Neonatal Stabilization Team: A Critical Team Providing Neonatal Care for Military Families in Guam

Since 2021, Guam has lacked an accredited neonatal intensive care unit (NICU), which is a major public health concern for the approximately 150,000 residents and 20,000 military service members and their families on the island. In August 2021, the military established a Neonatal Stabilization Team (NeoStaT) to stabilize critically ill neonates born to U.S. military beneficiaries at U.S. Naval Hospital Guam (USNHG) until they could be transported to a NICU with appropriate resources. The NeoStaT consisted of 1 neonatologist, 2 NICU nurses, and 1 respiratory care practitioner (RCP) who were available at all times to stabilize neonates requiring care exceeding newborn nursery capabilities. This report summarizes the results of the NeoStaT mission although describing the personnel involved, patients cared for, and infants requiring transport from Guam.

Records were reviewed to characterize the personnel staffing the NeoStaT mission from August 15, 2021 to September 30, 2024. Temporary duty costs were estimated based on the duration of assignments for NeoStaT personnel. Existing patient records were reviewed and data on patient care and air transports were extracted. Finally, transport costs were calculated based on estimates provided by the Theater Patient Movement Requirements Center (TPMRC). The report received a non-research determination by the Brooke Army Medical Center institutional review board.

A total of 54 personnel participated in the NeoStaT mission (21 neonatologists, 19 NICU nurses, and 14 RCPs) with an estimated total temporary duty (TDY/TAD) cost of $1.7M. Neonatal Stabilization Team admitted 80 patients with an average length of stay of 3 days. The most common admission diagnoses were respiratory distress/failure (80%) and prematurity (36% were born at <37 weeks gestational age). Sixty-nine percent of patients admitted to NeoStaT were dispositioned back to their parents and 29% were transported off island. Two patients died before transport. Among the 23 transported patients, the most common diagnosis was prematurity (<37 weeks gestational age), which was present in 17 patients (74%). All transported patients survived to eventual hospital discharge. Eighteen transports (78%) were performed by a military neonatal transport team based out of U.S. Naval Hospital-Okinawa (USNHO)/18th Medical Group, Kadena AB, although 4 (17%) were performed by Tripler Army Medical Center (TAMC), and 1 was performed by a civilian air ambulance company. Tripler Army Medical Center was the most common transport destination, accepting 16 patients (70%) although USNHO accepted 7 patients (30%). The total cost of these transports was estimated to be $5.7M. Forty-nine patients required >24 hours of care in the NeoStaT unit and did not require transport, potentially saving $12.7M in transport costs.

This report highlights the scope of personnel, patients, and transports associated with the NeoStaT in Guam. The authors believe this experience may be useful in future considerations of how to most effectively meet the dependent care needs of military-affiliated families stationed in present and future remote locations around the world.