For most women, pregnancy is an uncomplicated and generally uneventful process, aside from the obvious pain and discomfort that comes with delivering a baby. This is quickly forgotten, or at least temporarily pushed to the back of mind, when both parents finally 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 will need to be transported to more appropriate facilities.
It is currently estimated that one in 7 newborns, premature or term, will require admission to neonatal services. Depending on the gestation, this can mean a prolonged hospital stay for both the baby and the parents, with the possibility of complications and the potential for challenges later in life. To put this into perspective, a newborn born at 23 weeks (17 weeks earlier than his full-term counterpart) should expect a hospital stay of a minimum of three months. Of course, this will depend on clinical needs and will vary depending on hospital policy. During this time, the challenges your newborn will face can feel like a never-ending roller coaster ride, with tasks that would normally be simple, like setting up feedings, taking weeks to adjust. While this is not the case for all admissions, most infants who require increased care will require ongoing observation and/or monitoring for an indefinite period.
Neonatal Services in the UK
As a result of the current structure of neonatal service delivery across the UK, many babies will require transport to specialist units. The UK currently has three levels of care, and a neonatal unit will be classified according to these levels, depending on the services it offers. The Special Care Baby Unit (SCBU) provides care for babies who require low-level interventions, such as oxygen therapy, phototherapy (used to treat neonatal jaundice), and antibiotics, just to name a few. The acuity of the staff will be significantly lower than that of the Neonatal Intensive Care Unit (NICU) and therefore the equipment available will be limited. Most SCBUs do not accept infants less than 32 weeks’ gestation, as well as those requiring prolonged non-invasive or invasive ventilation.
The next step up the ladder of neonatal services is the Local Neonatal Unit (LNU). Here, the babies will usually be 28 weeks gestation and will require short-term, low-level intensive care. Staff acumen will be increased and specialized facilities and equipment will be more readily available. With the increasing pressure on intensive care units, babies are being transferred from SCBU to LNU more and more often. Historically, most babies requiring improved care would be transferred to the NICU, however, with advances in treatments and technology to support this fragile group of patients, the NICU is now under immense pressure. .
The NICU is our third rung on the ladder, providing care for the sickest newborns in a wide geographic area. Supporting babies from the viability of life (23 weeks onwards), the NICU offers a vital lifeline for those who require high-level intensive care, one-on-one nursing support and specialized intervention services. In an ideal world, all babies who ‘may’ require such a high level of care would receive antenatal and post-delivery support in a NICU-providing hospital.
. Taking this into account, it can be concluded that transport services will be assigned the task of transporting the sickest and most complex babies.