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 The
Front Line
Neonatal
transport
by
James M. Adams, Jr., MD
In
1978, the Baylor Section of Neonatology, in conjunction
with Texas Children’s Hospital, initiated a neonatal transport
team to serve the rapidly expanding needs of the Houston metropolitan
area. Establishment of a regional Perinatal Outreach Program under
the Direction of Dr. Joseph Garcia-Prats preceded the development
of neonatal transport capabilities. The outreach program provided
community hospital staff with specific training in neonatal risk
assessment, stabilization and early management of serious disorders
of the newborn. The transport team was developed in conjunction
with construction of a new 20 bed NICU, which opened in January
1979.
Lead
by Dr. James M. Adams, the team Medical Director, a select group
of neonatologists and neonatal intensive care nurses received
a comprehensive training program extending over several months.
The curriculum included acute neonatal pathophysiology, use of
transport equipment and stabilization and medical management of
the critically ill neonate in the unique transport environment.
Ambulances provided under contract by a local company were equipped
for the special needs of neonatal care during intra-facility transport.
Initially,
a neonatologist and a transport nurse provided care. When the
Baylor/Texas Children’s Neonatal Nurse Clinician Program graduated
its first class in 1980, nurse practitioners assumed the primary
role of care during transport. Tremendous growth in the Baylor
Neonatology Section and the Special Care Nurseries at Texas Children’s
was accompanied by a parallel increase in the volume of neonatal
transports.
At
the present time, under the supervision of Baylor neonatologists,
the neonatal transport team provides both air and ground ambulance
service throughout Texas as part of the Texas Children’s Kangaroo
Crew. Annually, 625 critically ill neonates are transported to
the 120 beds in the Newborn Center at the hospital. Nearly 20%
of these patients come from other Level III neonatal units and
air transports represent an ever-increasing proportion since the
inception of this service in 1999. Usual team composition includes
a Neonatal Nurse Practitioner, NICU nurse and registered respiratory
therapist. Two teams of these specialists are now maintained to
meet the heavy demands of air and ground transport requests. The
teams are able to provide all forms of neonatal ventilatory support,
including inhaled nitric oxide.
Current
construction at Texas Children’s Newborn Center will provide 140
completely new intensive care beds for critically ill neonates
by the year 2004. The proportion of babies referred from hospitals
outside the Texas Medical Center continues to increase. The Baylor
Neonatology Section anticipates steady growth in demands for transport
services as the number of referrals and severity of illness continues
to accelerate in the high risk newborn population.
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