When Your Baby Has to Travel: What Research Says About Moving Newborns Between Hospitals

Two 2026 reviews examine what happens to babies born outside a specialist centre, and what makes the journey safer

Some babies are born at a hospital that cannot provide the specialised care they turn out to need, and must be moved to a larger centre. Two research reviews published in 2026 looked at what that journey means for newborns. Together they show that the risks are real but largely preventable — and that warmth, careful preparation before leaving, and a specially trained team make much of the difference.

Both reviews appeared in the journal Children. One, by Damian and colleagues, pulled together every study it could find on how transferred babies fare [1]. The other, by Meyer and Totapally, describes how newborn transport actually works today — the teams, the equipment, and the safety systems behind them [2].

Why babies get moved at all

Hospitals that care for newborns are not all the same, and this is by design. Some provide routine care for healthy babies. Others can look after moderately early or moderately unwell infants. A smaller number are equipped for the sickest and most premature newborns, and a very small number can also perform complex surgery on site. These tiers are formally defined, so that everyone knows which hospital can do what [3].

The system works best when a baby who is expected to need intensive care is born in a hospital that can provide it. Sometimes doctors can predict this in advance and arrange for the mother to be transferred before delivery. But labour is not always predictable. Babies arrive early, or unexpectedly unwell, or with a problem that was not visible before birth. When that happens, the baby — rather than the mother — has to make the journey, and a team travels out to collect them.

What the journey used to look like

In the 1980s, moving a critically ill newborn between hospitals was often improvised. Crews used whatever equipment was available, monitoring was limited, and training varied enormously. Babies frequently lost body heat, developed low blood sugar, or ran into breathing problems on the way [2]. The first recorded helicopter transport of a premature baby happened in 1967, and it took several more decades before dedicated newborn transport teams became standard.

Over time, medical organisations set out what a transport service ought to look like — who should be on the team, what skills they need, what equipment must be carried, and how hospitals should communicate with each other [4]. Ambulances and aircraft were fitted with incubators and monitors that work reliably while moving. The travelling team stopped being a taxi service and became, in effect, a mobile intensive care unit.

One thing never happened, though. Because it would be unethical to randomly assign a sick newborn to a less experienced team, there has never been a randomised trial comparing specialist newborn transport teams with general ones. A major review of the evidence found no such trials at all [5]. Everything we know comes from carefully observing what happens in real hospitals — useful, but harder to draw firm conclusions from.

What the 2026 reviews found

The Damian review gathered every relevant study published between 2010 and 2025 [1]. The researchers started with 2,456 possible papers, narrowed them down through a defined process, and ended up with 44, of which 31 provided the main evidence.

Its central finding is that babies born outside a specialist centre and moved afterwards tend to do less well than babies born inside one. Among the 15 studies that compared the two groups, 12 found higher death rates in the transferred group and nine found more serious complications such as bleeding in the brain, bowel injury, chronic lung disease, or infection [1]. One large British study of extremely premature babies found roughly double the odds of dying in hospital, and a Japanese study of nearly 16,000 very small babies found a clear increase in serious brain bleeds. A separate British national study reached similar conclusions about brain injury [6].

The most hopeful result in the whole review

If the story stopped there, it would be discouraging. But it does not.

A large French study followed children to five and a half years of age. When researchers compared transferred and non-transferred premature babies who were genuinely similar — the same gestational age, and the same access to steroid injections given to the mother before birth to help the baby's lungs mature — the difference largely disappeared. Survival without moderate or severe developmental problems was essentially the same in both groups [1].

That result changes the meaning of everything else. Being born in the "wrong" hospital is not, by itself, a fixed disadvantage. It is a marker for a chain of things that may or may not have gone well: whether the risk was recognised in time, whether the mother received steroids, whether the baby was looked after skilfully in the first minutes, and whether the baby was properly settled before the journey began. Where health systems get those things right, the gap narrows dramatically. That is a much more encouraging message than "location determines destiny."

What actually goes wrong on the way — and what prevents it

Three problems come up again and again: babies get cold, their breathing becomes unstable, or their blood pressure and blood sugar drift [1].

Cold is the most common and the most fixable. Newborns lose heat far faster than adults, and the smallest babies — under about 1 kilogram — are the most vulnerable [2]. Simple measures work remarkably well: warming the incubator before the baby goes in, plastic wraps, hats, heated mattresses, and continuously watching the temperature rather than checking it occasionally. Studies of hospitals that introduced these steps as a bundle found that arriving cold became roughly two-thirds less likely [1].

Travel itself creates unusual physical stresses, which is one reason the teams are so specialised. Air is thinner at altitude, so the oxygen a baby actually receives falls as an aircraft climbs. Trapped pockets of air — in the bowel, in the chest, or in the small balloon that holds a breathing tube in place — expand by about a third at typical flying heights. Babies in ambulances and helicopters are exposed to noise as loud as a busy road and to constant vibration [2]. None of this is dangerous when it is anticipated. All of it can be if it is not.

The evidence for specialist teams is consistent. In one Australian comparison, unplanned problems occurred during 57% of journeys handled by newborn specialist teams compared with 77% of those handled by non-specialist teams — and complications involving the breathing tube disappeared entirely with specialist crews [1]. Teams also use a simple scoring system that combines temperature, breathing, blood pressure, and how alert a baby is into a single number, which helps both hospitals speak the same language about how the baby is doing [7].

