Newborn transport

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Integrated neonatal life support system Integrated neonatal life support system.jpg
Integrated neonatal life support system

Newborn transport [1] is used to move premature and other sick infants from one hospital to another, such as a medical facility that has a neonatal intensive care unit and other services. Neonatal transport services such as NETS use mobile intensive care incubators fitted with mechanical ventilators, infusion pumps and physiological monitors capable of being used in a mobile environment. [2] These transport systems seek to emulate the environment of a neonatal intensive care and permit uninterrupted care to occur in a referring hospital and then during the journey by road or air ambulance. Power and medical gas supplies are carried within the system as well as making use of external supplies; as available. Infant transport systems commonly weigh over 100 kg and present a challenge to vehicle operators in terms of weight, manual handling, crashworthiness and power consumption. [ citation needed ]

The United Kingdom's first neonatal transport ambulance shown outside Charing Cross Hospital in London (1968). The ambulance was possible thanks to the generosity of the Variety Club charity. Neonatal ambulance.jpg
The United Kingdom's first neonatal transport ambulance shown outside Charing Cross Hospital in London (1968). The ambulance was possible thanks to the generosity of the Variety Club charity.

Neonatal transportation was first started by the American physician Joseph Bolivar DeLee (1869 –1942). [3] DeLee showed an intuitive interest in the care of preterm infants, recognising the necessity of a thermo-regulated environment during their transfer. [4] The first organised neonatal transportation program began in New York in 1948 and was called the New York Premature Infant Transport Service. [5]  This remarkable system was created more than a decade before Neonatal Intensive Care Units (NICUs) were established, and incorporated many of the main characteristics of the modern neonatal transportation units. In 1968, in the United Kingdom, neonatologist Herbert Barrie introduced the country’s first dedicated neonatal ambulance. [6]   Barrie obtained funding from the Variety Club charity for an ambulance that could collect babies requiring intensive care from maternity hospitals and bring them back to the neonatal intensive care unit at Charing Cross Hospital. [7] [8]

Herbert Barrie taking delivery of the neonatal ambulance, pictured with his senior nurse (Hazel Maycock) and Dr Stanley Balfour-Lynn of the Variety Club. Inside neonatal ambulance.jpg
Herbert Barrie taking delivery of the neonatal ambulance, pictured with his senior nurse (Hazel Maycock) and Dr Stanley Balfour-Lynn of the Variety Club.
A newborn stabilised and ready for transport A newborn stabilised and ready for transport.jpg
A newborn stabilised and ready for transport

Normally, regular ambulance staff and their vehicles are not equipped to transport sick newborns and special newborn transport teams are provided from either particular hospitals (hospital-based) or established to serve many hospitals (regionally based). Team composition varies from one country to another, with options including various two or three person combinations of nurse, doctor and respiratory therapist. Access to neonatal transport also varies, particularly in developing countries. [9]

Typically, newborn transport teams spend some time stabilizing a baby's condition prior to transport. Without adequate stabilisation, a clinical deterioration en route may occur.

Wherever possible (and safe), in utero transfer is generally preferable to newborn transport. [10] Transfer of the mother while still pregnant leads to improved survival and quality of survival for the baby.

Related Research Articles

Retinopathy of prematurity (ROP), also called retrolental fibroplasia (RLF) and Terry syndrome, is a disease of the eye affecting prematurely born babies generally having received neonatal intensive care, in which oxygen therapy is used because of the premature development of their lungs. It is thought to be caused by disorganized growth of retinal blood vessels and may result in scarring and retinal detachment. ROP can be mild and may resolve spontaneously, but it may lead to blindness in serious cases. Thus, all preterm babies are at risk for ROP, and very low birth-weight is an additional risk factor. Both oxygen toxicity and relative hypoxia can contribute to the development of ROP.

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<span class="mw-page-title-main">Kangaroo care</span> Technique of newborn care

Kangaroo mother care (KMC), which involves skin-to-skin contact (SSC), is an intervention to care for premature or low birth weight (LBW) infants. The technique and intervention is the recommended evidence-based care for LBW infants by the World Health Organization (WHO) since 2003.

