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.
Timely referral of the pregnant woman and intrauterine transport of the fetus improve the outcome of a number of neonatal pathological processes, such as extreme prematurity and complex congenital malformations. Timely referral for cesarean section can prevent morbidity and mortality from delivery-related events (asphyxia). After delivery, transporting the mother and newborn together is essential to support exclusive breastfeeding and so is the use of the kangaroo mother method as a means of temperature control during transport.
The neonatal transport system faces increasingly complex and urgent interventions: extreme prematurity with respiratory distress, pulmonary hypertension and critical congenital heart disease. The complexity of interventions progresses in parallel to the increasing complexity in the healthcare system as a whole. A sound use of transport requires being able to provide basic care for newborns weighing 1800-2500 g or more at level I centers, close to the community. Transfers to level II centers are indicated in case of moderate disease and tertiary centers are reserved for the management of higher risk babies that need mechanical ventilation, surgical procedures, and other complex treatments.
As the severity of the disease increases, so does the need for a centralized transport system with trained staff, equipment, and appropriate protocols.
Maternal and infant admission to the referral hospital requires changes in policy, funding and capacity.
