For the majority of women, pregnancy is an uncomplicated and generally smooth process, other than the obvious pain and discomfort involved in delivering a baby. This is quickly forgotten, or at least temporarily placed to the back of the mind, when both parents finally get to meet their ‘healthy’ newborn for the very first time. Unfortunately, this is not the case for all.
The harsh reality is that the unpredictability of the onset of labor will mean that many infants are left requiring transportation to more appropriate facilities
It is currently estimated that one in 7 newborns, premature or term, will require admission to neonatal services. Gestation dependent, this can mean an extensive hospital admission for both baby and parents, with the possibility of complications, and the potential for challenges later in life. To place this into perspective, a neonate born at 23 weeks (17 weeks earlier than their term counterpart), should expect a hospital stay of a minimum of three months. This of course will be dependent on clinical needs and vary according to hospital policy. During this time, the challenges the newborn will face can feel like a never-ending roller coaster, with tasks that would ordinarily be simple, such as establishing feeds, taking weeks to fine tune. Whilst this is not the case for every admission, most babies requiring an escalation in care will need ongoing observation and/or management for an undefined period.
Neonatal Services in the UK
As a result of the current structure of neonatal service provision across the UK, many babies will require transportation to specialist units. Currently the UK has three levels of care, and a neonatal unit will be classified in accordance with these levels, dependent on which services it offers. The Special Care Baby Unit (SCBU) provides care to infants who require low level interventions such as oxygen therapy, phototherapy (used for the treatment of neonatal jaundice), and antibiotics, just to name a few. Staffing acuity will be significantly lower than that of the Neonatal Intensive Care Unit (NICU) and therefore the equipment available will be limited. Most SCBU will not accept babies below 32 weeks gestation, as well as those who require prolonged invasive or non-invasive ventilation.
The next step on the ladder of neonatal services is the Local Neonatal Unit (LNU). Here infants will generally be from 28 weeks gestation and requiring short term, low level intensive care. Staff acuity will be increased, and the specialist facilities and equipment more freely available. With the ever-increasing pressure on intensive care units, it is becoming more and more prevalent for Infants to be transferred from the SCBU to a LNU. Historically, most babies who required an uplift in care would be transferred to the NICU, however, with advances in treatments and technology to support this fragile patient group, the NICU is now under immense pressure.
The NICU is our third step up on the ladder, providing care to the sickest newborns, across a vast geographical area. Supporting infants from the viability of life (23 weeks onwards), the NICU offers a vital lifeline to those who require high level intensive care, one-to-one nursing support, and specialist interventional services. In an ideal world, all babies who ‘may’ require such a high level of care would receive antenatal support and subsequent delivery at a NICU providing hospital.
. With this is in mind it can be concluded that transport services will be allocated the task of moving the sickest and most complex of babies.