<span class="mw-page-title-main">Neonatology</span> Medical care of newborns, especially the ill or premature

Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn. It is a hospital-based specialty and is usually practised in neonatal intensive care units (NICUs). The principal patients of neonatologists are newborn infants who are ill or require special medical care due to prematurity, low birth weight, intrauterine growth restriction, congenital malformations, sepsis, pulmonary hypoplasia, or birth asphyxia.

<span class="mw-page-title-main">Neonatal intensive care unit</span> Intensive care unit specializing in the care of ill or premature newborn infants

A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit (ICU) specializing in the care of ill or premature newborn infants. The NICU is divided into several areas, including a critical care area for babies who require close monitoring and intervention, an intermediate care area for infants who are stable but still require specialized care, and a step down unit where babies who are ready to leave the hospital can receive additional care before being discharged.

Fetal viability is the ability of a human fetus to survive outside the uterus. Medical viability is generally considered to be between 23 and 24 weeks gestational age. Viability depends upon factors such as birth weight, gestational age, and the availability of advanced medical care. In low-income countries, half of newborns born at or below 32 weeks gestational age died due to a lack of medical access; in high-income countries, the vast majority of newborns born above 24 weeks gestational age survive.

<span class="mw-page-title-main">Newborn Emergency Transport Service</span>

NETS is an acronym for newborn emergency transport service orsystem. Such services provide critical care transport for newborn babies requiring care not available in the hospital of birth. Some provide other services; such as outreach education, return transport and coordination of high-risk obstetric transfer. Others provide transport services in older age-groups.

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<span class="mw-page-title-main">Neonatal nursing</span>

Neonatal nursing is a sub-specialty of nursing care for newborn infants up to 28 days after birth. The term neonatal comes from neo, "new", and natal, "pertaining to birth or origin". Neonatal nursing requires a high degree of skill, dedication and emotional strength as they care for newborn infants with a range of problems. These problems vary between prematurity, birth defects, infection, cardiac malformations and surgical issues. Neonatal nurses are a vital part of the neonatal care team and are required to know basic newborn resuscitation, be able to control the newborn's temperature and know how to initiate cardiopulmonary and pulse oximetry monitoring. Most neonatal nurses care for infants from the time of birth until they are discharged from the hospital.

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Monroe Carell Jr. Children's Hospital at Vanderbilt, also known as Children's Hospital at Vanderbilt, is a nationally ranked pediatric acute care children's teaching hospital and entity of Vanderbilt University Medical Center in Nashville, Tennessee. The hospital is affiliated with Vanderbilt University School of Medicine's Department of Pediatrics.

<span class="mw-page-title-main">Neonatal nurse practitioner</span> Type of certified nurse practitioner

A neonatal nurse practitioner (NNP) is an advanced practice registered nurse (APRN) with at least 2 years experience as a bedside registered nurse in a Level III NICU, who is prepared to practice across the continuum, providing primary, acute, chronic, and critical care to neonates, infants, and toddlers through age 2. Primarily working in neonatal intensive care unit (NICU) settings, NNPs select and perform clinically indicated advanced diagnostic and therapeutic invasive procedures. In the United States, a board certified neonatal nurse practitioner (NNP-BC) is an APRN who has acquired Graduate education at the master's or doctoral level and has a board certification in neonatology. The National Association of Neonatal Nurse Practitioners (NANNP) is the national association that represents neonatal nurse practitioners in the United States. Certification is governed by the National Certification Corporation for Obstetrics, Gynecologic and Neonatal Nursing Specialties (NCC).

Julius Hess was an American physician who is often considered the father of American neonatology. In 1922, he published the first textbook focused on the care of prematurity and birth defects in infants. That same year, Hess and nurse Evelyn Lundeen created the first premature infant station in the United States, recognizing the importance of nursing care and temperature management in the care of preterm babies. Hess also made early contributions to the transport of such infants to specialty centers.

