Transport of Critically ill Newborn – Everything You Need to Know by Dr Lathiesh Kumar Kambham

• Premature babies and newborns with emergency health conditions require neonatal transport.
• These kinds of medical transportation include inter-hospital shifting of sick neonates because of the unavailability of the apparatus.
• Most of the transports are in utero transports. These are the precautionary steps to avoid perinatal complications in babies, especially in rural and unequipped hospitals.
• In utero transports are also suggested for women with anticipated preterm deliveries.
• However, not all cases are the same. Sometimes, the doctors might encounter unexpected perinatal complications in newborns, which calls for immediate neonatal transport.
• Premature babies with respiratory problems like Respiratory distress syndrome (RDS), with no ventilator and oxygen support, are in need of transport.
• While transferring neonates with morbidities, one should follow all the necessary precautions.

[Read : Common Health Issues of Premature Babies]

Two Types of Transport of Critically Ill Newborn

There are different types of neonatal transport.

1. Inter-Hospital Neonatal Transport

• Inter-hospital neonatal transport is for neonates with emergency health conditions like increased postpartum problems, and unplanned premature births.
• Outborn premature babies or very early premature babies born with no access to any sort of facilities will require this mode of transport.
• Babies with severe respiratory distress syndrome and secondary health conditions may also require inter-hospital neonatal transport.
• The lack of optimal equipment needed for emergency care may demand inter-hospital neonatal transport. Any other special care requirements (specialist opinions) can call for inter-hospital neonatal transport.

2. Intra-Hospital Neonatal Transport

• Intra-hospital neonatal transport is a requirement if the baby’s condition calls for special care like NICU and specialist care treatments. The doctors may transport the baby from the ward to specialist neonatal care till recovery.
• Home to hospital neonatal transports is required if the baby is delivered at home and there is postpartum morbidity. Such conditions may call for immediate hospitalization.
• Post-care neonatal transport is for babies who are returning from specialist care and are good to go back home.

Top 5 Ways to Prepare a Baby For Neonatal Transport

Newborns are very tender and require special treatment. Sick neonates are more vulnerable to catching infections. Hence, it is vital to take proper precautions before neonatal transport.

It includes a few mandatory steps and arrangements in the vehicle, trained nursemaids, and fellow doctors to look after the baby carefully during the transportation.

Carrying a sick baby also calls for an emergency trained doctor who knows to incorporate CPAP and emergency cardiac troubles. Here are a few steps on how to prepare a baby for neonatal transport.

1. Communicate With Specialists and Parents

Keep your communication with the specialists of the destined hospital. Keep the parents and doctors informed and update the baby’s condition once you reach the destination. NICU specialists must have prior information about the baby’s arrival to keep the equipment ready for the treatment.

2. Temperature Maintenance

Maintaining an optimal temperature before transferring a sick neonate is as vital as giving critical care treatment. Since they are especially vulnerable and many neonatal mortalities occur due to improper temperature maintenance, providing the right temperature is mandatory.

Temperature-controlling transport incubators may help during neonatal transport. Kangaroo mother care and skin-to-skin contact can also help babies stay warm if the transport incubators are not available. Using polythene covers or polystyrene (thermocol) boxes is an ideal way to maintain warmer temperatures for the baby.

[Read : Kangaroo Mother Care For Newborn Babies]

3. Regular Blood Sugar and Blood Pressure Levels

For hypoglycemic babies, it is vital to correct the sugar levels before transport. Check and monitor the sugar level before transferring the baby into the vehicle and try to balance it beforehand. Check the blood pressure and heart rate. Analyze and note if the baby is on any cardiac medication and keep them ready before transport.

4. Check For Breathing

It is important to examine the airway openings in sick babies with severe respiratory distress syndrome. Keep the ET intubation ready before moving the baby into the vehicle.

5. Put the Baby on Parenteral Nutrition.

It is fine if the baby is ready to take the breast milk, but it is more ideal to put a sick neonate on intravenous fluids than breastfeeding. However, if the baby is fine with breast milk, controlled spoon feeding along with IVF can be helpful.

[Read : Spoon Feeding a Newborn]

How to Organize Transport of Critically Ill Newborn?

It is vital to organize a neonatal transport system well before moving the baby into it. There are a few points to look into and organize a proper neonatal transport system.

