Anemia of Prematurity - Portal Neonatal

Flight team personnel also are affected by the transport environment and need to be familiar with how
their own performances are altered. For example, if a flight team member with a head cold and upper
airway congestion experiences a sinus squeeze upon takeoff, they need to recognize and deal with
this phenomenon quickly so that patient care and team safety is not compromised.
Neonatal pharmacology issues
Neonatal patients are not simply scaled-down adults with respect to pharmacologic issues. An
example of this is chloramphenicol, which, if given to an infant in a dose that is simply proportional to
the infant's smaller size, will cause shock and possibly death from "gray baby syndrome," due to
decreased hepatic elimination.
For hepatically eliminated drugs, such as chloramphenicol, the neonate may have either a reduced or
a totally absent capacity for certain enzymatic degradation pathways. Thus, a drug that is metabolized
by one enzymatic pathway in adults (eg, glucuronidation) may instead be metabolized in infants via a
completely different pathway (eg, sulfation); this can result in unpredictable drug metabolism. The
enzymatic processes develop in the fetal liver progressively, with more complex enzymatic processes
requiring more gestational development (ontogeny of development).
Use caution when administering drugs excreted by the kidney, since the neonate, especially the
premature and/or critically ill infant, initially has a decreased glomerular filtration rate and generally has
decreased renal function. Prolonged dosing intervals often are used for medications with renal
excretion, and serum drug levels often are required.
QUALITY ASSURANCE Section 8 of 11
Quality management program
In addition to patient care issues, a quality management program assesses all aspects of the transport
program, including continuous monitoring and assessment of communications, initial and continuing
education, ambulance and aircraft maintenance, and operational issues, especially safety.
Quality management should be deeply imbedded into the program by beginning with a program scope
of care and mission statement. Hospital administration should guide the process with the involvement
of transport staff and the medical director.
Transport programs should have established patient care guidelines that are reviewed on an annual
basis by the staff, management, and medical director. There should be prospective agreement on the
applicable quality indicators. Industry guidelines for standards of operation and standards of care,
such as those issued by the Association of Air Medical Services (AAMS) and the Commission on
Accreditation of Medical Transport Systems (CAMTS), are available, and should be used. However,
for many other issues the team should decide on the indicators (objective measures that are
prospectively delineated and collected for analysis) and the thresholds (statistical measure of
compliance on the specific indicator) for acceptable outcome or compliance. Thresholds must be
attainable, realistic goals for assessing compliance and quantifying improvement.
Annual review needs to be made of the quality assurance process itself. Involving the staff in a peer
review process increases the success of a quality assurance program.
Data collection
Data collection provides important information that is used in quality assurance functions, as described
above. The transport team often takes on the task of data collection so that it functions as a
component of a larger system of perinatal care.