Evelyn Lundeen was an American nurse who headed the first premature nursery in the United States with Dr. Julius Hess. Outside of her work at the nursery, Lundeen traveled to other cities to teach the principles of nursing care for premature infants. With Hess, she also co-authored an early textbook on premature baby care.

Neelam Kler is an Indian neonatologist, known for her pioneering work on neonatal intensive care and ventilation. She is credited with developing neonatal care to better the survival rate of extremely tiny preterm babies to 90 percent. The Government of India honoured her with the third-highest civilian award, Padmabhushan, in 2014, for her services to the fields of medicine and neonatology.

<span class="mw-page-title-main">Herbert Barrie</span> Consultant paediatrician

Herbert Barrie, was a British consultant paediatrician and a leading figure in neonatology. He was a pioneer in the emerging specialty of paediatrics and neonatal medicine; and he developed one of the first neonatal intensive care units in London.

<span class="mw-page-title-main">Gerhard Jorch</span> German pediatrician (born 1951)

Gerhard Jorch is a German pediatrician. He is Professor for general pediatrics and neonatology at the Otto-von-Guericke University of Magdeburg and director of the University children's hospital.

Embrace Neonatal MRI System is the first FDA-approved MRI device that can be used for head and brain scans of newborns in the NICU. The Embrace system is designed for newborns between 2.2 and 10 pounds and with a head circumference of up to 15 inches. Produced by Aspect Imaging, the Embrace contains a temperature-controlled incubator and does not require that newborns be transported out of the NICU. In case of emergencies, babies can be removed from the system in less than 30 seconds. The device has been installed in the NICU at Shaare Zedek Hospital in Israel as well as at the NICU at Brigham and Women's in the United States.

References

  1. "What is a Pediatric Transport Team?". HealthyChildren.org. Retrieved 30 April 2020.
  2. Bellini, Carlo; de Biasi, Martina; Gente, Maurizio; Ramenghi, Luca A.; Aufieri, Roberto; Minghetti, Diego; Pericu, Silvia; Cavalieri, Martina; Casiddu, Niccolò (7 August 2019). "Rethinking the neonatal transport ground ambulance". Italian Journal of Pediatrics. 45 (1): 97. doi: 10.1186/s13052-019-0686-y . ISSN   1824-7288. PMC   6686524 . PMID   31391074.
  3. 1.     De Lee JB (1920) Infant incubation, with the presentation of a new incubator and a description of the system at the Chicago Lying-In Hospital. Chic Med Rec 22: 22-40.
  4. Butterfield LJ (1993) Historical perspectives of neonatal transport. Pediatr Clin North Am 40(2): 221-239
  5. 1.     Losty MA, Orlofsky I, Wallace HM (1952) A Transport service for premature babies. Am J Nurs 50(1): 10-12.
  6. Watts, Geoff (June 2017). "Herbert Barrie". The Lancet. 389 (10086): 2282. doi: 10.1016/S0140-6736(17)31500-3 . S2CID   54418830.
  7. 2nd European Congress of Perinatal Medicine 10 April 1970
  8. Frey, R.; Nagel, E.; Safar, P.; Rheindorf, Petra; Sands, Patricia, eds. (1976). Mobile Intensive Care Units. Anaesthesiologie und Intensivmedizin. Vol. 95. doi:10.1007/978-3-642-66284-3. ISBN   978-3-540-07561-5. S2CID   19457484.
  9. Niermeyer, Susan; Domek, Gretchen (2016). Neonatal ctransport in developing country settings: a systematic review. CLAP/WR Scientific Publication. Pan American Health Organization. hdl: 10665.2/31317 . ISBN   978-92-75-31917-8.
  10. Whyte, Hilary Ea; Jefferies, Ann L.; Canadian Paediatric Society, Fetus and Newborn Committee (June–July 2015). "The interfacility transport of critically ill newborns". Paediatrics & Child Health. 20 (5): 265–275. doi:10.1093/pch/20.5.265. ISSN   1205-7088. PMC   4472056 . PMID   26175564.