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Perspectives from military neonatal transport: past, present, and future

Journal of Perinatology volume 44, pages 1073–1078 (2024)Cite this article

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Abstract

This article traces the historical development of neonatal transport, from ancient Greek mythology to the modern era, with a particular focus on the contributions of U.S. military aviation. The narrative begins with early efforts in thermoregulation through stationary incubators and progresses to the pivotal role of aerial hospitals during World War II. Post-WWII, the establishment of neonatal transport services in New York and advancements in incubator technology set the stage for further innovation. The U.S. military’s involvement in neonatal transport, initiated in the 1970s, witnessed significant milestones, including the adaptation of ECMO technology for air transport. The narrative unfolds through the lens of U.S. military neonatology in the Western Pacific, particularly at Clark Air Base. The article concludes with insights into the U.S. Indo-Pacific Command’s neonatal transport mission, highlighting challenges faced during the SARS-CoV-2/COVID-19 pandemic and the development of specialized infection containment transport systems.

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Fig. 1: McDonnell Douglas C-9A Nightingale aeromedical evacuation aircraft.
Fig. 2: Historical events and capabilities in US military neonatal transport.
Fig. 3: Transport data map.

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References

  1. Mouskou S, Troizos-Papavasileiou P, Xanthos T, Lacovidou N. Neonatal transportation through the course of history. J Pediatr Neonatal Care. 2015;3:11–2.

  2. Iceton S, Whitelaw W, Coppes-Zantinga A. How to recognize the newborn that is worth rearing. Pediatr Res. 1999;45:126.

    Article  Google Scholar 

  3. Bulbille. La couveuse, une invention française [internet]. 2019 [updated 2019 Apr 24; cited 2024 Jan 18]. Available from: https://bulbille.fr/articles/la-couveuse-une-invention-francaise-pour-bebe-premature/.

  4. Toubas PL, Nelson R. The role of the french midwives in establishing the first special care units for sick newborns. J Perinatol. 2002;22:75–7.

    Article  PubMed  Google Scholar 

  5. Hess JH. Heated bed for transportation of premature infants. JAMA. 1923;80:1281–350.

    Article  Google Scholar 

  6. Butterfield LJ. Historical perspectives of neonatal transport. Pediatr Clin North Am. 1993;40:221–39.

    Article  CAS  PubMed  Google Scholar 

  7. Hess JH Chapter IX incubators. In: Lea and Febiger (Eds). Premature and congenitally diseased infants. Franklin Classics Trade Press: Philadelphia and New York, 1922.

  8. Link MM, Coleman HA Medical support of the army air forces in World War II. Office of the Surgeon General, USAF: Washington, DC, 1955.

  9. Oppenheimer GM. Prematurity as a public health problem: US policy from the 1920s to the 1960s. Am J Public Health. 1996;86:870–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Winged angels: USAAF flight nurses in WWII [internet]. National Museum of the United States Air Force Web site. 2024 [cited 20 April 2024]. Available from: https://www.nationalmuseum.af.mil/Visit/Museum-Exhibits/Fact-Sheets/Display/Article/196161/winged-angels-usaaf-flight-nurses-in-wwii/.

  11. Barger J. World War II army flight nurses [internet]. 2018 [Updated 2018; cited 20 April 2024]. Available from: https://judithbarger.com/world-war-ii-army-flight-nurses-10-nov-2018/.

  12. E.I. du Pont de Nemours & Company [Advertisement]. He’s safe … he’s Sight … he’s in ‘lucite’ : DuPont plastics. E.I. du pont de nemours & company advertising department records (accession 1803), 1946.

  13. Century Manufacturing. The lucite story [internet]. 2024 [updated 2024; cited 2024 Jan 18]. Available from: https://centurymfg.com/the-lucite-story/.

  14. Chance GW, Matthew JD, Gash J, Williams G, Cunningham K. Neonatal transport: a controlled study of skilled assistance. mortality and morbidity of neonates less than 1.5 kg birth weight. J Pediatr 1978;93:662–6.

    Article  CAS  PubMed  Google Scholar 

  15. Hess JH. Chicago plan for care of premature infants. J Am Med Assoc. 1951;146:891–3.

    Article  CAS  PubMed  Google Scholar 

  16. Merkatz IR, Johnson KG. Regionalization of perinatal care for the United States. Clin Perinatol. 1976;3:271–6.

    Article  CAS  PubMed  Google Scholar 

  17. Chalmers B, Aziz K, Biringer A, Ciofani L, DiLallo S, LeDrew M, et al. Family-centered maternity and newborn care: National guidelines. Ottawa: Minister of Public Works and Government Services 2020.

  18. Shepard KS. Air transportation of high-risk infants utilizing a flying intensive-care nursery. J Pediatr. 1970;77:148–9.

    Article  CAS  PubMed  Google Scholar 

  19. Ryan GM. Toward improving the outcome of pregnancy recommendations for the regional development of perinatal health services. Obstet Gynecol. 1975;46:375–84.

    PubMed  Google Scholar 

  20. Committee on Hospital Care; Guidelines for Air and Ground Transportation of Pediatric Patients. Pediatrics. 1986;78:943–50.

