Noninvasive Monitoring during Interhospital Transport of Newborn Infants

Abstract

The main indications for interhospital neonatal transports are radiographic studies (e.g., magnet resonance imaging) and surgical interventions. Specialized neonatal transport teams need to be skilled in patient care, communication, and equipment management and extensively trained in resuscitation, stabilization, and transport of critically ill infants. However, there is increasing evidence that clinical assessment of heart rate, color, or chest wall movements is imprecise and can be misleading even in experienced hands. The aim of the paper was to review the current evidence on clinical monitoring equipment during interhospital neonatal transport.

Figure 1

During positive pressure ventilation (PPV), the airway pressures rise to set PIP. At the end of inspiration, PIP decreases to baseline (PEEP). The area underneath the gas flow waves during inflation and expiration is similar, which is reflected in the V _T wave returning to the baseline after expiration. No leak is displayed.

Figure 2

During PPV, the area underneath inspiratory gas flow is larger compared to expiratory gas flow. This is reflected in the display of a large amount of leak around the ETT.

Figure 3

During PPV, the ETT suddenly becomes obstructed, which can be identified by gas flow and V _T cessation. Airway pressures are continuously delivered.

Figure 4

During PPV, the ETT suddenly becomes dislodged.

Figure 5

During PPV, the delivered V _T is between 21 and 30 mL/kg. Once the PIP is decreased from 30 cm H₂O to 20 cm H₂O, the displayed V _T decreases to around 9 mL/kg.

Figure 6

During manual inflations the infant is taking a spontaneous breath.