Where families fit in

This is the part of the research that is most likely to matter to you personally, and the numbers are honest about a gap. Only about half of parents travelled with their baby, and only about half felt genuinely involved in the process [2]. When parents were asked what would help, they consistently named the same things: being able to accompany their baby where possible, receiving a phone call as soon as the baby arrived, and being given clearer information before and during the transfer.

If your baby is being transferred, it is entirely reasonable to ask who is on the team, whether you can travel with them or follow directly behind, how you will be contacted on arrival, and who you should call at the receiving hospital. Transport teams expect these questions. Asking them is not an interruption of the medical process — it is part of it.

What researchers are working on next

The biggest current obstacle is not clinical, it is bookkeeping. Hospitals do not record the same information in the same way, which makes it hard to compare services or prove that a change helped. A review of 108 studies found wide variation in what was recorded and frequently no agreed definitions [8]. A group of specialists has agreed on a shared set of quality measures — such as how often the breathing tube goes in successfully on the first attempt, and how many babies arrive with a normal temperature and blood sugar [9]. Some countries are already doing this at national scale: Italy surveyed all 55 of its newborn transport services and recorded 6,494 journeys in a single year [10].

There is also a large and uncomfortable global gap. In some lower-income settings, up to 30% of transferred newborns die, and around half of those deaths occur within a day of arrival [2]. Studies from Tanzania found ambulances carrying no incubators at all, and a study in Ghana found that babies who died had waited a median of two hours at the first hospital they reached, compared with half an hour for those who survived [11]. Much of what would help there is inexpensive: warmth, skin-to-skin holding during transfer, and faster referral.

Looking forward, portable ultrasound is being tested so teams can check tube and line positions and assess the heart during a journey, though the research is still early — a 2026 review found only 20 relevant studies [12]. Better monitoring, lighter equipment, and video links to specialists are all advancing.

The overall message from both 2026 reviews is steady rather than dramatic. Transferring a newborn carries real risk, but most of that risk sits in things people can control: how well the baby is settled before leaving, how warm they are kept, who travels with them, and how carefully the two hospitals talk to each other. If your baby is being moved, they are being moved because a team believes a better-equipped hospital can help — and the journey itself is something the people involved have spent decades learning to do well.

References

  1. Damian RO, Boldeanu L, Cucu MG, et al. Neonatal Interfacility Transport to Tertiary and Quaternary Centres: Clinical Outcomes and System-Level Determinants—A Systematic Review. Children. 2026;13(8):1064. doi:10.3390/children13081064 ↩
  2. Meyer K, Totapally BR. Neonatal and Pediatric Transport: A Contemporary Review. Children. 2026;13(2):175. doi:10.3390/children13020175 ↩
  3. American Academy of Pediatrics. Standards for Levels of Neonatal Care: II, III, and IV. Pediatrics. 2023;151(6):e2023061957. doi:10.1542/peds.2023-061957 ↩
  4. Whyte HEA, Jefferies AL; Canadian Paediatric Society, Fetus and Newborn Committee. The interfacility transport of critically ill newborns. Paediatr Child Health. 2015;20(5):265–269. doi:10.1093/pch/20.5.265 ↩
  5. Chang ASM, Berry A, Jones LJ, Sivasangari S. Specialist teams for neonatal transport to neonatal intensive care units for prevention of morbidity and mortality. Cochrane Database Syst Rev. 2015;2015(10):CD007485. doi:10.1002/14651858.CD007485.pub2 ↩
  6. Helenius K, Longford N, Lehtonen L, Modi N, Gale C. Association of early postnatal transfer and birth outside a tertiary hospital with mortality and severe brain injury in extremely preterm infants: observational cohort study with propensity score matching. BMJ. 2019;367:l5678. doi:10.1136/bmj.l5678 ↩
  7. Lee SK, Aziz K, Dunn M, et al. Transport Risk Index of Physiologic Stability, version II (TRIPS-II): a simple and practical neonatal illness severity score. Am J Perinatol. 2013;30(5):395–400. doi:10.1055/s-0032-1326983 ↩
  8. Bekkevold M, Solvik-Olsen T, Lang AM, Heyerdahl F, Hagemo JS, Rehn M. Data variables reported during neonatal transport: a systematic literature review. J Perinatol. 2026;46(1):6–11. doi:10.1038/s41372-025-02483-y ↩
  9. Schwartz HP, et al. Quality Metrics in Neonatal and Pediatric Critical Care Transport: A National Delphi Project. Pediatr Crit Care Med. 2015;16(8):711–717. doi:10.1097/PCC.0000000000000477 ↩
  10. Bellini C, Gente M, Minghetti D. Neonatal Emergency Transport Organisation and Activities in Italy—The Nationwide 2023 Survey by the Neonatal Transport Study Group of the Italian Society of Neonatology. Children. 2025;12(2):162. doi:10.3390/children12020162 ↩
  11. Tette EMA, Nuertey BD, Akaateba D, Gandau NB. The Transport and Outcome of Sick Outborn Neonates Admitted to a Regional and District Hospital in the Upper West Region of Ghana: A Cross-Sectional Study. Children. 2020;7(3):22. doi:10.3390/children7030022 ↩
  12. Chan B, Alvey B, Barton B, Singh Y. Current Practices and Gaps in Integrating Point-of-Care Ultrasound in Neonatal and Pediatric Transport: A Scoping Review. Diagnostics. 2026;16(3):471. doi:10.3390/diagnostics16030471 ↩