Neonatology pp 291-303 | Cite as

Neonatal Transport Services

  • Rocco AgostinoEmail author
  • Roberto Aufieri
  • Maurizio Gente
Reference work entry


Neonatal transfer is necessary when a newborn baby needs care that cannot be provided in the referral center. Since it represents an additional risk factor for a critically ill neonate, it should be performed, when possible, by a well-organized neonatal transport service. In a network, aimed at the regionalization of perinatal care, high-risk pregnancies should be transferred “in utero” in order to minimize risks for both mother and neonate. However, there will always be a number of neonates who need to be transferred for unpredicted or unpredictable reasons. Every maternity unit should therefore be able to provide effective neonatal resuscitation in the delivery room, be able to maintain a sick baby in a stable condition in the short term, and have access to a neonatal emergency transport service (NETS) for the provision of neonatal intensive care when appropriate. Thus, NETS provides a bridge between birth centers and neonatal intensive care units (NICUs).

Organization of NETS, quality evaluation, transport process, family-centered care, and challenging situations that can be encountered during neonatal transport are some of the topics treated in this chapter.


  1. Agostino R, Chabernaud JL, Di Renzo GC (1998) Neonatal transport service, types, cost/benefit ratio, indicators of efficiency and effectiveness. Dev Physiopathol Clin 8:113–115Google Scholar
  2. Agostino R, Fenton AC, Kollée LAA et al (1999) Organization of neonatal transport in Europe. Prenat Neonatal Med 4:20–34Google Scholar
  3. Akula VP, Joe P, Thusu K et al (2015) A randomized clinical trial of therapeutic hypothermia mode during transport for neonatal encephalopathy. J Pediatr 166:856–861CrossRefGoogle Scholar
  4. Argus BM, Dawson JA, Wong C et al (2009) Financial costs for parents with a baby in a neonatal nursery. J Paediatr Child Health 45:514–517CrossRefGoogle Scholar
  5. Arora P, Bajaj M, Natarajan G et al (2014) Impact of interhospital transport on the physiologic status of very low-birth-weight infants. Am J Perinatol 31:237–244PubMedGoogle Scholar
  6. Azzopardi D, Strohm B, Marlow N et al (2014) Effects of hypothermia for perinatal asphyxia on childhood outcomes. N Engl J Med 371:140–149CrossRefGoogle Scholar
  7. Bouchut JC, Van Lancker E, Chritin V et al (2011) Physical stressors during neonatal transport: helicopter compared with ground ambulance. Air Med J 30:134–139CrossRefGoogle Scholar
  8. Broman LM, Holzgraefe B, Palmér K et al (2015) The Stockholm experience: interhospital transports on extracorporeal membrane oxygenation. Crit Care 19:278CrossRefGoogle Scholar
  9. Broughton SJ, Berry A, Jacobe S et al (2004) The mortality index for neonatal transportation score: a new mortality prediction model for retrieved neonates. Pediatrics 114:e424–e428CrossRefGoogle Scholar
  10. Chaudhary R, Farrer K, Broster S et al (2013) Active versus passive cooling during neonatal transport. Pediatrics 132:841–846CrossRefGoogle Scholar
  11. Dhillon R (2012) The management of neonatal pulmonary hypertension. Arch Dis Child Fetal Neonatal Ed 97:F223–F228CrossRefGoogle Scholar
  12. Di Lallo D, Franco F, Farchi S et al (2010) Pre-transport stabilization time and characteristics of the referring hospital: an epidemiological study on neonatal transport in Lazio. Eur J Public Health 20:118Google Scholar
  13. European Committee for Standardization (2003a) EN 13976-1:2003 rescue systems – transportation of incubators – part 1: interface conditions (harmonised standard under the Directive 93/42/EEC)Google Scholar
