Research, Governance, Audit and Publications

Research, Governance, Audit and Publications


Clinical Governance is a process of continuously improving the quality of their services and maintaining high standard of care by creating an environment in which clinical excellence can be developed.  (Guidance on Clinical Governance, GOV.UK).  One of the key pillars of Clinical Governance is clinical effectiveness and research.  Hence, research and quality improvement are viewed highly in London NTS.  We currently have 6 ongoing quality improvement projects aiming to deliver safe and effective services as a transport team, and assisting other NICUs in London to providing evidence-based medical treatment to our babies. 


Those 6 projects are:


An ongoing quality improvement project on standardising decision making on neonatal therapeutic cooling treatment across London. The pathway of the CoolTriP can be found on London Neonatal Operational Delivery website (



A prospective data collection looking at the presentation of babies who present with bilious vomiting. It aims to see if the colour of bile or other aspects of the history can predict if there is significant surgical pathology or a medical cause for the bilious vomit or aspirate.



Another prospective data collection aiming to establish factors predicting whether a baby with NEC (necrotizing enterocolitis) requires surgical intervention.  The data collection includes blood results (such as lowest WBC, Platelets, Albumin, CRP and lactate) and all abnormal systematic, abdominal and radiological findings.  One of the aims of the study is ensure babies who are likely to need surgical intervention are transferred surgical centres.


Pain Project

An ongoing quality improvement project looking at use of a pain assessment tool to ensure that all babies being transferred are reviewed for signs of pain and treated appropriately.  It started with a focus on babies being transferred post-operatively but has been extended to all emergency transfers including babies who are ventilated, preterm and undergoing therapeutic hypothermia.  The assessment is conducted using the PIPP-R scoring system at 3 different time points: a baseline measure at the referring unit, during handling and on arrival at the accepting unit.  If an intervention was done, baby will need to be reassessed.  We are also exploring the practices of transport units throughout the country.


Difficult Airway

This ongoing quality improvement project is implementing a Difficult Airway guideline and pathway for the NTS teams to follow, including the use of new equipment. As this becomes imbedded in our team we shall support the other neonatal units in our area to develop protocols and guidelines for managing difficult airways in their own settings.


PremWarm – Preterm Servo-Controlled Thermoregulation

A quality improvement project on monitoring the effectiveness and adverse effects of themoregulating preterm babies (up to 32 weeks gestation) using Tecotherm and Therm Aqua Pad mattresses.  The eligibility criteria for participation are as follow:

  • <32 weeks gestation OR < 1 kg
  • <14 days old
  • Transfer for uplift of care.

Journal articles published by NTS staff


1.coverOutcomes of full-term infants with bilious vomiting: observational study of a retrieved cohort

Syed Mohinuddin, Pankaj Sakhuja, Benjie Bermundo, Nandiran Ratnavel, Stephen Kempley, Harry C Ward, Ajay Sinha

Arch Dis Child 2015;100:14-17 doi:10.1136/archdischild-2013-305724

Web link


7946.cover-sourceInfants with suspected intestinal malrotation or volvulus are not prioritised for transfer (letter)

Syed M Mohinuddin, Nandiran Ratnavel, Ajay K Sinha

BMJ 2014;348:g2020 doi: 10.1136/bmj.g2020

Web link


cov150hEvaluating and improving neonatal transport services

Nandiran Ratnavel

Early Human Development , Volume 89 , Issue 11 , 851 – 853  DOI:

Web link


Suppl_1.coverAdverse events during emergency transfer of neonates performed by regionalised dedicated transfer service

R Senthilkumar, N Corpuz, N Ratnavel, A Sinha, S Mohinuddin

Arch Dis Child 2011;96:A91 doi:10.1136/adc.2011.212563.211

Web link


cov150hIn-utero transfer is too difficult: Results from a prospective study

C. Gale, A. Hay, C. Philipp, R. Khan, S. Santhakumaran, N. Ratnavel

Early Human Development , Volume 88 , Issue 3 , 147 – 150 DOI:

Web link


6.coverPassive cooling for initiation of therapeutic hypothermia in neonatal encephalopathy

