Transporting palliative/DNR/dying/dead neonates

[wensday, MSN, RN, APN, NP]

Hi I'm part of a Neonatal network transport team and am writing a guideline about transportation of infants surrounding death. This will particularly focus on transporting infants with DNRs back to home NNUs/hospices, but I thought it might as well cover all issues relating to neonatal death during transfer.

Does anyone have a guideline that may be of use to me?

Am only just starting it today so I'm going to contact a few local networks and see what they do.

Thanks for reading xxx

[NicuGal, MSN, RN]

We use our regular transport guidelines except if they code in route we don't do anything. If a baby goes bad during transport we do CPR until we land on the helipad and then the fellow can pronounce. That happened to me once...we were over one of the Great Lakes and the kid, who was cardiac, went south fast. We did CPR and pushed meds until we could land somewhere and then we pronounced. It really, really sucks to do that in the air, at least on ground they can pull over!

[umcRN, BSN, RN]

don't really know of any policies. Have only seen this situation once and it was very recent, had a baby who was transferred to our unit for her prenatally dx cardiac defect and it turned out she also had no kidneys...so the cardiac defect was really the least of her issues. She was transported back to the mothers hospital for withdrawal of care. And she went downhill real fast as soon as she was placed in the transport isolette, transport had to bag her the whole way back just to keep her alive, to be withdrawn with her mother, poor kiddo :smackingf

[wensday, MSN, RN, APN, NP]

Thanks for your replies.

Our neighbouring network doesn't have a guideline either.

We have had a few DNR transfers recently for specialist reviews and repatriation to home NNUs/hospices and there was some conflict over nurse-led/medic and paramedic/high dependancy vehicle use.

Ordinarily we would do as you say, just resus til you arrive somewhere useful preferably wherever the parents are. However that is for babies we would resus if they were on the nnu. The DNR thing is a bit hazy and it's come up 3 times in a month.

[NicuGal, MSN, RN]

I forgot to add, if they are going to a long term care facility, we don't go with them, they go with the ambulance crew in a car seat or car bed. When they go to hospice, usually the parents go with them in the ambulance.