High Frequency Oscillatory Ventilation in Long Distance Transfer of Neonates in Australia – A Case Series from a Single Centre

Summary: Located on the northernmost coastline of Australia, Royal Darwin Hospital (RDH) is the first point of referral for more than 60 remote communities, servicing an area > 650 000 2 km². Aeromedical transfer of infants for sub-specialist review or an escalation in medical care to quaternary services requires a minimum of four hours of flight time. Since commencing in April 2018, the Northern Territory Neonatal Emergency Transport Service (NETS NT) has transferred more than 30 infants to interstate hospitals. This case series reviews the transport of four critically unwell infants from RDH to two quaternary hospitals, each more than 3400km from Darwin. All babies were transferred in the setting of respiratory failure requiring High Frequency Oscillatory Ventilation (HFOV) to access locally unavailable therapies, both surgical and medical. Three of the four infants were born very prematurely, <29 weeks gestational age, with weights 968 g- 1317 g at the time of transfer. One infant was born at term but required transfer due to respiratory failure on maximal available therapy for meconium aspiration syndrome. Use of this mode of ventilation in transport has been described, however, few reports relate to HFOV in long-distance transfers of more than 2500km. The NETS NT experience of >2500km transfer of 4 critically unwell infants receiving HFOV is unique, with lessons learned in this highly specialized environment. This case series will discuss the specific preparations required, including pre-departure stabilization, preparation for and management of in-flight deteriorations, and consideration of specialized equipment given the long flight time on HFOV.