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Within neonatal intensive care units, nasal continuous positive airway pressure (nCPAP) provides a means of respiratory support in a variety of acute and chronic clinical situations.1,2 We have used it as a means of respiratory support during neonatal transfer and describe our experience below.
nCPAP was provided by the Infant Flow Driver (Electro Medical Equipment Ltd, Brighton, Sussex, UK). This was clamped on to the vertical frame of the transport incubator, and a modified ventilation circuit, designed by the medical physics department of the Princess Royal Maternity, connected the Infant Flow Driver to the infant via short binasal prongs (Electro Medical Equipment Ltd). All infants were transferred by road in the West of Scotland Region dedicated neonatal ambulance. This ambulance provided an oxygen and air supply of 4000 litres each and AC power from a petrol generator.
Over a one year period from April 2002 until April 2003 there were seven nCPAP transfers involving six infants. The median gestational age at birth was 29 weeks (range 26–32) and the median age at transfer was 23 days (range 5 hours to 91 days). These included infants with complex congenital abnormalities requiring specialist treatment and those returning to their base hospital. The median transfer time was 45 minutes (range 30–60). No major problems were encountered during transfer. All transfers using nCPAP were discussed in advance with a senior neonatologist experienced in neonatal transport.
We have shown in a small and carefully selected cohort of infants that transfer with nCPAP support is feasible and safe. Our infants, with one exception, had been stable on nCPAP for some time before transfer. Further studies are required to explore whether this form of respiratory support has a role in the transfer of neonates with acute respiratory distress syndrome who are stable on nCPAP, and who would currently be intubated only because of the need for transfer.
Correct attachment of the nCPAP driver to the transport incubator system is vital. Further modifications are being engineered to our transport incubator system to comply with regulations ensuring safety in crash situations.
Even with our confidence in the use of nCPAP for selected clinical situations in transport, we would still strongly recommend that intubation remains the first choice for airway management during neonatal transfer.
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