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Acta Paediatr. 2019 Jul 18. doi: 10.1111/apa.14940. [Epub ahead of print]

Neurocritical care of high-risk infants during inter-hospital transport.

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University of Southampton, Southampton, UK.
Wessex Southampton Oxford Neonatal Transport (SONeT) & Neonatal Intensive Care Services, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK.
Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, Wales, UK.
Faculty of Medicine and Healthcare, University of Sydney, Sydney, NSW, Australia.
Grace Centre for Newborn Intensive Care, Children's Hospital at Westmead, SCHN and NETS NSW, Sydney, NSW, Australia.
CenTre Neonatal Transport Service, University Hospitals of Leicester NHS Trust, Leicester, UK.
CenTre Neonatal Transport Service, Nottingham University Hospitals NHS Trust, Nottingham, UK.


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.


brain; neonatal transport; neurocritical care; neuromonitoring


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