Roni Octavian Damian

Background and Objectives: Neonatal sepsis is time-sensitive, yet the role of interhospital transport in its early care pathway is poorly characterised. This scoping review systematically identified and classified contemporary neonatal transport variables, interventions, and organisational practices potentially relevant to early sepsis care, examined the evidentiary proximity of the available literature to neonatal sepsis, and identified priorities for direct investigation. Materials and Methods: PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library were searched for English-language, peer-reviewed reports published from 1 January 2020 to 30 June 2026. Google Scholar, an academic search engine, and backward citation searching supplemented the database search. Two reviewers independently screened records; a third author charted data using a predefined matrix. Findings were reported according to PRISMA-ScR and synthesised descriptively because the mapping question and non-comparable concepts and outcomes did not support a pooled estimate. Results: Thirty-nine sources of evidence were included. They covered system organisation; respiratory and procedural stabilisation; haemodynamic, metabolic, and thermal management; medication and fluid use; adverse events; environmental exposures; and communication. Evidence was predominantly indirect: 24 sources were classified as indirect clinical, seven as indirect organisational, four as indirect technical, one as indirect experiential, and three as direct transport-process/indirect sepsis-outcome evidence. Few reports addressed infection-related processes, and none established that a transport intervention independently improved sepsis-specific outcomes. Antimicrobial timing, culture status, perfusion trajectories, and structured sepsis handover were rarely reported. Conclusions: Contemporary neonatal transport research identifies measurable care processes that may matter when sepsis is suspected, but the sepsis-specific effect of transport remains unproven. Prospective multicentre studies should directly link transport-phase processes with infection-defined populations and outcomes.

Background/Objectives: Outborn neonates—those born outside tertiary perinatal centres and transferred postnatally—may experience higher mortality and morbidity than inborn infants. This systematic review without meta-analysis synthesised contemporary evidence on neonatal interfacility transfer to tertiary and quaternary neonatal centres, focusing on mortality, major morbidity, physiological instability, prognostic tools, and organisational determinants. Methods: Four electronic databases (PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library) were searched for English-language publications from January 2010 to December 2025. Study selection and data extraction were performed independently by two reviewers, with disagreements resolved by consensus. Narrative synthesis followed PRISMA 2020 and SWiM principles. Of the 2456 records identified, 44 publications were retained: 31 primary studies and 13 contextual or methodological sources. Results: Across the primary evidence, outborn status was generally associated with higher mortality and major morbidity, particularly among very preterm infants, although effect magnitude varied across healthcare systems. Hypothermia, respiratory deterioration, and haemodynamic instability were recurrent transport-related complications. Specialised teams, standardised stabilisation, and thermal-management bundles were associated with better physiological stability. TRIPS and TRIPS-II showed prognostic utility. Conclusions: Predominantly observational evidence suggests that neonatal transport outcomes reflect interactions between biological vulnerability, transport-related stress, and system organisation. Strengthening regionalised transport pathways and standardising stabilisation practices may improve outcomes, but causal inference remains limited.