies in Nairobi County, Kenya, may need some form of inpatient neonatal care. Prior work showed many facilities are inadequately prepared to provide sick newborn care, however, only 16.6% of babies from facilities were referred to a better-equipped facility. We sought to examine referrals to and from three busy first-level referral public hospitals in Nairobi and what infrastructure and systems are available to support neonatal transport from these first-referral level hospitals to the main tertiary care center. Methods Patient-level data of newborns over 13 months were retrospectively abstracted from routinely collected patient data and examined to characterize those referred into and out of three newborn units in the study hospitals. Structural assessments using a checklist completed during hospital visits were used to describe hospitals’ readiness to support newborn referral and transport. Results Five percent (398/7720) of the cohort studied were referrals either out or to the hospitals. 68% (272/398) were referred to these hospitals. A majority (397/398) and two-thirds (268/398) of patients had their sex and gestation age documented respectively. Among both referrals in and out, 63% (251/397) were male and 44% (118/268) were preterm infants. Among those referred in, 26% (69/272) died and 2.6% (7/272) were further referred to a tertiary-care newborn unit in Nairobi County. Equipment, drugs, and medical supplies needed to provide safe in-transit care in the ambulance, including oxygen and infant warmers were unavailable. Conclusion Neonatal transport from first-referral hospitals to the tertiary center in Nairobi County is poor and likely to be unsafe for newborn transfer services. This jeopardizes their well-being and survival. There is a need to develop, equip and maintain a high-quality referral and newborn transport system which can support the continuum of newborn care across referral care pathways into and from first-referral level hospitals.

Capnometry during neonatal transport-Mini review.

The aim of this review was to give an overview of available data on end-tidal CO2 (etCO2 ) monitoring, also called capnometry, during neonatal transport. Pubmed/MEDLINE database was searched using research question (capno* OR etCO2 OR detCO2 OR (['end tidal' OR 'end-tidal'] AND [CO2 OR 'carbon dioxide']) AND (neonat* OR infant* OR newborn*) AND transport*). All articles relevant to the topic were reviewed and summarised. The lack of studies relevant to neonatal transport prompted us to extend the search to capnometry in a neonatal intensive care setting. The published studies are showing conflicting results. The different study populations, technologies used to measure etCO2 , types of etCO2 sampling and the diverse sites of blood gas tests make the data unsuitable for systematic comparison. Further research to obtain more data on capnometry during neonatal transport will be necessary to define precisely under what circumstances can end-tidal monitoring of CO2 be reliably used in neonates during transport and also how to interpret the measured values.

Primary neonatal and pediatric ECMO transport: First experience in Spain.

The organization of primary Extracorporeal membrane oxygenation (ECMO) transport is highly variable. To present the experience of the first mobile pediatric ECMO program in Spain, we designed a prospective descriptive study of all primary neonatal and pediatric (0-16years) ECMO transports carried out over 10years. The main variables recorded include demographic information, patient background, clinical data, ECMO indications, adverse events, and main outcomes. 39 primary ECMO transports were carried out with a 66.7% survival to hospital discharge. The median age was 1.24months[IQR: 0.09-96]. Cannulation was mostly peripheral venoarterial (33/39). The mean response time from the call from the sending center to the departure of the ECMO team was 4h[2.2-8]. The median inotropic score at the time of cannulation was 70[17.2-206.5], with a median oxygenation index of 40.5[29-65]. In 10% of the cases, ECMO-CPR was performed. Adverse events occurred in 56.4%, mostly related to the means of transport (40% overall). On arrival at the ECMO center, 44% of the patients underwent interventions. The median PICU stay was 20.5days[11-32]. 5 patients developed neurological sequels. Statistically significant differences between survivors and deceased patients were not found. A good survival rate, with a low prevalence of serious adverse events, suggests a clear benefit of primary ECMO transport when conventional therapeutic measures are exhausted and the patient is too unstable to undergo conventional transport. A nationwide primary ECMO-transport program must therefore be offered to all patients regardless of their location.

A Multicenter Survey of Pediatric-Neonatal Transport Teams in the United States to Assess the Impact of the Coronavirus Disease 2019 Pandemic on Staffing

ObjectiveThe coronavirus disease 2019 pandemic has resulted in unprecedented burnout in frontline health care providers. However, the impact of the pandemic on interfacility pediatric and neonatal transport team members has not been studied. The current study uses a survey design to document the impact of the pandemic on pediatric and neonatal transport team members with a focus on staffing and resilience promotion strategies. MethodsData for this study came from a short cross-sectional survey distributed to members of the American Academy of Pediatrics Section on Transport Medicine. ResultsSixty-six teams responded (around 45%). Forty-one respondents (62%) reported vacancies on their transport teams, with 35 (53.8%) reporting more vacancies during the pandemic. Forty percent of highly trained registered nurses and respiratory therapists from specialty teams left their positions for those with better compensation during the pandemic. Forty-two percent of respondents were not trained to recognize burnout, stress, or compassion fatigue. ConclusionOur study shows that half of the respondents had more vacancies during the pandemic than in previous years and reported difficulty in filling those positions. We were unable to link the vacancies to the pandemic and burnout because hospitalizations and transports in the pediatric facilities decreased during the pandemic; however, we do report that coronavirus disease 2019 exposure before the vaccine was a source of stress for team members. There are opportunities to improve the identification of burnout and to foster resilience and boost retention of this highly skilled niche workforce.

