As a pediatrician who did my training in India and who is presently
working with NETS - a regional, neonatal and paediatric retrieval service
for newborns and children in Sydney, I read this article with great
interest(1). I would like to commend Rainbow Hospital for developing the
retrieval service to transport patients safely to their hospital. There
are numerous studies that support their findings that the overall
prognosis for such babies is improved.
Sophisticated neonatal transport has improved the
safety of transporting preterm infants but may not be the substitute for
the benefits of in utero transport. It is recommended to develop
state wide or countrywide coordinated strategies in reducing non tertiary
hospital births and hence optimizing the vital implications for health
outcomes and resource planning(2).
The authors have not taken in to account the
preretreival state as well as the distance of transport in the two groups.
Teaching basic skills in temperature regulation, fluids, neonatal
resuscitation and prevention of hypoglycemia (keeping them "warm, pink and
sweet") to general practitioners, pediatricians and other doctors working
in remote areas will prevent the various complications studied by the
authors. The stabilization of newborns before the retrieval process is as
important as the retrieval.
In Australia, the demography and population density
make it mandatory to have specialised neonatal transport services. It is
indeed a less expensive option than establishing intensive care facilities
in low population remote areas.
In India, where population density is high and
distances are not that great, the need for regional transport services is
more difficult to justify. The model to adopt should be similar to
that in the USA, where hospitals like Rainbow in India have trained
personnel doing routine hospital work, but yet available to do retrievals
when required. The Australian model of regional transport services
requires a huge capital infrastructure. This money can be better invested
in increasing the facilities of neonatal intensive care units.
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