O3326: Variation in Neonatal Transport Procedures and Practices within the Children’s Hospital Neonatal Consortium (CHNC)

Background: Interfacility transport of neonates presents a multifaceted and resource-intensive effort, requiring the relocation of medically fragile neonates to facilities offering specialized care. Despite its frequency, there remains a scarcity of comprehensive data regarding the scale, acuity of condition, and patient outcomes among transported neonates. While individual institutions in the United States have established protocols for neonatal transport (NT), there exists a gap in knowledge of types of team composition, operational dynamics, procedural standards, education provided, most frequent challenges encountered, and quality benchmarks, both nationally and within the CHNC. There is an increasing necessity for the establishment of standardized protocols governing the interfacility transfer of neonates. The most recent comprehensive evaluation of NT in North America is over a decade old, underscoring the pressing need for updated guidance in this critical aspect of neonatal care. The CHNC is a qualitative collaborative of 49 quaternary Neonatal Intensive Care Units (NICU) aimed at improving and standardizing neonatal care.

Methods: A survey questionnaire utilizing Redcap was disseminated to level IV NICUs actively engaged within the CHNC (46 NICUs at the time of the survey). To ensure data integrity, we sought a singular response from each institution. The questionnaire covered four overarching domains: 1) general institutional details, 2) composition of the neonatal transport team, 3) resource utilization and accreditation status of the team, and 4) team clinical capabilities.

Results: A total of 67% (31/46) of institutions responded. See Table 1 for survey results. Of note, regarding transport leadership positions among neonatologists, 87% of respondents hold a transport-related administrative position, with only 51% receiving protected time for their role. While 41% have more than 5 years’ experience, their roles in hiring, credentialing, and quality improvement were limited. Most provided team education, case reviews, and feedback to referring hospitals. Nearly all teams could initiate and continuing therapeutic hypothermia, provide inhaled nitric oxide, perform intubation, administer surfactant, perform needle decompression, initiate intraosseous access, and can place umbilical lines. However, clinical capabilities varied among teams (see Figure 1). The survey also revealed that only 45% of of institutions are CAMTS certified and 65% submit to the GAMUT database.

Conclusion: The survey reveals considerable heterogeneity within the CHNC regarding interfacility neonatal transport. There is variation in team composition, clinical capabilities, leadership structure and protected time for physicians in an administrative / leadership position. To our knowledge, this is the most recent comprehensive survey of its kind. The findings provide a foundation for future evaluation of neonatal transport, with the objective of establishing evidence-based best-practice guidelines, fostering knowledge exchange, and promoting collaboration to enhance outcomes for neonates transferred to quaternary NICUs.