Neonatal transport involves moving sick newborn infants from hospitals without intensive care facilities to hospitals with neonatal intensive care units. This is done for both emergency and planned transfers. Safe transport requires maintaining the newborn's temperature, airway, blood pressure, blood sugar levels, and organ function. A skilled transport team including a senior doctor and trained nurse uses an incubator with vital sign monitoring and other necessary medical equipment to stabilize and care for the infant during the journey.

1. Neonatal transport

2. Definition
• Newborn transport is used to
move premature and other sick infants
from hospitals without specialist, intensive
care facilities require for optimal care of the
baby to hospitals with neonatal intensive
care and other specialist services.

3. Out born newborns
• A significant number of neonates require
emergent transfer to a tertiary care center,
often because of medical, surgical, or rapidly
emerging postpartum problems. These are
termed “outborn” neonates, because they
have been born somewhere besides the
facility to which they’ve been transferred.

4. TRANSFER
• Transfer can be within the hospital; to ICU
• Transfer can be to other hospital

5. Neonatal transfer types
• Emergency: unplanned
• Elective : planned and informed

6. How can we transfer?
• The short distance transport within the
hospital can be accomplished in a
transport incubator.
• The use of plastic basket with perforated
sides coupled with careful placing of hot
water bottles is recommended for use in
the rural setting.

7. • The baby can be wrapped in tin foil or
covered with several layers of cotton.
• Themocele (polystyrene) box is an
effective insulator and can be used in
community.
• Skin to skin contact with mother or a
care taker is a useful modality of
transport in rural areas or resource poor
settings.

8. Indications of neonatal transport
• Preterm infant with a birth weight
<1500g or gestation <32 weeks
• Respiratory distress requiring CPAP or
assisted ventilation
• Severe hypoxic-ischemic encephalopathy
• Life threatening sepsis
• Intractable seizures
• Bleeding neonate

9. • Congenital anomalies or surgical neonate
• Inborn errors of metabolism
• Severe jaundice
• Procedures or diagnostic facilities
unavailable at parent hospital.

10. Transport equipments
1. Transport incubator with multi channel
vital signs monitor for recording
temperature, heart rate, NIBP, oxygen
saturation
2. CPAP facility with nasal prongs and
portable ventilator
3. Airway equipment: suction devices,
oral airways, bag and mask,
laryngoscopes (size 00,0 and 1 blades)

11. 4. Infusion facilities: infusates, infusion
pumps, glucometer
5. oxygen, compressed air cylinder, oxygen
mask, hood, heat and light, sources of
electric powers and adapters.
6. disposables: catheters (5,6,7,8,10,12Fr),
syringes, needles, feeding tubes (8 &
10Fr), alcohol, betadine swabs,
micropore tape, gloves etc.

12. 7. Instrument tray for ET intubation,
vascular access, insertion of chest tubes,
NG tube etc
8. Life saving drugs

13. Note
• All the equipment should have a battery
back up and should be kept fully charged
all the time.
• Enough O2 supply should be carried
which should last during the period of
journey.

14. Transport team
• The neonate needing special or intensive
care should be transported by a skilled
transport team.
• Teams include at least,
a) One senior resident
b) One specially trained neonatal nurse

15. Principles of safe transport
• Sugar
• Temperature
• Airway
• Blood pressure
• Lab work
• Emotional support

16. • Sugar
• Arterial circulatory support
• Family support
• Environment
• Respiratory support

17. • Temperature
• Oxygenation (airway and breathing)
• Perfusion
• Sugar

18. Protocols
i. Maintain airway, oxygenation, thermal
stability and tissue perfusion
ii. Stop oral feeding and start parenteral
feeding with 10% of dextrose.
iii. Ensure umbilical or peripheral venous
access
iv. Insert an NG tube and decompress the
stomach
v. Maintain adequate blood glucose level

19. vi. Obtain culture samples and administer
first dose of antibiotics.
vii. Obtain a recent chest skiagram as a
base line and to check the position of
catheters and tubes.
viii. Take the family member or parents
along with the baby whenever feasible.
ix. When required transport team should
undertake life saving procedures (like ET
tube insertion, chest tube insertion etc)

20. x. administer life saving drugs like
surfactant and prostaglandins
xi. The referring hospital should prepare a
detailed transport note including copies
of obstetric and neonatal charts for the
transport team.
xii. Monitor the baby’s color and
temperature.

21. Arrival at the receiving NICU
• The transport team should remain in
constant touch with the referral NICU
during the course of journey.
• The team should brief the NICU care
givers regarding the status of the baby
and immediate clinical concerns.
• Hand over all the documents.

22. • The referring hospital and parents should be
informed about the safe arrival and latest
condition of the baby.
• The inventory of transport equipment should
be checked, medications and essential
supplies should be restocked for the next
transport service.