Critical issues underpinning the safe transfer of ill neonates: A review of the literature


advanced life support (ALS) paramedics

How to Cite

Bhagwan R. Critical issues underpinning the safe transfer of ill neonates: A review of the literature . Australasian Journal of Paramedicine [Internet]. 2021May18 [cited 2023Feb.6];18. Available from:



Critically ill neonates often require urgent transport to a neonatal care facility shortly after birth. The safe transfer of ill neonates is a critical part of their continuum of care.


A review of the empirical work and literature around the safe transfer of ill neonates was undertaken to explore what factors influence a safe transfer.


What emerged was that a multitude of adverse events influence the clinical deterioration of the neonate, including the physiological condition of the neonate, equipment-related challenges and the unpreparedness of those involved to deal with neonatal clinical emergencies.


This review highlights the necessary equipment required, the nature of clinical emergencies that may arise, and the need to consider utilising specialised neonatal transfer units to effect the safe transfer of the critically ill neonate.


Dorrington RE, Bradshaw D, Laubscher R, Nannan N. 2016. Rapid mortality surveillance report. Cape Town: South African Medical Research Council; 2015.

Rhoda NR, Velaphi S, Gebhardt GS, Kauchali S, Barron P. Reducing neonatal deaths in South Africa: progress and challenges. S Afr Med J 2018;108(Suppl 1):9-16.

Kulshrestha A, Singh J. Inter-hospital and intra-hospital patient transfer: recent concepts. Indian J Anaesth 2016;60:451.

Ashokcoomar P. Inter-healthcare facility transfer of critically ill neonates: the development of a programme for emergency medical care in the South African context. Doctoral dissertation; 2018.

Whyte HEA, Jefferies AL. The interfacility transport of critically ill new-borns. Paediatr Child Health 2015;20:265-75.

Messner H. Neonatal transport: a review of the current evidence. Early Hum Dev 2011;87:77.

Carreras-Gonzalez E, Brió-Sanagustin S. Prevention of complications in the air transport of the critically ill paediatric patient between hospitals. Ann Pediatr 2014;81:205-11.

Health Professions Council of South Africa. Professional Board of Emergency Care. 2014. Available at: [Accessed 1 February 2014].

Velaphi S, Rhoda N. Reducing neonatal deaths in South Africa – are we there yet, and what can be done? SAJCH 2012;6:67-71.

Stroud MH, Trautman MS, Meyer K. Pediatric and neonatal interfacility transport: results from a national consensus conference. Pediatrics 2013;132:359-66.

Lim MT, Ratnavel N. A prospective review of adverse events during interhospital transfers of neonates by a dedicated neonatal transfer service. Pediatr Crit Care Med 2008;9:289-93.

Pan P. Inter hospital transfer of critically ill neonates-challenges faced. J Pediatr Neonatal Care 2017;6:00235.

Sabzehei MK, Basiri B, Shoukohi M, Torabian S, Razavi Z. Factors affecting the complications of inter-hospital transfer of neonates referred to the neonatal intensive care unit of Besat Hospital in 2012-2013. J Clin Neonatol 2016;5:238-42.

Hosseini MB, Jannati A, Gholipour K, et al. Perception and expectation of Iran neonatal transport expert regard to developing neonatal transport system in Iran: a qualitative research. ibid. 2014;3:25.

Fenton AC, Leslie A, Skeoch CH. Optimizing neonatal transfer. Arch Dis Child Fetal Neonatal 2004;89:215-9.

Sundrani EJ, Katariya U, Mulye S, et al. Effect of current neonatal transport services on short term outcome of outborn neonates. J Evol Med Dent Sci 2019;8:81-8.

Goldsmit G, Rabasa C, Rodríguez S, et al. Risk factors associated to clinical deterioration during the transport of sick newborn infants. Arch Argent Pediatr 2012;110:304-9.

Janati A, Hosseini MB, Gholipoor K, Zadeh YM, Izadi S. Neonatal transport system in developed and developing countries: a comparative study. Depiction of Health 2019;2:1-8.

Lunze K, Bloom DE, Jamison DT, Hamer DH. The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival. BMC Med 2013;11:24.

Sethi D, Subramanian S. When place and time matters: how to conduct safe inter-hospital transfer of patients. Saudi J Anaesth 2014;8:104-13.

Henry S, Trotman H. Challenges in neonatal transport in Jamaica: a resource-limited setting. J Trop Pediatr 2017;63:307-13.

Ashokcoomar P, Naidoo R. An analysis of inter-healthcare facility transfer of neonates within the eThekwini Health District of KwaZulu-Natal, South Africa.

Mgcini DT. The quality of neonatal inter-facility transport systems within the Johannesburg metropolitan region. Master of Medicine, University of Witwatersrand; 2011.

Senthilkumar R, Corpuz N, Ratnavel N, Sinha A, Mohinuddin S. Adverse events during emergency transfer of neonates performed by regionalised dedicated transfer service. BMJ 2011;96(Suppl 1):96-9.

Dalal E, Vishal G, Solanki D. Study on neonatal transport at tertiary care centres. Int J Sci Res 2013;2:289-92.

Porwal G, Mahale R, Mahale K, Chetan G, Aggarwal R. Clinical profile and outcome underlying neonatal transport from periphery to a tertiary care center in South India. Karnataka Paediatric Journal 2013;28:10-5.

Borimnejad L, Ansari K, Tatarpour P, Haghani H. Studying high risk newborn intra-hospital transport in neonatal intensive care unit (NICU). Iran Journal of Critrical Care Nursing 2012;6:199-206.

Parmentier-Decrucq E, Poissy J, Favory R, et al. Adverse events during intrahospital transport of critically ill patients: incidence and risk factors. Ann Intensive Care 2013;3:1-10.

Kue R, Brown P, Ness C, Scheulen J. Adverse clinical events during intrahospital transport by a specialized team: a preliminary report. Am J Crit Care 2011;20:153-62.

Gilpin D, Hancock S. Referral and transfer of the critically ill child. BJA Educ 2016;16:253-7.

McEvoy CG, Dscloux E, Schuler M, et al. Evaluation of neonatal transport in Western Switzerland: a model of perinatal regionalization. Clin Med Insights Pediatr 2017;11:1-7.

Wiegersma JS, Droogh JM, Zijlstra JG, Fokkema J. Quality of interhospital transport of the critically ill: impact of a mobile intensive care unit with a specialized retrieval team. Crit Care 2011;15:2-8.

Vieira AL, dos Santos AM, Okuyama MK, et al. Factors associated with clinical complications during intrahospital transports in a neonatal unit in Brazil. J Trop Pediatr 2011;57:368-74.

Fried MJ, Bruce J, Colquhoun R, Smith G. Inter-hospital transfers of acutely ill adults in Scotland. Anaesthesia 2011;65:136-44.

Kumar PP, Kumar CD, Shaik FA, Ghanta SB, Venkatalakshmi A. Prolonged neonatal interhospital transport on road: relevance for developing countries. Indian J Pediatr 2010;77:151-4.

Sampathkumar P, Gobinathan S. A study on status of neonatal transport to a level III neonatal intensive care unit. Int J Contemp Pediatr 2018;5:1040-3.