1. Stabilize the Baby

Well, this is the first and foremost step before moving the baby into the vehicle. Ensure to check and note the Sugar, Temperature, Artificial breathing, Blood pressure, Laboratory work, and Emotional support (STABLE). Correct the abnormalities like hypothermia, hypoglycemia, and oxygenation before transport.

2. Equip the Transport System With All the Requirements

Here are a few vital needs that a neonatal transport system needs.

• Power backup to ensure the uninterrupted working of the incubator, ventilator, and other monitoring equipment.
• Availability of fully charged equipment, for uninterrupted service. It is also helpful during emergencies.
• Filled oxygen tanks and air tanks are mandatory.
• Disposables like needles, masks, cotton, catheters, and feeding tubes are a must.
• Emergency medications.
• Endotracheal intubation tubes, to ensure the airways are open in case of severe Respiratory distress syndrome in sick neonates.
• Transport incubators or warm clothing that avoids conditions like hypothermia. Ignoring this can lead to neonatal mortality because of the rapid temperature loss.
• A well-maintained vehicle or ambulance with enough space to fit and fasten the incubator and other equipment like ventilators, oxygen cylinders, and output monitors.

3. Staff and Medical Professionals

Some medical experts and staff  that a neonatal transport must include are

• A doctor who is also an expert in dealing with neonatal emergencies and sudden respiratory and cardiac troubles.
• A neonatologist to explain and look out for the health of a sick newborn.
• An executive to maintain proper communication between the two hospitals and the specialist doctors.
• Nurses who are specialists in neonatal care, a secondary emergency doctor, and an anesthetist must be there in case of prolonged and traffic-interrupted journeys.

It is vital to have mini emergency care and to build a mini NICU with all the required equipment to treat the baby during transport. The baby may need all this and sometimes more like emergency care during transportation. Along with the emergency care trained nurses, anesthetists, and specialized doctors, one of the parents or a family member must be allowed during transport.

What Care Needs to be Given During Transport of Critically Ill Newborn?

Here are some care and precautionary steps to take during neonatal transport.

• Sick neonates must have continuous ventilator support in the case of extreme breathing issues.
• Check if the baby is getting the right amount of oxygen. A pulse oximeter can help analyze the levels of oxygen in the blood
• It is also vital to take note of any discoloration, like the baby turning blue due to the lack of oxygen (cyanosis).
• Evaluating and stabilizing the passage of fluids inside the body is the vital step to take before moving the baby into the vehicle. It will control blood pressure and other cardiac emergencies.
• Emergency cardiac medications to analyze the heartbeat are mandatory during transport.
• It is essential to provide warm clothing and provide a warm environment for the baby to avoid hypothermia.
• Temperature control is particularly important, and this can also include kangaroo mother care.
• Proper oxygenation and placing the baby in an elevated neck position to get adequate breathing are vital.
• Emergency CPAP incorporation is for severely sick RDS babies.

What Situations Need Special Precautions During Neonatal Transport?

There are a few situations that may require special precautions during transport.

• Babies with severe respiratory distress syndrome may need to be on continuous ventilation support. For this, a well-organized transport system with power backup and plugins for output monitor is very much important.
• Proper ventilation and oxygenation can help in controlling secondary health conditions like apnea and hypoxemia.
• Endotracheal intubation helps open the airways and acts as breathing assistance, and this can help avoid emergencies in babies with congenital heart diseases, RDS, and repeated seizures.
• Conditions like esophageal atresia and air leak syndromes may also require special care during the transport and require proper care and stabilization before transportation.
• Maintaining a sufficient oxygen supply can help keep the baby stable in such conditions.

It may be overwhelming to see your baby being taken away from you right after birth, especially in an ambulance. But parents and family must understand that the staff and the neonatal specialists work on helping the baby thrive and stay healthy.

Neonatal transport is a safe way to shift the baby to an exclusive special care unit where the probability of getting better treatment is higher. With all the precautions and required equipment, successful transport of critically ill newborn is possible.

FAQ’s

1. Can NICU Babies be Transferred?

A baby can be transferred to another specialist care center even if they are in NICU. This process is called Neonatal Transport which consists of all the required treatment equipment that a baby might need during the transport.

2. How Do You Move a Baby From The NICU?

By taking required precautions like stabilizing the baby, the doctors can move the baby from the NICU for transport.

Read Also: Caring For Your Baby in NICU by Dr Lathiesh Kumar Kambham