NEONATAL TRANSPORT (PROF. DR CHAKRADHAR MADDELA)

NEONATAL TRANSPORT

1. NEONATAL RESUSCITATION WORKSHOP –
NEONATAL TRANSPORT
ORGANISED BY DEPARTMENT OF
PAEDIATRICS
(DIVISION OF NICU)
Prof.Dr ChakradharMaddelaNeonatologist
“AADVIDYA” 28/08/24, MNR MEDICAL COLLEGE MNR
UNIVERSITY CAMPUS, SANGAREDDY TELANGANA INDIA

2. NEONATAL TRANSPORT -BACKGROUND
Anticipating High risk deliveries is not always possible
In utero transfer is the best but always not feasible
High risk neonatal transfer by self transport or in ill-equipped
ambulance often results in clinical & metabolic deterioration, Multi
organs dysfunction and failure
HR neonatal transport in dedicated well equipped ambulance (NTS)
yields better clinical outcomes
Common clinical deterioration include development of hypoxia
acidosis hypothermia hypotension shock hypoglycaemia and
shock.

3. NEONATAL TRANSPORT-TYPES
Types of neonatal transport:
❖Home to health care centre ( home deliveries)
❖Intra-hospital transport (delivery room to NICU)
❖Inter-hospital transport-for specialist care services –cardiac,
neurological, surgical etc
❖Retrieval and reverse transport between level 1 –2 to level 3 –4
NICU units (to & from transport)
❖ROAD TRANSPORT/ AIR TRANSPORT (FIXED WING PRESSURISED
AIRCRAFT OR UNPRESSURISED HELICOPTER)
❖NEONATAL TRANSPORT TEAM : Neonatal fellow, Neonatal nurse,
GNM-ANM, RESPI-THERAPIST, Ambulance crew & Team leader

4. MEDICAL EQUIPMENT & DRUGS
Well equipped ambulance with
Two O2 cylinders Inverter Portable Power generator, Rails &
fixations, Fastening belts for equipment, Electric power adapters &
sockets, Permissible noise & vibration, Thermal control & infection
control, safe to measures & insurance for all passengers.
Special equipment: Neonatal transport incubator, vital monitoring
devices, resuscitation equipment, NIBP, transport ventilator,
glucometer, ABG, Thermometer, suction (battery & manual) &
syringe pumps
DRUGS: IV fluids –0.9%NS, RL, 10 & 20%D, Calcium gluconate,
Adrenalin, glucagon, NORAD, Dobutamine, midazolam, morphine,
fentanyl, Na2CHO3, Surfactant, syringes, tubes & others

5. COMMUNICATION WITH REFERRING UNIT & DOCUMENTATION
Once referral to Tertiary care unit is decided, contact and
communicate with the referral –receiving unit for cot availability &
confirm facilities needed for the child.
Communicate with SBAR
S –Situation-main problem, reason for transfer
B –Background-maternal & newborn history
A –Assessment-clinical status by examination & lab reports
R –request and recommendations-advice for further stabilisation &
evaluation.
COMMUNICATE WITH PARENTS: Clinical status, severity, time, type &
mode of transport, facilities at receiving unit, note name, mobile no. &
address of receiving unit, care & procedures during transport, cot
availability & reservation at receiving unit.

6. CLINICAL ASSESSMENT AND STABILISATION OF REFERRING BABY
STABILISATION: Done with structured protocols—“STABLE / TABCDE”
AIM: To restore physiological equilibrium before transfer like
normothermia, euglycemia, prevention & management of hypoxia,
acidosis & hypotension, surfactant therapy, assisted ventilation &
adequate organ perfusion.
S –sugar blglucose, T –temperature, A –assisted ventilation, B –BP, L –
Lab work up, E –emotional support to parents & family
Keep ready the equipped ambulance ready for transfer.
DOCUMENTATION: Ante & intra natal records, H & E findings of newborn
after birth, medications administered, procedures done, X ray, image &
lab reports, address google map, mobile number of referring &
receiving units, parents consent forms & evidence of verbal and written
documentation of handover in presence of witnesses.

7. PREPARATION AND PLAN –HANDOVER & TAKEOVER
Handover should be done in presence of both referring & receiving
teams in a conductive environment with written consent.
Transfer the baby by 2 persons by tail lift & secure with floor clamps
Prevent hypothermia by partially opening the port holes
Keep transport incubator on half side for maximum visibility
Secure all tubes & catheters
Secure the baby and equipment by neostrains& fastening the belts.
COMMUNICATION should be carried throughout the journey
between team leader, parents, referring & receiving units

8. FEEDBACK COMMUNICATION & TAKEOVER AT RECEIVING UNIT
Once the baby received at receiving unit, the neonatal transport
team leader will communicate the baby’s status to the parents &
referring unit about the following:
Clinical status
Probable diagnosis
Prognosis
Hospital stay
Finances
Insurance
Further management
Probable date & time of reverse transport

9. FURTHER READING
Advanced reading:
1.Chakradhar Maddela et al “ Organisation of Neonatal Transport
Service with Regional Perspective-Review Article. ActaScientific
Paediatrics 5.3 (2022): 19-24.
2.Peter Barry Andrew Lesile“ Neonatal and Pediatric Critical Care
transport BMJ 2003.