Paeds · fetal-neonatal-and-perinatal
Neonatal transport and retrieval
Also known as Neonatal retrieval · Inter-hospital neonatal transport · Neonatal transport service · Specialist neonatal transfer · Back-transfer of the convalescing neonate
Fellowship guide to neonatal transport and retrieval: triaging a transport request, the STABLE pretransport stabilisation, the specialist retrieval pathway, temperature and glucose control in transit, therapeutic hypothermia on transport, and regional retrieval systems across ANZ, the UK and North America.
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Target exams
Red flags
- Sick newborn being moved before airway, ventilation and temperature are stabilised
- Admission temperature outside 36.5 to 37.5 degrees on arrival at the receiving unit
- Cooling clock running in a term infant with encephalopathy and no cooling centre identified within six hours
- Duct-dependent cyanotic lesion without a prostaglandin E1 infusion running before transfer
- Ventilated infant transferred without continuous capnography and a secured, rechecked endotracheal tube
- Active servo-controlled cooling in transit causing hypocapnia or overcooling beyond 33 to 34 degrees
- No structured handover (SBAR) between referring hospital, retrieval team and receiving NICU
- Surgical abdomen or pneumothorax not decompressed before a long-distance move
Life stages
Care settings
Clinical exam formats
Board mappings
- Recognition and management of the acutely unwell neonate
- Principles of stabilisation before inter-hospital transfer
- Communication, handover and referral in neonatal emergencies
- Organisation and conduct of neonatal retrieval
- Stabilisation of the sick newborn for transport: airway, breathing, temperature, glucose
- Therapeutic hypothermia and neurocritical care during transport
- STABLE pretransport mnemonic and its application
- Temperature, glucose and ventilation control in transit
- Human factors, team structure and SBAR in neonatal retrieval
- Long case: coordination of retrieval for a sick or preterm newborn
- Communication with a regional centre and with the family before transfer
- Neonatology and infant health: stabilisation and transfer
- Health systems: neonatal networks and transport services
- Patient safety: adverse events and quality metrics in neonatal transport
- Neonatal physiology, thermoregulation and the impact of transport
- Pharmacology: prostaglandin E1, sedation and fluids in transit
- Evidence base for specialist neonatal transport teams
- Communication: structured referral and handover (SBAR)
- Neonatal transport scenario station
- Neonatal stabilisation and transport
- Neonatal thermoregulation and glucose homeostasis in transit
- Systems of care: regionalisation and neonatal retrieval
- Patient Care: stabilisation and transport of the sick newborn
- Medical Knowledge: physiological insults of neonatal transport
- Systems-Based Practice: regional neonatal retrieval networks
- Medical Expert: pretransport stabilisation and in-transit care
- Collaborator: retrieval team, referring hospital and receiving NICU
- Health Advocate: equitable access to neonatal intensive care
Overview & Definition
A baby born at a hospital without neonatal intensive care, or one who outgrows or destabilises at a lower-level unit, needs to be moved to a higher level of care. Neonatal transport and retrieval is the organised process of moving that sick newborn between hospitals safely, using a specialist team and purpose-built equipment to deliver intensive care throughout the journey. The guiding idea is simple and exam-friendly: you bring the NICU to the baby, stabilise the baby as if already in the NICU, and only then move. [1] [2]
Two directions of travel matter for exams. An antenatal (in-utero) transfer moves the mother before birth so the baby is delivered where it will be needed — the safest option when risk is identified early, because a fetus in utero travels better than a neonate on a ventilator. A postnatal (ex-utero) retrieval moves the baby after birth, and this is the harder, riskier task that this page is about. When antenatal transfer is not possible, a sick newborn will need postnatal retrieval, and the quality of the stabilisation at the referring hospital is the single biggest determinant of how that baby does. [2]
The distinction that frames every transport decision is between stabilisation and movement. Stabilisation is everything done at the bedside to make the baby safe to move — securing the airway, optimising ventilation, correcting temperature and glucose, establishing vascular access and treating the reversible problems. Movement is the journey itself, which adds cold, vibration, acceleration and noise on top of a borderline physiology. The baby is, in the language of retrieval teams, "retrieved" at the bedside; the road or the air leg is the part you do only once stability is held. [3] [5]
References10ShowHide
- [1]Chang AS Specialist teams for neonatal transport to neonatal intensive care units for prevention of morbidity and mortality. Cochrane Database Syst Rev, 2015.PMID 26508087
- [2]Leslie A Tracking national neonatal transport activity and metrics using the UK Neonatal Transport Group dataset 2012-2021: a narrative review. Arch Dis Child Fetal Neonatal Ed, 2024.PMID 38272658
- [3]Skiöld B Predictors of unfavorable thermal outcome during newborn emergency retrievals. Air Med J, 2015.PMID 25733114
- [4]Saito-Benz M Impact of Education on Hypothermia Delivery during Neonatal Transport. Neonatology, 2019.PMID 30889592
- [5]Gupta N Neurocritical care of high-risk infants during inter-hospital transport. Acta Paediatr, 2019.PMID 31321815
- [6]Annicq ASJM Clinical Characteristics and Outcomes for Neonates, Infants, and Children Referred to a Regional Pediatric Intensive Care Transport Service for Extracorporeal Membrane Oxygenation. Pediatr Crit Care Med, 2020.PMID 32886461
- [7]Robertson NJ Techniques for therapeutic hypothermia during transport and in hospital for perinatal asphyxial encephalopathy. Semin Fetal Neonatal Med, 2010.PMID 20399718
- [8]Akula VP A randomized clinical trial of therapeutic hypothermia mode during transport for neonatal encephalopathy. J Pediatr, 2015.PMID 25684087
- [9]Fairchild K Therapeutic hypothermia on neonatal transport: 4-year experience in a single NICU. J Perinatol, 2010.PMID 19847186
- [10]Szakmar E Asphyxiated neonates who received active therapeutic hypothermia during transport had higher rates of hypocapnia than controls. Acta Paediatr, 2018.PMID 29171918