The equipment used in transport must comply with several general characteristics:
• Appropriate for the age group and for the health problems to be managed.
• Lightweight, portable, rugged and easy to clean
• It must be securely fastened in the transport vehicle for patient and equipment safety.
• Tested in transport conditions (temperature, altitude, vibration).
It is essential to have equipment that allows for:
In addition to the implementation of the International Code of Marketing of Human Milk Substitutes, other complementary actions are needed to promote the optimal feeding of infant and young children. The Breastfeeding Promotion Initiative led by WHO and UNICEF, aims to increase global commitment to breastfeeding. In addition to achieving full implementation of the code through strong legal measures, the initiative's call to action urges governments, donors and partners to do the following:
• Increase funding for breastfeeding promotion initiatives.
Regionalization poses the challenge of defining where to assign resources to intensive care, transport or prevention and primary care.
Neonatal transport should be seen in the context of regionalized perinatal care, which encompasses the care of the pregnant woman and her fetus, the mother-to-be and her baby.
Universal newborn hearing screening (UNHS) with otoacoustic emissions (OAE) or automated auditory brainstem evoked potentials (ABEP-A) testing is recommended for early detection of permanent bilateral hearing loss (PBHL). UNHS should be accompanied by diagnostic and treatment services for infants in whom hearing loss is detected.
Applying emollient or moisturizing creams or any other product on the skin of newborns is not recommended.
At birth, human skin is covered with an acid mantle, which is key to maintaining the baby’s defenses. Although there is no scientific evidence about the harmful effects of emollients, no benefits have been demonstrated in their application.
Therefore, it is not recommended to apply emollients or other products on the skin. If in doubt, it is always advisable to ask your health care team.
Routine application of topical emollients is not recommended for the prevention of skin conditions in healthy full-term infants.
This recommendation was developed by the WHO Guidelines Development Group (GDG). The GDG agreed that there was insufficient evidence on the beneficial and harmful effects of routine application of topical emollients on healthy term newborns to prevent skin conditions such as atopic dermatitis, dry skin and others.
Before organizing a neonatal transport system, there needs to be planning and coordination at the national and regional levels to align transport goals and objectives with those of the health system as a whole.
The planning process includes:
• Alignment of the objectives aimed to improve health system outcomes and transportation priority cases (and cases excluded).
• Estimation of the demand for care for each health problem selected and per region (met and unmet needs).
In gestations with high risk of prematurity or potentially needing admission to the Neonatal Care Unit, prenatal admission is an opportunity for communication with the pregnant women.
Evidence-based counseling about the benefits of human milk feeding is a public health intervention that improves breastfeeding rates. Repeated prenatal informational interviews are more effective than isolated interventions and should be documented in the medical record.
Nutritional interventions are important in the development of young children. However, they are not enough on their own. They must be accompanied by responsive care in the context of early learning opportunities.
A paradigmatic example of adequate nutrition and responsive care is the feeding of human milk on demand to newborns and infants.
Delays in the neonatal transfer system can have an impact on mortality. The “three delays” model (Thaddeus and Maine, 1994) describes a conceptual framework for the factors and phases of delay that influence timely access to specialized emergency care. The model makes it possible to analyze delays in the process at each stage of neonatal transfers.
In most cases, neonates are transferred from a primary care center to a referral center, but it can also occur from the community, from a facility or from within the same center.