Neonatal transport and retrieval — formative SAQs

SAQ 1 — Triaging the request and pretransport stabilisation (10 marks)

A general hospital calls the neonatal retrieval service about a 2-hour-old, 35-week infant with increasing respiratory distress, a temperature of 35.6 degrees and a glucose of 1.9 mmol per litre. The referring team asks how quickly the baby can be moved. ^{[2] [3]}

Questions

1. Take the referral call in a structured way, state how you would triage the urgency, and explain why the baby is not yet fit to move. (4 marks) ^{[2] [5]}
2. Outline the STABLE pretransport stabilisation you would perform at the referring hospital before the vehicle moves. (4 marks) ^{[3] [5]}
3. Give two reasons why a specialist neonatal transport team is preferred over an ad-hoc transfer, citing the evidence. (2 marks) ^[1]

Model answer

Referral and triage (4). Take the call using SBAR — situation, background, assessment, recommendation — capturing gestation, age, weight, the presenting problem, current observations, airway and access, drugs given, and what the baby needs, then read it back to prevent misheard doses or wrong bed bookings. This is an urgent (not yet time-critical) retrieval: respiratory distress needing a higher level of care, but no closing treatment window. The baby is not fit to move because the temperature (35.6 degrees) and glucose (1.9 mmol per litre) are both below safe thresholds, and the airway and vascular access must be confirmed — moving an unstabilised infant is the cardinal transport error. ^{[2] [5]}

STABLE stabilisation (4). Correct the glucose with a dextrose bolus and start a maintenance dextrose infusion (Sugar); actively rewarm to hold 36.5 to 37.5 degrees with a pre-warmed incubator, hat and warm blankets (Temperature); assess and secure the airway, intubating if the work of breathing is excessive (Airway); measure blood pressure and perfusion and support the circulation with fluid or inotropes if needed (Blood pressure); take a blood gas, septic screen and chest radiograph, and speak to the parents (Lab work); and check the transport equipment and escort before movement (Equipment). ^{[3] [5]}

Specialist team (2). The Cochrane review of specialist neonatal transport teams found that specialist teams reduce transport-related adverse events compared with non-specialist transfer, because they bring neonatal intensive care skill and purpose-built equipment to the bedside; this is the evidence base for regionalising retrieval rather than improvising it. ^[1]