Clinical Review ABC of preterm birth

Moving the preterm infant

BMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7471.904 (Published 14 October 2004) Cite this as: BMJ 2004;329:904
  1. Peter W Fowlie,
  2. Philip Booth,
  3. Charles H Skeoch

    Introduction

    Many different health service models for providing neonatal intensive care have been established over the past 30 years, and much of the developed world is moving towards a centralised model of care. At least initially, preterm infants often require specialised care in an intensive care setting. As a result, newborn infants and pregnant mothers may have to move between hospitals for appropriate care because of prematurity or the threat of preterm delivery. Sometimes this move means that the infant and family have to travel hundreds of miles.

    This article focuses on the postnatal transfer of preterm infants between hospitals. Antenatal transfer of pregnant women is not considered here, although in utero transfer has better clinical outcomes for mother and infant than transfer after birth. Many of the issues discussed are applicable to transfers within hospitals.


    Embedded Image

    Neonatal transport system—mobile intensive care unit for safe and comfortable transport of infants

    Interhospital transport services

    In utero transfer is not always possible—for example, if labour is too advanced. Of the several models for transporting newborn infants, the most sophisticated are regional transport services that carry out all neonatal moves in a defined area using dedicated staff and equipment. These teams are responsible for neonatal transport only and are often “independent,” not being affiliated to a particular maternity or neonatal unit. A medical director usually runs such regional services, and the staff carrying out the transports may be medical or nursing staff with other professionals sometimes contributing. Referring hospitals and receiving hospitals do not have to provide staff or equipment, and each transport is undertaken by dedicated staff who have training and experience in transporting sick neonates.

    View this table:

    Reasons for transferring preterm infants between hospitals

    When no regional transport service is available, medical and nursing staff from either referring or receiving units undertake the transport on an ad hoc …

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