INTRODUCTION Congenital heart disease is one of the most common birth defects with approximately 25% them being considered ‘critical’, requiring

surgical intervention to improve the restrictive circulation very soon after birth. Such infants require ‘time critical transfer’ due to significant risk of rapid deterioration if duct patency is insufficient to maintain adequate pulmonary or systemic circulation. Transport

of these high-risk, critically ill newborns requires experienced, specialized teams. ‘In house' delivery would be ideal as severe desaturation may occur rapidly after birth if the mixing of blood at the atrial level is

severely restrictive. However, very few paediatric cardiac centres in the UK have on‐site obstetric services so this is most often not a possibility for these babies.

KIDS is a regionalized, paediatric intensive care retrieval service based in the UK Midlands, transporting around 800 critically ill infants and children every year.

CASE STUDIES

Three babies with Hypoplastic Left Heart Syndrome with intact/restrictive septum were referred to KIDS ante-natally, born at Birmingham Women’s Hospital (BWH) and transferred to Birmingham Children’s Hospital (BCH), 4.5 miles away.

3 P’s and Pod – Practical Preparation and Planning for time critical neonatal

cardiac transfers.

CONCLUSIONS Careful planning prior to delivery with the KIDS team, local neonatal and obstetrics teams included; role

assignment, prior preparation of infusions ready to attach, equipment set up and journey planning. Planning these practical elements of the transfer gave these babies the best possible chance to get the right

treatment as quickly as possible.

Key elements in planning: Infusions: All made up to an agreed estimated weight, put into pumps and started running into a bile bag during

the pre-birth period to allow for instant action once attached. Role assignment: every role within the resuscitation was planned, right down to the placement of the

saturation probe, to ensure everything was done promptly and safely. Clear expectations of everyone involved.

KIDS Intensive Care and Decision Support, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK

KEY MESSAGE Preparation and planning of all practical elements of these types of transfers is

the critical element to undertaking them in a safe and timely manner.

Birmingham Children’s Hospital NHS Foundation Trust University Hospitals of North Midlands NHS Trust

Anneke Gyles, Sarah Taylor anneke.gyles@bch.nhs.uk / sarah.taylor4@bch.nhs.uk

REFERENCES Bu'Lock F A. Transporting babies with known heart disease; who, what and where? Arch Dis Child Fetal Neonatal Ed. 2007 Mar; 92(2): F80–F81.

BABY ONE born at 13.12, arrived in theatre at BCH at 13.38 = 26 mins

Referred 7/10/14, Born 21/10/14, Elective LSCS • 14 days to plan for 2nd team, and appropriate

equipment. • Team arrived at BWH @ 11.47 baby born @

13.12, allowing 1hr 20 mins for planning, setting up and talking to parents.

• Clear role assignment prior to birth, including possible complications.

• Resuscitation team outside theatre, baby brought out immediately after birth

• Roles assigned: Neonatal team = Intubation, UVC insertion. KIDS team = ETT strapping, probe and electrode placement, infusion

attachment Whole team transfer to Babypod and KIDS team secure.

• BCH aware and appropriate departments ready for patient to allow for rapid, safe and

seamless transfer directly to cardiac theatre.

BABY TWO born at 18.05, arrived in PICU at BCH at 18.44 = 39 mins

Referred 21/12/14, Born on 22/12/14 , NVD (late diagnosis of intact septum).

• Team arrived at BWH @ 15.21 baby born @ 18.05, due to unknown timings for NVD planning, setting up and talking to parents all done in this

time. • Neonatal team in delivery room, KIDS team

outside until point of birth. • Clear role assignment prior to birth, including

possible complications. • Roles assigned: Neonatal team = Intubation, UVC

and PVL insertion. KIDS team: = ETT strapping, monitoring attachment, infusion attachment.

Whole team transfer to Babypod and KIDS team secure before leaving

• BCH PIC, Cardiology and Cardiac Surgery teams aware of patient arrival time allowed for

seamless transfer to PICU.

BABY THREE born at 11.50, arrived in theatre at BCH at 12.20 = 30 mins

Referred 25/03/15, Born 08/04/15, Elective LSCS • 14 days to plan for 2nd team, and appropriate

equipment. • Team arrived at BWH @ 10.10 baby born @

11.50, allowing 1hr 40 mins for planning, setting up and talking to parents.

• Resuscitation team INSIDE theatre and resuscitating baby whilst mum is still

undergoing surgery • Roles assigned: Neonatal team = intubate and

strap ETT, insert UVC and PVL. KIDS team = monitoring attachment and awareness,

infusion attachment, transfer to Babypod • 2x chest compressions for bradycardia

• BCH aware and appropriate departments ready for patient to allow for rapid, safe and seamless transfer directly to cardiac theatre.