Giles S Kendall, Andrew Kapetanakis, Nandiran Ratnavel, Denis Azzopardi, Nicola J Robertson on behalf of the Cooling on Retrieval Study Group

Arch Dis Child Fetal Neonatal Ed 2010;95:F408-F412 doi:10.1136/adc.2010.187211

Web link


cov150hSafety and governance issues for neonatal transport services

N Ratnavel

Early Human Development , Volume 85 , Issue 8 , 483 – 486  DOI:

Web link


cov150hVehicles and equipment for land-based neonatal transport

S.T. Kempley, N. Ratnavel, T. Fellows

Early Human Development , Volume 85 , Issue 8 , 491 – 495 DOI:

Web link


XLargeThumb.00130478-200805000-00000.CVA prospective review of adverse events during interhospital transfers of neonates by a dedicated neonatal transfer service

Lim, Michael Teik Chung MRCPCH (UK); Ratnavel, Nandiran MRCPCH (UK)

Pediatric Critical Care Medicine: May 2008 – Volume 9 – Issue 3 – pp 289-293 doi: 10.1097/PCC.0b013e318172dbfd

Web link


3.coverEffect of a centralised transfer service on characteristics of inter-hospital neonatal transfers

S T Kempley, Y Baki, G Hayter, N Ratnavel, E Cavazzoni, T Reyes

Arch Dis Child Fetal Neonatal Ed 2007;92:F185-F188 doi:10.1136/adc.2006.106047

Web link


1.cover (1)Critical dependence of acetate thermal mattress on gel activation temperature

A Carmichael, S McCullough, S T Kempley

Arch Dis Child Fetal Neonatal Ed 2007;92:F44-F45 doi:10.1136/adc.2006.096297

Web link


6.cover (1)Census of neonatal transfers in London and the South East of England

S T Kempley, A K Sinha, on behalf of the Thames Regional Perinatal Group

Arch Dis Child Fetal Neonatal Ed 2004;89:F521-F526 doi:10.1136/adc.2003.029017

Web link





Posters and Presentations


Thermoregulation of Premature babies during Neonatal Transfer

Royal London Hospital / NTS Local Audit Meeting 2014

Miss R Shah (medical student), Dr S Galu, Dr A Sinha, Dr S Mohinuddin, Dr N Ratnavel

Thermoregulation during Transfer 2014


Therapeutic Hypothermia During Neonatal Transfer: Comparison of Passive vs Active Cooling

Nitin Goel, Syed Mohinuddin , Nandiran Ratnavel , Ajay Sinha

European Congress of Perinatal Medicine, Florence May 2014, Poster and Oral Presentation

Therapeutic ECPM Poster 251 2014


Is it always reasonable to transfer babies with necrotizing enterocolitis to neonatal surgical units?

E Molnar, E Fukari-Irvine, C King, N Ratnavel, A Sinha

European Congress of Perinatal Medicine, Florence May 2014, Poster

NEC Transfer ECPM 2014


Neurological assessment in infants referred for therapeutic hypothermia: a need for more structured assessment and /or pragmatic criteria?

Nitin Goel, Syed Mohinuddin , Nandiran Ratnavel, Ajay Sinha

European Congress of Perinatal Medicine, Florence May 2014, Poster

Neurological Assesment ECPM Poster 659 2014


Patient Safety Incident Reporting Data Trends of a Regional Neonatal Transfer Service

Davidson SL, Ratnavel N, King C, Sinha A, Mohinuddin S

Neonatal Transport Group Conference, Belfast November 2014, Poster

Patient Safety NTG 2014


Evaluating a Network Based Multi-Professional Neonatal Emergencies Simulation Course

Davidson S.L, Naidu S, Ratnavel N, Sellwood M, Mohinuddin S

RCPCh Annual Conference 2014, Poster



Hypoxic Respiratory Failure in Term and Near Term Newborns: …Perspective from the London Neonatal Transfer Service

Davidson SL, Ratnavel N, King C, Sinha A, Mohinuddin S

European Academy of Paediatrics Congress 2013, Poster

Hypoxic Respiratory Failure EAPS 2013