Neonatal Aviation Medicine | AirMed and Rescue

For the majority of women, pregnancy is generally a smooth and uncomplicated process, other than the obvious pain and discomfort involved in delivering a baby. This is quickly forgotten, or at least temporarily put in the back of mind, when both parents are finally able to meet their “healthy” newborn for the first time. Unfortunately, this is not the case for everyone.

The harsh reality is that the unpredictability of the onset of labor will mean that many babies are left in need of transportation to more appropriate facilities.

It is currently estimated that 1 in 7 newborns, premature or term, will need admission to neonatal services. Depending on the pregnancy, this can mean extensive hospitalization for both the baby and the parents, with the potential for complications, and the potential for challenges later in life. To put this into perspective, a newborn born at 23 weeks (17 weeks before his class counterpart) should expect a hospital stay of at least three months. This of course depends on clinical needs and varies according to hospital policy. During this time, the challenges a newborn will face can feel like an endless roller coaster, with tasks that are usually simple, like creating meals, that take weeks to tune in. While this is not the case for every admission, most children who require an escalation in care will need continuous monitoring and/or management for an indefinite period.

Newborn services in the UK

As a result of the current structure to provide neonatal services across the UK, many babies will need to be transferred to specialist units. In the UK there are currently three levels of care, and the neonatal unit will be categorized according to these levels, depending on the services it provides. The SCBU provides care for babies who require low-level interventions such as oxygen therapy, photodynamic therapy (used in the treatment of neonatal jaundice), and antibiotics, to name a few. The staffing unit will be much less than in the NICU and therefore the available equipment will be limited. Most SCBUs will not accept infants under 32 weeks of gestation, as well as those who require prolonged or non-surgical ventilation.

The next step on the neonatal service ladder is the Local Neonatal Unit (LNU). Babies here will generally be from 28 weeks gestation and require short-term, low-level intensive care. Personnel will be sharpened, specialized facilities and equipment will be available more freely. With the ever-increasing pressure on intensive care units, it is becoming more and more prevalent for infants to be transferred from SCBU to LNU. Historically, most babies requiring an increase in care were transferred to the NICU, however, with advances in treatments and technology to support this vulnerable group of patients, the NICU is now under tremendous pressure.

The NICU is the third step on the priority ladder, providing care for the sickest newborns, across a vast geographic area. The Neonatal Intensive Care Unit supports viability (23 weeks onwards), and provides a vital lifeline for those who require high-level intensive care, individualized nursing support, and specialized interventional services. In an ideal world, all babies who “might” need such a high level of care would receive prenatal and postnatal support in the neonatal intensive care unit (NICU) that the hospital provides.

. With this in mind, it can be concluded that the task of transport services will be devoted to transporting the sickest and most complex children.