Neonatal Emergency Transport Organisation and Activities in Italy—The Nationwide 2023 Survey by the Neonatal Transport Study Group of the Italian Society of Neonatology

<b>Background</b>: The regionalisation of perinatal care emphasises the importance of transferring high-risk pregnancies "in utero" to minimise risks; yet, neonatal inter-facility transport remains necessary. Neonatal Emergency Transport Services (NETSs) play a crucial role in reducing transportation risks, especially for very preterm infants. Italy's healthcare system, which is decentralised in nature, leads to variations in NETS organisation and resources across the country, resulting in disparities in access and quality of care. <b>Methods</b>: A questionnaire regarding neonatal transfer practices and NETS activity was sent to the 55 NETSs operating in twenty Italian regions. Demographic data were obtained from the Italian National Statistical Institute (ISTAT). <b>Results</b>: Survey Overview. A 2022 national survey by the Italian Society of Neonatology aimed to assess the status of NETS in Italy, achieving a 100% response rate from the 55 NETS. The 2022 data highlighted the transport of 6494 neonatal, of which 92% were primary transports (transferred to higher-level care) and 553 were back-transports (returning stabilised neonates to lower-level care). Subgroup analysis identified 544 transports of neonates born at 30-34 weeks of gestation and 305 transports of neonates born at under 30 weeks of gestation. This was shown to have regional variability. NETS coverage: 18 regions have full NETS coverage. Sicily offers partial coverage. Sardinia, despite an approved plan, lacks an operational NETS. Operational models: all NETS provide a 24/7 service; 50 NETSs rely on an on-call basis using NICU staff for transport. Only five NETS have dedicated teams exclusively for neonatal transport. This decentralisation results in heterogeneity in service availability, access, and quality. <b>Conclusions</b>: This study highlights that although differences still exist, the NETS in Italy is adequately structured and effective. The presence of NETS operating with limited transport volumes puts a strain on maintaining skilled staff and cost-effective operations. Regional disparities: inequities in NETS access (e.g., in Sicily and Sardinia regions) underline the need to improve regional collaboration. While Italy has made progress in organising NETS, regional discrepancies persist in access and service quality, reflecting the decentralised nature of its healthcare system.