  14. European Committee for Standardization (2003b) EN 13976-2:2003 rescue systems – transportation of incubators – part 2: system requirements (harmonised standard under the Directive 93/42/EEC)Google Scholar
  15. Fenton AC, Leslie A (2009) Who should staff neonatal transport teams? Early Hum Dev 85:487–490CrossRefGoogle Scholar
  16. Finnstrom O, Otterblad Olausson P, Sedin G et al (1997) The Swedish national prospective study on extremely low birth weight (ELBW) infants. Incidence, mortality, and survival in relation to level of care. Acta Paediatr 86:503–511CrossRefGoogle Scholar
  17. Gaddam Bhoomaiah S, Chandra P, Leslie A (2014) Inhaled nitric oxide therapy during transport of neonates – experience of CenTre transport service. Arch Dis Child Fetal Neonatal Ed 99:A44CrossRefGoogle Scholar
  18. Gente M, Di Lallo D, Franco F et al (2015) Stabilization of the critically ill neonate awaiting transport. Ital J Pediatr 41(Suppl1):A15CrossRefGoogle Scholar
  19. Gupta N, Kamlin CO, Cheung M et al (2013) Prostaglandin E1 use during neonatal transfer: potential beneficial role in persistent pulmonary hypertension of the newborn. Arch Dis Child Fetal Neonatal Ed 98:F186CrossRefGoogle Scholar
  20. Gupta N, Kamlin CO, Cheung M et al (2014) Improving diagnostic accuracy in the transport of infants with suspected duct-dependent congenital heart disease. J Paediatr Child Health 50:64–70CrossRefGoogle Scholar
  21. Hermansen MC, Hasan S, Hoppin J et al (1998) A validation of a scoring system to evaluate the condition of transported very low birth weight neonates. Am J Perinatol 5:74–78CrossRefGoogle Scholar
  22. Huang T, Moon-Grady AJ, Traugott C et al (2008) The availability of telecardiology consultations and transfer patterns from a remote neonatal intensive care unit. J Telemed Telecare 14:244–248CrossRefGoogle Scholar
  23. Jackson L, Skeoch CH (2009) Setting up a neonatal transport service: air transport. Early Hum Dev 85:477–481CrossRefGoogle Scholar
  24. Jacobs SE, Berg M, Hunt R et al (2013) Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 1:CD003311Google Scholar
  25. James AG (1993) Resuscitation, stabilization, and transport in perinatology. Curr Opin Pediatr 5:150–155CrossRefGoogle Scholar
  26. Karlsson BM, Lindkvist M, Lindkvist M et al (2012) Sound and vibration: effects on infants’ heart rate and heart rate variability during neonatal transport. Acta Paediatr 101:148–154CrossRefGoogle Scholar
  27. Kempley ST, Baki Y, Hayter G et al (2007) Effect of a centralized transfer service on characteristics of inter-hospital neonatal transfers. Arch Dis Child Fetal Neonatal Ed 92:F185–F188CrossRefGoogle Scholar
  28. Kendall GS, Kapetanakis A, Ratnavel N et al (2010) Cooling on Retrieval Study Group: passive cooling for initiation of therapeutic hypothermia in neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 95:F408–F412CrossRefGoogle Scholar
  29. Kollèe LA, Brand R, Schreuder A et al (1992) Five-year outcome of preterm and very low birth weight infants: a comparison between maternal and neonatal transport. Obstet Gynecol 80:635–638PubMedGoogle Scholar
  30. Lee SK, Zupancic JA, Pendray M et al (2001) Transport risk index of physiologic stability: a practical system for assessing infant transport care. J Pediatr 139:220–226CrossRefGoogle Scholar
  31. Leslie AJ, Stephenson TJ (1994) Audit of neonatal intensive care transport. Arch Dis Child 71:F61–F66CrossRefGoogle Scholar
  32. Leslie AJ, Stephenson TJ (1997) Audit of neonatal intensive care transport – closing the loop. Acta Paediatr 86:1253–1256CrossRefGoogle Scholar
  33. Leslie A, Stephenson T (2003) Neonatal transfers by advanced neonatal nurse practitioners and paediatric registrars. Arch Dis Child Fetal Neonatal Ed 88:F509–F512CrossRefGoogle Scholar
