Managing the neonatal transfer system

In this video we describe the different kinds of neonatal transfer in detail and the range of challenges in establishing and managing a neonatal transfer system. And we share the experience from the UK of setting up a national neonatal transfer system.

Categories of neonatal care

Across different health systems there are different categories of neonatal care. In the UK, three categories are used: special care, high dependency care and intensive care:

• Special care is provided for all babies who cannot reasonably be looked after at home but do not need high dependency care or intensive care. Babies receiving special care may need to have their breathing and heart rate monitored, be fed through a tube, be supplied with extra oxygen or treated for jaundice. Special care which occurs alongside the mother outside the neonatal unit in a ward setting is often called transitional care.

• High dependency care takes place in a neonatal unit and is provided to babies who need continuous monitoring but who do not fulfill any of the requirements for intensive care. Babies who weigh less than 1000g or are receiving help with their breathing via continuous positive airway pressure (CPAP) or are being given intravenous feeding may require high dependency care.

• Intensive care is provided for babies with the most complex problems who require constant supervision and monitoring and, usually, mechanical ventilation. Due to the possibility of acute deterioration, a doctor must always be available. Extremely premature babies (< 28 weeks gestational age) all require intensive care and monitoring.

Adapted from the ‘Toolkit for High Quality Neonatal Services. NHS, 2009’

Moving the preterm infant

Some newborn infants may need to be moved between hospitals. Neonatal transport services need to be well organised. The service should be staffed by professionals trained in neonatal transport medicine and in using appropriate equipment.

With good preparation and stabilisation of the baby before setting off, minimal active intervention should be needed during the transfer. However, infants can deteriorate spontaneously, for example, because of a pneumothorax (when air leaks into the space between the lung and chest wall) or if equipment, such as endotracheal tubes or intravenous lines, become dislodged. Skills and equipment to deal with such eventualities must be available during the transfer. Care should be taken to maintain the infant’s temperature and, when possible, the environmental temperature of the vehicle should be raised.

Good verbal and written communication between health professionals throughout transport episodes is vital. Using clinical guidelines, operational policies, and checklists is helpful. Parents also need to know plans for their baby’s care, and the transport team should meet the parents when possible. In some settings informed consent is needed for transport and care. If parents are not travelling in the ambulance with their infant, they may need to know how to get to the destination hospital and what facilities will be available for them when they arrive. Helpful written information (for example, leaflets about the destination neonatal unit and maps) can be stored electronically and downloaded as needed.

Excerpt adapted from ‘ABC of preterm birth: Moving the preterm infant.’ BMJ 2004;329:1277

How is neonatal transfer managed in your setting and which key personnel are (or should be) involved?