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Paeds Vivasfetal-neonatal-and-perinatal

Paeds Vivas · fetal-neonatal-and-perinatal

Neonatal transport and retrieval — branching viva

Viva on triaging a transport request, the STABLE pretransport stabilisation, the specialist retrieval pathway, temperature and glucose control in transit, and therapeutic hypothermia on transport.

branching clinical structured oral3 min readVerification in progress

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
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Study tools

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A referring hospital calls about a 3-hour-old term infant with moderate hypoxic-ischaemic encephalopathy; the nearest cooling centre is two hours away by road, the baby's temperature is 35.8 degrees, and the referring registrar asks whether to start cooling and how quickly the baby can be moved.

Opening (candidate)

My first move is to take the referral with a structured call-back using SBAR, and to make clear that the baby is retrieved at the bedside before any vehicle moves. This is a time-critical retrieval because the cooling clock is running — the six-hour window starts at birth, and the baby is already three hours old. I would activate the specialist neonatal retrieval team, book the cooling cot, and begin the STABLE stabilisation at the referring hospital, starting by correcting the temperature and glucose and securing the airway and access. I would not move an unstabilised, cold infant. [2] [5]

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References7ShowHide
  1. [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. [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. [3]Skiöld B Predictors of unfavorable thermal outcome during newborn emergency retrievals. Air Med J, 2015.PMID 25733114
  4. [5]Gupta N Neurocritical care of high-risk infants during inter-hospital transport. Acta Paediatr, 2019.PMID 31321815
  5. [7]Robertson NJ Techniques for therapeutic hypothermia during transport and in hospital for perinatal asphyxial encephalopathy. Semin Fetal Neonatal Med, 2010.PMID 20399718
  6. [8]Akula VP A randomized clinical trial of therapeutic hypothermia mode during transport for neonatal encephalopathy. J Pediatr, 2015.PMID 25684087
  7. [10]Szakmar E Asphyxiated neonates who received active therapeutic hypothermia during transport had higher rates of hypocapnia than controls. Acta Paediatr, 2018.PMID 29171918
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