As efforts to improve the outcomes of neonatal survival are scaled up, there is an increased demand for access to safe and effective transport.
Improving the procedures related to neonatal transport and the quality of care in critical conditions requires evidence-based technical guidelines as a reference for agencies, facilities, and health professionals responsible for setting health system priorities and policies around newborn transport.
Guidelines for neonatal transport have generally been developed by incorporating specific practices and principles from the different contributing fields, including neonatology, intensive and emergency pediatrics, pediatric surgery, pediatric trauma, and emergency medicine.
The guidelines should meet the needs of policy makers, hospitals and health system administrators, communications personnel and clinicians directly involved in patient care.
In the past, guidelines have been largely based on expert opinion and consensus; however, available scientific evidence can be incorporated to support recommendations, especially for developing countries seeking to improve or establish neonatal transport systems.
Studies that seek to generate scientific information about neonatal transport should incorporate interventions with proven impact on neonatal outcomes:
• Stabilization on site prior to transfer.
- Administration of surfactant.
• Referral documentation.
• Communication between the referring and receiving centers.
- At the start of transport
- When the transport vehicle is sent to the referral center
- During transport (advise on how to manage the patient)
- After the transfer, follow-up of the referred patient.
• Minimum equipment needs and specific material for each medical entity (incubator, infusion pump, feeding tube, nasogastric suction, cardiorespiratory monitoring, oximeter, blood pressure monitoring, temperature monitoring and feedback control, serum blood glucose monitoring, intravenous fluids, antibiotics, anticonvulsants).
• Vehicle selection, operating characteristics, critical maintenance.
• Creation of team and training on resuscitation and stabilization, assessment.
• Professional role (physician, nurse, respiratory physiotherapist, paramedic).
• Alternative methods to maintain a stable temperature (Mother Kangaroo).
• Triage and assessment tools.
• Quality improvement efforts focused on transportation.
• Critical incident analysis.
• Case reviews.
• Follow-up.
• Cost-benefit analysis (DALYs, life expectancy).
• Sources of funding for transportation.
• Family satisfaction.
