Fifty Years of Progress in Neonatal and Maternal Transport for Specialty Care

Abstract

Specialty care for preterm and critically ill infants has evolved over many years. Neonatal intensive care nurseries were developed, and physicians and nurses learned how to provide intensive care for these infants. Neonatal and maternal (in utero) transport to tertiary centers became common in regionalized systems of care to facilitate the specialized care of high-risk neonates when childbirth occurred in settings without specialized personnel or equipment. Annually, nearly 70,000 neonatal transports occur in the United States. Although specialty care helps reduce rates of neonatal mortality, racial disparities and disparities between urban and rural areas exist. The purpose of this article is to review the progress achieved in neonatal and maternal transport over the past 50 years. The knowledge developed can be used to improve the care provided to women, their fetuses, and infants.

The Need for Reliable Robust Maternal Transport Program to Improve Maternal Outcomes in Rural America

“…Maternal Transport followed in the late 1960s and 1970s when it was discovered that outcomes were improved and there was less expense when the fetus was transported in utero. 3 Maternal Transport was expanded from ambulances to helicopters, fixed wing aircraft, and water vehicles as these means became methods of transport for patients. 1 In 1986, The Emergency Medical Treatment and Labor Act (EMTALA), the Emergency Medical Treatment and Active Labor Act, commonly known as the "antidumping law" which was part of the Consolidated Omnibus Reconciliation Act, was enacted which required hospitals to provide emergency screening with stabilization of an emergency condition to any person regardless of their ability to pay, legal status, or citizenship.…”

“…Transport is simply defined as moving a person or patient from one place to another. Maternal Transport followed in the late 1960s and 1970s when it was discovered that outcomes were improved and there was less expense when the fetus was transported in utero 3. Maternal Transport was expanded from ambulances to helicopters, fixed wing aircraft, and water vehicles as these means became methods of transport for patients 1…”

Interventions for supporting parents of infants requiring neonatal inter‐hospital transport: A systematic review

“…6 Regionalisation of neonatal care occurred during the last two decades to centralize specialized resources and staff expertise, thus necessitating neonatal transport in the UK 7,8 and other countries. 9 Three levels of neonatal care are provided in the UK, comparably with international literature, and are defined by the British Association of Perinatal Medicine 10 as intensive care, high dependency care, and special care. Infants in any of these categories may require transportation for a variety of reasons.…”

“…Sick and unstable infants require urgent uplift of care to Neonatal Intensive Care Units (NICU's) which may be unexpected and may be undertaken by any vehicle available to any hospital that accepts the infant for ongoing care. 9 This may be a long distance from the parents' home. However, in the UK, neonatal transport teams strive to keep infants in the same geographical area, termed neonatal network, which is a group of NNU's with a lead NICU, thus minimizing parents' travelling.…”

“…7 The other major reason for neonatal transfer is called "back-transfer", which occurs frequently from NICU to a hospital closer to the parents' home, once the infant's condition is stable. 9 Back-transfers tend to be planned, including the mode of transfer, as the urgency for transfer is no longer present. Infants may also be transferred from NICU's for resource reasons to provide capacity for sicker infants.…”