1. Dr Lucinda Perkins*, Richard Lee +, Dr Jean Matthes * j Affiliations: *Singleton Hospital Neonatal Intensive Care Unit, Swansea, West Wales + Wales Ambulance Service

2. Introduction Inter hospital neonatal transport services function effectively across the UK In contrast, there is little guidance available on pre-hospital transport of newborn infants Paramedic guidelines lack detail in certain areas Training for staff undertaking transfers varies We assessed local practice in pre-hospital transfer of newborn babies born outside hospital with a view to developing best practice guidelines to support paramedics/midwives to improve care

3. Method Patients were identified from the Midwifery Led Unit (MLU) log of transfers and Neonatal Unit admissions record 3 year period (from 2011 to 2013) 22 babies were identified Retrospective data collection Standardised proformat Resuscitation, stabilisation, care during transfer and outcome

4. Results - Demographics

5. Place of Birth

6. Reason for Transfer Secured during Transfer?

7. Documentation 59% - no documentation of events during transfer 22% evidenced regular checks 10% mandatory paramedic transfer sheet filed Of those transferred from MLU 45% had MLU SBAR sheet Where midwife present 53% made no documentation at any point

8. Assessment during transfer Not Documented Yes

9. Intervention during Transfer Not Documented Yes

10. On arrival → 20% Normothermic → 76% Normoglycaemic Temperature on Arrival Blood Glucose on Arrival

11. Outcomes On arrival, 9% of babies had a HR < 60bpm 59% had a gas on arrival – of these 62% had pH>7.20, 23% had pH<7.0 No documentation of paramedics or midwives being debriefed Mean duration of stay was 28 days (min 7hrs, Max 156 days) 9% mortality - D137 and D216 respectively No deaths during transfer or within first weeks/months of life

12. Conclusions Documentation suboptimal - difficult to reliably assess practice Paramedic notes/sheet often not filed in the neonatal hospital record 50% showed documentation of efforts to try to maintain infants body temperature - 80% of babies were cold on arrival Lack of documentation does not necessarily equate to lack of care - despite proportion requiring significant resuscitation no early mortality

13. Recommendations A multidisciplinary approach is required to improve practice Best Practice guidelines are required to support paramedic staff in managing newborn resuscitation, including thermal care, care of airway and monitoring during transfer Medical equipment carried routinely on ambulances does not support transfer of very small babies – we are working with the Welsh ambulance service to improve this A neonatal pack to be part of all Ambulance kits will include a crib sheet for paramedics and certain basic kit We need to improve training to support paramedics - must be cascaded

14. Thank You Any Questions?