title: Redirecting treatment during neonatal transport.
abstract: Neonatal transport teams comprise multidisciplinary health care providers who are skilled in patient care, communication and customer service, and equipment mechanics. They are extensively trained in resuscitation and stabilization, preparing for accelerating care, and their focus is preservation of life. In any situation focused on caring for critically ill patients, ethical issues and questions may arise. For instance, is it compassionate and/or cost-effective to separate mothers and infants when continuing/accelerating care is futile, and when and how should care be redirected from acute and lifesaving care to comfort care and bereavement support for the family? The knowledge and skills required to address such situations and communicate and participate in a redirection of care may not be adequately emphasized in the preparation of the professionals responsible for stabilizing and transporting critically ill newborns. This article raises issues relating to transport and redirecting care such as eligibility for transport, parental request and consent, separation of mothers and infants, palliative and bereavement care, ethical considerations, competitive transport environment, and customer service. A shared mental model is essential. The focus of this article is not to provide answers to all of these issues, but to highlight the complexity of the topic of redirecting treatment during neonatal transport. Redirecting treatment needs to be discussed, and health care professionals should be prepared during their transport team training. Each family and situation must be approached individually, with the acceptance that there will always be more questions than answers.
authors.affiliation: Department of Pediatrics, University of Maryland Hospital for Children, Baltimore, MD, USA. Sdulkerian@mdmercy.com
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Dulkerian
authors.forename: Webra Price
authors.initials: WP
authors.lastname: Douglas
authors.forename: Renee McCraine
authors.initials: RM
authors.lastname: Taylor
mesh_terms: D000046:Academic Medical Centers; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality / Q000628:therapy*; D007258:Informed Consent; D033183:Interdisciplinary Communication; D008297:Male; D033282:Parental Consent; D010348:Patient Care Team / Q000458:organization & administration*; D010360:Patient Transfer / Q000458:organization & administration*; D012017:Referral and Consultation; D018570:Risk Assessment; D015996:Survival Rate; D017749:Total Quality Management