Criteria for Neonatal Referral
NETS expects to be called about (and possibly retrieve) newly born babies in the following categories:
1. Preterm < 35 weeks or < 2,000g. (outside the delineated role[i] of the referring hospital).
2. Preterm < 30 weeks or < 1,500g. Such patients may be assumed to need intensive care transport.
3. Respiratory distress …
a) of early onset or
b) rapidly progressive or
c) persistent beyond 4 hours or
d) with accompanying apnoea or asphyxia.
4. Meconium aspiration demonstrated on X–Ray with a need for supplemental oxygen.
5. Babies needing oxygen more than:
a) FiO2 0.6
b) FiO2 0.4 — if regular blood gases not possible.
6. Cyanosis persisting despite oxygen therapy.
7. Unwellness, especially if initially well.
8. Heart failure or Arrhythmia.
9. Shock, Sepsis or Seizures.
10. Depression following perinatal asphyxia.
11. “Apgar” score persistently less than 7.
12. Capillary refill persistently longer than 3 seconds.
13. Apnoea.
14. Bleeding.
15. Surgical conditions requiring acute therapy.
16. Airway problems interfering with gas exchange.
Inter–Intensive Care transfers
Patients are transferred from Level 5 to a Level 6 hospital for treatment such as surgery not available in the referring hospital. It has been agreed that all such transfers only occur after consultant–consultant discussion. If these patients are hæmodynamically stable and not requiring ventilation or significant vaso-active support, it is appropriate for referring staff to escort the patient. Where a baby requires an assessment that can be performed by a visiting specialist, consideration should be given to taking the assessment equipment and staff to the patient rather than moving the patient.
NETS cannot necessarily provide medical retrieval resources when a transfer between intensive care units is requested because of bed shortages. Where such transfers do occur, finding and confirming the bed is the responsibility of the referring intensive care hospital rather than NETS and should precede the transfer.
‘Elective’ transfers (including ‘reverse’)
NETS role is to provide medical retrieval of all intensive care patients (ventilated or on vaso–active support) judged to need transfer between hospitals. This includes those patients needing relocation after surgery or when specific investigations have been completed. The timing of these transfers needs negotiation and since NETS will always place a higher priority on emergency transfer requests, a team cannot always be provided on demand.
NETS also offers medical retrieval of intensive care patients where it is intended that those treatments be withdrawn following transport. However, the process of withdrawal of treatment is the responsibility of the accepting hospital and NETS expects the accepting consultant to be present and to take full clinical responsibility for these patients.
Other ‘reverse’ transfers are the responsibility of the sending hospital that should ensure that the patient can be adequately catered for in the accepting hospital in terms of physical space, equipment, staffing and local policies. NETS can offer advice on how to safely move care patients in the convalescent phase.