  21. Personal e-mail correspondence with Dale Gerstmann MD (Dale_Gerstmann@mednax.com), Reese H. Clark MD (Reese_Clark@mednax.com), and Bradley A. Yoder MD (2021 Jun 18-19).

  22. Newhall C, Hendley II JW, Stauffer PH. The cataclysmic 1991 eruption of Mount Pinatubo, Philippines [internet]. 2005 [updated 2005 Feb 28; cited 2024 Jan 18]. Available from: https://pubs.usgs.gov/fs/1997/fs113-97/.

  23. Haulman DL. Fiery vigil [internet]. [cited 2024 Jan 18]. Available from: https://amcmuseum.org/history/fiery-vigil/.

  24. Null DM, Yoder BA, DiGeronimo RJ. Early neonatal research at Wilford Hall US Air Force Medical Center. Pediatrics. 2012;129:20.

    Article  Google Scholar 

  25. Coppola CP, Tyree M, Larry K, DiGeronimo R. A 22-year experience in global transport extracorporeal membrane oxygenation. J Pediatr Surg. 2008;43:46–52. discussion 52

    Article  PubMed  Google Scholar 

  26. McAdams RM, Dotzler SA, Pole GL, Kerecman JD. Long-distance air medical transport of extremely low birth weight infants with pneumoperitoneum. J Perinatol. 2008;28:330–4.

    Article  CAS  PubMed  Google Scholar 

  27. Schulz EV, Ottolini KM. Teaching with QR codes: accessible technology for the novice educator. eLearn 2023;2:6.

  28. Correll DS. Soldiers’ premature twins medically evacuated out of South Korea now receiving treatment at Walter Reed [internet]. 2020 [updated 2020 Mar 30; cited 2024 Jan 18]. Available from: https://www.militarytimes.com/news/your-military/2020/03/30/soldiers-premature-twins-medically-evacuated-out-of-south-korea-to-receive-treatment-at-walter-reed/.

  29. Air Mobility Command Public Affairs. NPC completes first operational patient movement [internet]. 2020 [updated 2020 Jul 6; cited 2024 Jan 18]. Available from: https://www.af.mil/News/Article-Display/Article/2245845/npc-completes-first-operational-patient-movement/.

  30. Nicastro LA. U.S. defense infrastructure in the Indo-Pacific: Background and Issues for Congress. U.S. Congressional Research Service; 2023 Jun. 55 p. Report No.: R47589.

  31. Tilghman A Guam: Defense infrastructure and readiness. U.S. Congressional Research Service; 2023 Aug. p. Report No: R47643.

  32. C-9A/C nightingale [internet]. Air Mobility Command Museum Web site. 2024 [cited 2024 April 20]/ https://amcmuseum.org/at-the-museum/aircraft/c-9ac-nightingale/.

  33. Bedi S The “Cadillac of medevac”: The C9A’s lasting mark on the aeromedical evacuation system [internet]. 2018 [updated 2018 Mar 7; Accessed 2024 Apr 20]. Air Force Medical Service Web site. https://www.airforcemedicine.af.mil/News/Display/Article/1459865/the-cadillac-of-medevac-the-c9as-lasting-mark-on-the-aeromedical-evacuation-sys/.

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Acknowledgements

We would like to acknowledge former U.S. Air Force and Army leaders in transport medicine for their correspondence, historical orations, and provision of photography: Drs. Reese Clark, Robert DiGeronimo, Dan Dirnberger, Dale Gerstmann, Howard Heiman, Jay Kerecman, Donald Null, and Bradley Yoder. Separately, we are indebted to the leaders, neonatologists, neonatal transport nurses, and respiratory therapists of Kadena Air Base’s 18th Medical Group/Critical Care Air Transport Team, U.S. Naval Hospital Okinawa, and Tripler Army Medical Center for their support of the neonatal transport mission in the Western Pacific. The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the United States Air Force, Department of Defense, or the United States Government. I am a military service member (or employee of the U.S. Government). This work was prepared as part of my official duties. Title 17, USC, §105 provides that ‘Copyright protection under this title is not available for any work of the U.S. Government.’ Title 17, USC, §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA

    Elizabeth V. Schulz & Caitlin M. Drumm

  2. Department of Pediatrics, George Washington University, 2300 Eye Street NW, Washington, DC, 20052, USA

    Katherine M. Ottolini

  3. Division of Neonatology, Children’s National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA

    Katherine M. Ottolini

Authors
  1. Elizabeth V. Schulz
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  2. Caitlin M. Drumm
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  3. Katherine M. Ottolini
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Contributions

KMO and EVS created the article conception and design. KMO, CMD, and EVS each participated in data collection and manuscript preparation. All authors reviewed the work and approved the final version of the manuscript.

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Correspondence to Elizabeth V. Schulz.

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Schulz, E.V., Drumm, C.M. & Ottolini, K.M. Perspectives from military neonatal transport: past, present, and future. J Perinatol 44, 1073–1078 (2024). https://doi.org/10.1038/s41372-024-02007-0

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