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Neonatal transport

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While we aim for prenatal transfer to level-3 units (when applicable, for example, in birth <28 weeks, antenatally diagnosed hydrops etc) we sometimes end up with a critically ill infant in our level-2 unit. Most of us have previously worked in level-3 settings so the initial management with stabilization is similar regardless of initial level-of-care.

We have a good communication with our regional level-3 unit (at Karolinska hospital) and discuss those cases carefully over the phone, and reach consensus what to do. And naturally, also involving the parents of course! Usually it is possible to aim for a postpartum transport, but sometimes further treatment is judged as futile.

I agree with @dracunculus that decisions are really taken on an individual basis.

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The most interesting case scenario in my experience is this: term baby born in a background of perinatal compromise, with poor response to resuscitation and then gets a heart rate at about 30 minutes or so and the baby getting transferred to a level-3 neonatal unit for active cooling. Invariably, the short-term prognosis in these babies is very poor and difficult decisions are taken in the level-3 unit, including withdrawal of care. 

the question shouldn't  just be babies who "cannot" be transported, but also babies who "should" not be transported. 


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