When I’m not working in the emergency department, playing with my children or doing DFTB ‘stuff’ I work for the state retrieval service. As the name Adult Retrieval Victoria implies I spend my time moving and coordinating the movement of critically ill or injured adults around the state. There is a dearth of retrieval textbooks out there and so I was excited to see the Oxford Handbook of Retrieval Medicine make it into print.
Minh Le Cong has done a great review of the book that you can listen to here. Given that Don’t Forget The Bubbles is a website dedicated to all things paediatric, I thought it might be worthwhile taking a look at those sections that might be of particular import regarding the retrieval and transfer of critically ill neonates and children – something which I have very little experience in.
I think that neonatal retrieval should be practiced by those who have undergone the appropriate training, especially given the improvement in morbidity and mortality brought by specialist NETS teams.
The section comes into its own, however, when viewed as a primer for those who may only rarely look after neonates and have to stabilise and prepare them for transfer. It should really be read as a pocket-sized guide to the serious medical and surgical conditions that may occur in neonates and how they should be initially managed. There is even a quick run through of some of the basic (and more complex) procedures that may be required prior to transfer.
In order to understand more about the challenges of neonatal retrieval I reached out to chapter author, Jane Cocks.
When did you first get involved in neonatal retrieval? What attracted you to the speciality?
I was originally involved in both paediatric and neonatal retrievals when I was a registrar in Sydney (~1995), experiencing initially unit-based services and then observing the set up of the stand alone NETS NSW service. Many years later (2009), I was offered the opportunity to be involved in setting up a combined stand alone retrieval service in SA. I was keen to be involved in this project as I believed there would be true benefit to the patients from consolidating and combining retrieval services in our state.
What attracted you to this project?
I was keen to be involved in the textbook to help educate staff either directly or indirectly involved in neonatal retrievals with up-to-date information about current best practice.
Who is the target audience of your chapter?
Retrieval medical and nursing staff. Referring staff, in order to inform them of possible retrieval team management and perhaps enable them to initiate treatment early.
What changes have you seen in the practice of neonatal retrieval over the last 10 years?
In line with the extensive changes in NICU care, neonatal retrievals have had some significant improvements. Rationalisation of the use of oxygen in neonatal resuscitation, early use of surfactant, increased use of nasal CPAP, increasing use of humidified high flow nasal oxygen, rationalisation of ventilation strategies and most recently improved retrieval ventilators which allow higher level ventilation strategies in line with those available in NICU.
If you were not limited for space what would you like to have included?
I was pretty happy with the contents we included, not sure there was anything else we wanted to include.
Can you give an example of a resource readers can access to learn more about neonatal retrieval?
There is a definite paucity of retrieval specific neonatal resources. Both NETS NSW and PIPER have some on line guidelines and the statewide SA Perinatal guidelines also have some information. Many of the textbooks on neonatology include some information, but it is pretty limited.
Are there one or two key messages that you would like readers to take away from your chapter?
Structured approach, focus on respiratory support, call for help and advice early, don’t forget the possibility of congenital cardiac issues, remember the basics – add oxygen thoughtfully, maintain temperature, maintain glucose homeostasis and minimise handling (pink, warm, sweet and happy).
My bottom line take is that this chapter of the book does an excellent job of covering common life threatening neonatal conditions. It would be well worth picking up a copy and keeping in your rural (or not so rural department) and flicking to the relevant chapter should a sick newborn present. It would also be a useful guide for those studying for the fellowship exams though you’ll need to go to your bigger textbooks for more knowledge. You won’t read the 57 pages and come out with the skills of Jane Cocks, Trish Woods, or Hazel Talbot but you will better understand the questions they are going to be asking you over the telephone.
If you want to know more about the challenges of neonatal retrieval then come and listen to Jane Cocks and Trish Woods at DFTB17.
(Time for me to declare my conflict of interest – two of the editors (MK and CE) are my bosses at one of my workplaces. They don’t look after children.)