O3330: Neonatal Stabilization Team: A Critical Team Providing Neonatal Care for Military Families in Guam

Background: Since 2021, Guam has lacked an accredited neonatal intensive care unit (NICU), which is a major public health concern for the approximately 150,000 residents and 20,000 military service members and their families on the island. In August 2021, the military established a Neonatal Stabilization Team (NeoStaT) to stabilize critically ill neonates born to U.S. military beneficiaries at U.S. Naval Hospital Guam (USNHG) until they could be transported to a NICU with appropriate resources. The NeoStaT consisted of one neonatologist, two NICU nurses, and one respiratory care practitioner (RCP) covering 4 to 24-week rotations at USNHG that were available 24/7 for neonates requiring care beyond a newborn nursery. This report summarizes the NeoStaT mission while describing the personnel involved, patients cared for, and infants requiring transport from Guam.

Methods: Records were reviewed to determine the number and type of personnel staffing the NeoStaT mission from August 15, 2021 through September 30, 2024. Temporary duty costs were estimated based on the duration of assignments for NeoStaT personnel. Existing patient records were reviewed and data on patient care and air transports were extracted. Finally, transport costs were calculated based on estimates provided by the Theater Patient Movement Requirements Center-West. The study received a non-research determination by the Brooke Army Medical Center institutional review board.

Results: A total of 54 personnel participated in the NeoStaT mission (21 neonatologists, 19 nurses, and 14 RCPs) with an estimated total TDY cost of $1.8M. NeoStaT admitted 80 patients who had an average length of stay of 3 days. The most common admission diagnoses were respiratory distress/failure (80%) and prematurity (36% were born at < 37 weeks gestational age). Sixty-nine percent of patients admitted to NeoStaT were able to be dispositioned back to their parents and 29% were transported off island. Two patients died prior to transport. Among the 23 transported patients, the most common diagnosis was prematurity ( < 37 weeks gestational age), which included 17 patients (74%). All transported patients survived the transport and to eventual hospital discharge. Eighteen (78%) transports were performed by a military neonatal transport team based out of U.S. Naval Hospital-Okinawa (USNHO)/18th Medical Group, Kadena AB, while 4 (17%) were performed by Tripler Army Medical Center (TAMC), and 1 was performed by a civilian air ambulance company. TAMC was the most common transport destination, accepting 16 patients (70%) while USNHO accepted 7 patients (30%). The total costs of these transports were estimated to be $6.5M.

Conclusion: This report highlights the scope of personnel, patients, and transports associated with the NeoStaT in Guam. The authors believe this experience may be useful in future considerations of how to most effectively meet the dependent care needs of military-affiliated families stationed in present and future strategic locations around the world.