  34. Lim MT, Ratnavel N (2008) A prospective review of adverse events during interhospital transfers of neonates by a dedicated neonatal transfer service. Pediatr Crit Care Med 9:289–293CrossRefGoogle Scholar
  35. Lowe CG, Trautwein JG (2007) Inhaled nitric oxide therapy during the transport of neonates with persistent pulmonary hypertension or severe hypoxic respiratory failure. Eur J Pediatr 166:1025–1031CrossRefGoogle Scholar
  36. Lupton BA, Pendray MR (2004) Regionalized neonatal emergency transport. Semin Neonatol 9:125–133CrossRefGoogle Scholar
  37. Lutman D, Petros A (2008) Inhaled nitric oxide in neonatal and paediatric transport. Early Hum Dev 84:725–729CrossRefGoogle Scholar
  38. Macnab A (1991) Optimal escort for interhospital transport of pediatric emergencies. J Trauma 31:205–209CrossRefGoogle Scholar
  39. Maka E, Imre L, Somogyvári Z et al (2015) Laser treatment for retinopathy of prematurity in neonatal intensive care units. Premature Eye Rescue Program. Orv Hetil 156:192–196CrossRefGoogle Scholar
  40. Morrison J, Cheema I (2007) Neonatal transfers by advanced neonatal nurse practitioners: is it time to end the debate? Early Hum Dev 83:134CrossRefGoogle Scholar
  41. Mosher SL (2013) The art of supporting families faced with neonatal transport. Nurs Womens Health 17:198–209CrossRefGoogle Scholar
  42. Neto MT (2006) Perinatal care in Portugal: effects of 15 years of a regionalized system. Acta Paediatr 95:1349–1352CrossRefGoogle Scholar
  43. Puri P, Doodnath R (2011) Transport of the surgical neonate in “Newborn Surgery 3E” Prem Puri. CRC Press, Boca Raton, pp 83–90Google Scholar
  44. Rambaud J, Léger PL, Larroquet M et al (2016) Transportation of children on extracorporeal membrane oxygenation: one-year experience of the first neonatal and paediatric mobile ECMO team in the north of France. Intensive Care Med 42:940–941CrossRefGoogle Scholar
  45. Ramnarayan P (2009) Measuring the performance of an inter-hospital transport service. Arch Dis Child 94:414–416CrossRefGoogle Scholar
  46. Sedin G, Agostino R, Chabernaud JL et al (1999) Technical aspects of neonatal transport in Europe. Prenat Neonatal Med 4:35–45Google Scholar
  47. Shivananda S, Kirsh J, Whyte HE et al (2010) Accuracy of clinical diagnosis and decision to commence intravenous prostaglandin E1 in neonates presenting with hypoxemia in a transport setting. J Crit Care 25(174):e1–e9Google Scholar
  48. Steinhorn RH (2010) Neonatal pulmonary hypertension. Pediatr Crit Care Med 11:S79–S84CrossRefGoogle Scholar
  49. Warren D, Jarvis A, Leblanc L et al (2001) Canadian paediatric triage and acuity scale: implementation guidelines for emergency departments. CJEM 3:S1–S27Google Scholar
  50. Waterham M, Bhatia R, Donath S et al (2016) Phototherapy in transport for neonates with unconjugated hyperbilirubinaemia. J Paediatr Child Health 52:67–71CrossRefGoogle Scholar
  51. Whyte HEA, Jefferies AL, Canadian Paediatric Society, Fetus and Newborn Committee (2015) The interfacility transport of critically ill newborns. Paediatr Child Health 20:265–275CrossRefGoogle Scholar
  52. Zeitlin J, Papiernik E, Bréart G et al (2004) Regionalization of perinatal care in Europe. Semin Neonatol 9:99–110CrossRefGoogle Scholar
  53. Zupancic JA, Richardson DK, Horbar JD et al (2007) Revalidation of the score for neonatal acute physiology in the Vermont Oxford network. Pediatrics 119:e156–e163CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Rocco Agostino
    • 1
    Email author
  • Roberto Aufieri
    • 2
  • Maurizio Gente
    • 3
  1. 1.Ethics CommitteePediatric Hospital Bambino GesùRomeItaly
  2. 2.Division of Neonatology and Neonatal Intensive CareCasilino General HospitalRomeItaly
  3. 3.Department of Pediatrics and Infant Neuropsychiatry, Neonatal Emergency Transport ServiceSapienza University of RomeRomeItaly

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