For most women, pregnancy is an uncomplicated and generally smooth process, aside from the obvious pain and discomfort associated with giving birth to a baby. This is quickly forgotten, or at least temporarily in 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 result in many babies having to be transported to more suitable facilities
It is currently estimated that one in seven newborns, either preterm or term, should be admitted to neonatal services. Depending on the pregnancy, this could mean extensive hospitalization for both baby and parents, with the possibility of complications and the potential for challenges later in life. To put this in perspective, a newborn born at 23 weeks (17 weeks earlier than their full-term counterpart) should expect a hospital stay of at least three months. This is of course dependent on clinical needs and varies according to hospital policy. During this time, the challenges the newborn faces can feel like an endless roller coaster, with tasks that would normally be simple, such as setting up feeds, and taking weeks to refine. While this is not the case with every admission, most infants requiring escalation in care will require continuous observation and/or treatment for an indefinite period of time.
Neonatal Services in the UK
Due to the current structure of neonatal services in the UK, many babies will need to be transported to specialized wards. Currently the UK has three levels of care and a neonatal unit will be classified in accordance with these levels depending on the services it provides. The Special Care Baby Unit (SCBU) provides care for infants who require low-level interventions such as oxygen therapy, phototherapy (used to treat jaundice in newborns), and antibiotics, to name a few. The workforce will be significantly lower than that of the Neonatal Intensive Care Unit (NICU) and therefore the equipment available will be limited. Most SCBUs will not accept babies less than 32 weeks gestational age, as well as those requiring long-term invasive or non-invasive ventilation.
The next step up the ladder of neonatal services is the Local Neonatal Unit (LNU). Here, babies will generally be from 28 weeks of gestation and will require low-level intensive care in the short term. Staff sharpness will be increased and specialist facilities and equipment will be more freely available. With the ever increasing pressure on intensive care units, it is becoming more common for babies to be transferred from the SCBU to an LNU. Historically, most babies who needed better care would be transferred to the NICU, but with advances in treatments and technology to support this vulnerable patient group, the NICU is now under tremendous pressure.
The NICU is our third rung, providing care for the sickest newborns in a vast geographic area. Supporting infants from the viability of life (23 weeks and beyond), the NICU provides a vital lifeline for those requiring high-level intensive care, one-on-one nursing support, and specialized intervention services. In an ideal world, all babies who ‘might’ need such a high level of care would receive prenatal support and subsequent delivery in a NICU hospital.
. With this in mind, it can be concluded that transport services are tasked with transporting the sickest and most complex babies.