Table 1

Outline of key issues in stabilising neonates for transfer19

  • Should the baby be intubated before transfer? A lower threshold for intubation should be used than on the neonatal intensive care unit, to minimise the need to intervene in transit. In an infant > 30 weeks gestation, if the vital signs (pulse, blood pressure, respiratory rate, temperature) have been consistently stable in oxygen < 50% and if the Paco2 is normal, it may be acceptable to move the baby without intubation. If the infant is: unstable

    • has a rising oxygen requirement > 50%

    • has a rising PaCO2

    • has recurrent apnoea

    • is < 30 weeks gestation

then intubation and respiratory support is highly likely to be required, at least for the duration of the journey.
  • If already intubated, the endotracheal tube (ETT) must be correctly positioned and secure. ETTs must be secured to a high standard, to avoid accidental extubation in transit.

  • Adequate respiratory support must be given.

  • Surfactant must be administered if indicated.

  • Arterial access, if not already established, should be considered in infants who require repeated blood gas analysis or accurate blood pressure measurement. If siting a line will not influence practice before or during the journey, then it may be acceptable to delay this until after the transfer.

  • Correct positioning and security of the catheter must be checked.

  • Circulation with fluids and/or inotropes should be supported early, as indicated.

  • Assess temperature and consider the support required for transfer.

  • Use temperature maintenance adjuncts, such as chemical gel mattresses.20,21

Blood glucose
  • Measure and stabilise blood glucose.

  • Secure intravenous access.

  • Screen for infection as indicated.

  • Start treatment.

Parents’ information and wishes
  • Discuss plans with parents. Ascertain their plans about travelling to referral unit. Liaise with midwifery staff about maternal transfer.

  • Ensure the team at the referral unit will have all the necessary information to advance the care of the baby.