Neurocritical care of high‐risk infants during inter‐hospital transport

Abstract

The centralisation of neonatal intensive care in recent years has improved mortality, particularly of extremely preterm infants, but similar improvements in morbidity, such as neurodevelopmental impairment, have not been seen. Integral to the success of centralisation are specialised neonatal transport teams who provide intensive care prior to and during retrieval of high‐risk neonates when in‐utero transfer has not been possible. Neonatal retrieval aims to stabilise the clinical condition and then transfer the neonate during a high‐risk period for patient. Transport introduces the hazards of noise and vibration; acceleration and deceleration forces; additional handling and temperature fluctuations. The transport team must stabilise the infant fully prior to transport as when on the move they are limited by space and movement to effectively attend to clinical deterioration. Inborn infants have better neurodevelopmental outcome compared with the outborn and aetiology of this seems to be multifactorial with the impact of transport itself during critical illness, remaining unclear. To improve the neurological outcomes for transported infants, it seems imperative to integrate the advancing intensive care neuromonitoring tools into the transport milieu. This review examines current inter‐hospital transport neuromonitoring and how new modalities might be applied to the neurocritical care delivered by specialist transport teams.

Outcomes of neonatal hypoxic-ischaemic encephalopathy in centres with and without active therapeutic hypothermia: a nationwide propensity score-matched analysis

“…The transport process itself exposes the infant to noxious stimuli which could contribute to on-going brain injury. 45 Preterm infants transferred in early life have an increased risk of brain injury. 46 It is unclear if exposure to significant levels of vibration and noise during inter-hospital transport, beyond that deemed safe for healthy adults, is a contributory mechanism to the additional seizures identified in this study.…”

Long-term outcomes of children with neonatal transfer: the Japan Environment and Children’s Study

“…Second, neonatal transfer involves additional handling, temperature instability, noise and vibration exposure, and suboptimal monitoring and ventilator management [ 26 ]. Therefore, inter-hospital transfer may induce physiological deterioration in neonates [ 5 , 27 , 28 ].…”

“…Higher levels of discomfort as indicated by an increase in premature infant pain profile scores were reported during transport compared with baseline [ 29 ]. Therefore, organization of a sophisticated retrieval team [ 30 , 31 ] and neurocritical care of high-risk newborns during neonatal transfer [ 26 ] may improve the outcomes of outborn neonates. Whether neonatal transfer itself affects the outcome [ 13 ] or does not affect the outcome [ 32 – 34 ] is controversial.…”

Organizational factors associated with delayed therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy: the LyTONEPAL cohort

“…Organization of care is much more complex for term-born neonates because neonatal events leading to hospitalization are rare and frequently unpredictable. In addition, most term births occur in centres without neonatal intensive care, and specialized neonatal transport teams have an important role in neurocritical care [5].…”