Long-distance air transport of an infant weighing less than 500 g: Is it in the patient's best interest?

When a preterm infant is delivered in a region where resources are limited, long-distance air transport may be required. However, such transport is a significant stressor on an extremely fragile patient, and the neonate's best interest must be evaluated. The current article presents the case of the smallest infant ever reported to have been transported by air, over more than 2300 km, and reflects on clinical and ethical challenges. Is a fragile 450 g baby born in a developing country better off spending the first week of his/her life where he/she was born, or risking a difficult transport to where he/she could have optimal care? What if this baby had already suffered a significant intraventricular hemorrhage? What if we were transporting the baby to provide palliative care 'at home'? These questions are discussed to illustrate the complexity of the decision-making process, and to facilitate a debate on transport of such fragile patients.