Use of access port covers in transport incubators to improve thermoregulation during neonatal transport

Hypothermia in newborns increases the risk of health complications and mortality. This study aimed to evaluate the effectiveness of using covers over snap-open access ports of a transport incubator to maintain the temperature within. The change in temperature inside the transport incubator was evaluated over a 15-min period at three ambient room temperatures (20 °C, 24 °C, and 28 °C), as well as for three snap-open access port conditions: closed, where ports are closed; open, where the two ports on one side are open; and covered, where the two ports on one side are open but a cover is used. The automatic temperature control of the incubator was set to 37 °C for all conditions. We repeated the same experiments three times. The temperature decrease inside the incubator was greater for the open than for the closed or covered access port conditions at all three 4 °C-increasing room temperatures (p < 0.05). The incubator temperature decreased as a function of decreasing room temperature only for the open condition, with no significant difference between the closed and covered conditions. Therefore, snap-open access port covers provide an option to maintain a constant temperature within the transport incubator, which may lower the risk of neonatal hypothermia.

Assessment of the neonatal referral and transport system for patients with gastroschisis in Kenya

To assess the neonatal referral and transport system for gastroschisis patients referred to a tertiary level hospital in Kenya. This was a prospective cross-sectional study carried out at Kenyatta National Hospital (KNH) which recruited patients with gastroschisis using consecutive sampling approach. Data were collected on pre-, intra-transit factors, time and distance covered. Assessment was done using pre and intra transit factors as per the standard transport protocols in literature. Twenty-nine patients presented with gastroschisis during the eight month study period. Mean age was 7.07h. There were 16 (55.2%) males and 13 (44.8%) females. Mean birthweight was 2020g, and a mean gestational age of 36.5weeks. Mean duration of transit was 5h. Mean distance from referring facility was 153.1km. Most affected factors in the pre-transit protocol were lack of monitoring chart (0%), comment on blood investigations (0%), gastric decompression (3.4%), and prenatal obstetric scan (44.8%). For intra-transit scores, most affected were incubator use (0%), bowel monitoring (0%), functioning nasogastric tube (13.8%), and adequate bowel cover (34.5%). This study demonstrates that pre-transit and transit care of neonates with gastroschisis is inadequate in Kenya. Interventions needed, as identified by this study, to promote care of neonates with gastroschisis are advised.

Clinical profile of low-birth-weight neonates admitted in NICU: a tertiary care hospital-based study

Background: LBW is defined as weight at birth less than 2.5kg irrespective of gestational age. LBW neonate remains at much higher risk of morbidity and mortality than normal birth weight baby. Morbidity and mortality among LBW babies are a major health problem in our country, so it’s important to identify risk factors. Methods: A prospective observational study was conducted on 153 extramural LBW neonates admitted in Neonatal intensive care unit of civil hospital, BJ medical college Ahmedabad from April 2021 to January 2022. Results: Out of 153 neonates, 94 (61.4%) were preterm, appropriate for gestational age and 59 (38.6%) were small for gestational age including 41 (26.8%) term and 18 (11.8%) preterm. 16 (10%) were extremely LBW neonates and 28 (18%) were very low birth weight neonates. 77 (53%) neonates were late preterm and term gestational age. Most common indication of NICU admission was respiratory distress syndrome in 53 (27.8%) followed by sepsis 35 (18.4%), neonatal hyperbilirubinemia 22 (11.6%), birth asphyxia 15 (7.8%) and prematurity+LBW 16 (8.4%). Conclusions: Majority of LBW babies were preterm AGA babies. Respiratory distress syndrome, sepsis, birth asphyxia, prematurity and neonatal hyperbilirubinemia are major causes of admission. While, Respiratory distress syndrome, sepsis and birth asphyxia were common causes of expires. Respiratory distress syndrome is most common cause of morbidity and mortality in low-birth-weight babies. Appropriate and effective use of oxygen delivery system, surfactant, safe, early and effective transportation of neonates should be advised.

Pre-/perinatal reduced optimality and neurodevelopment at 1 month and 3 years of age: Results from the Japan Environment and Children's Study (JECS).

Neurodevelopmental disorders (NDDs) in children are associated with a complex combination of genetic and/or environmental factors. Pre-/perinatal events are major known environmental suboptimal factors, and their individual and combined contributions vary. This study investigated the association between pre-/perinatal reduced optimality and child development observed by parents at 1 month, as well as NDDs at 3 years of age (i.e., motor delay, intellectual disability, developmental language disorder, and autism spectrum disorder), in the context of the Japan Environment and Children's Study. The study also assessed whether child development at 1 month predicted NDDs at 3 years of age. Associations between 25 pre-/perinatal factors and (a) developmental concerns at 1 month of age and (b) NDDs at 3 years were analyzed (n = 71,682). Binomial regression models were used to investigate risk ratios of the developmental outcome at each time point for total pre-/perinatal reduced optimality scale scores, as well as for individual pre-/perinatal factors of the reduced optimality scale. Finally, we assessed the ability of parental observations of offspring development at 1 month to predict NDDs at 3 years. Total reduced optimality scores were positively associated with 1-month developmental concerns and 3-year NDDs, with higher scores (i.e., a reduction in optimality) associated with an increased risk of both NDDs and earlier parental concerns. Neonatal transportation, epidural analgesia, advanced maternal age, cesarean section delivery, Apgar score ≤8, and hyperbilirubinemia were identified as individual risk factors for 3-year NDDs, overlapping with 14 risk factors for 1-month developmental concerns except Apgar score ≤8. Among six developmental items assessed at 1 month of age, concerns about gross motor function and difficulty holding/trouble calming down had the strongest associations with later-diagnosed motor delay and autism spectrum disorder, respectively. Five perinatal factors and advanced maternal age were associated with NDD at 3 years of age, as were early parental developmental concerns regarding their offspring's overall development, indicating the importance of careful follow-up of offspring born with pre-/perinatal reduced optimality. The results also implicated early parental concerns, as early as 1 month, may also be a useful indicator of later NDD status.