INTRODUCTION:United Kingdom regulations mandate hemoglobin (Hb) testing at each commercial (Class 1) pilot medical examination. The utility of point-of-care finger-prick capillary Hb in determining aeromedical certification outcomes remains unquantified. METHODS:A retrospective review was conducted of all initial Class 1 medical examinations recorded in the UK Civil Aviation Authority medical records system from April 2021 to March 2025. Applicants with capillary Hb outside thresholds (male <115 g · L-1, female <105 g · L-1, all >180 g · L-1) were identified. Clinical pathways, confirmatory testing, and fitness outcomes were analyzed. RESULTS:Of 3353 applicants, 48 (1.43%; 95% confidence interval 1.08-1.89) had abnormal capillary Hb (33 high, 15 low). Of those, 35 (73%) were certified fit, 1 (2%) was assessed as unfit due to predeclared sickle cell disease, and 12 (25%) were lost to follow-up prior to fitness determination. Only 3 of 36 applicants receiving a fitness outcome were assessed as unfit or required treatment before certification (positive predictive value 8.3%; 95% confidence interval 2.9-21.8%). Among 13 applicants undergoing confirmatory venous testing, 12 returned normal results. No cases of polycythemia were identified. DISCUSSION:Capillary Hb screening did not identify conditions leading to unfit assessment beyond predeclared disease. The sole unfit determination resulted from a disqualifying history before testing. Two applicants (0.06%) required treatment before certification; whether these would have been detected through clinical evaluation alone is uncertain. These findings suggest limited utility for this screening practice in asymptomatic initial pilot applicants, though value in serial assessments of established pilots warrants further investigation. MacMillan PP. Routine capillary hemoglobin testing in United Kingdom commercial pilot applicants. Aerosp Med Hum Perform. 2026; 97(8):601-606.
INTRODUCTION:An optimal spatial orientation is essential for pilots. Therefore, pilot applicants in the Royal Danish Air Force undergo various ear-nose-throat evaluations. It is recommended to avoid alcohol for a minimum of 24 h before evaluation. No recommendation has been made regarding nicotine and, with the increasing availability of nicotine through pouches and other products, it is therefore relevant to examine its impact on vestibular function, particularly on nystagmus, which plays a key role in clinical vestibular assessment. METHODS:We conducted a structured literature search using PubMed and Cochrane Library as the primary databases in 2025 and 2026. The search strategy used a combination of keywords and MeSH terms and criteria for inclusion and exclusion were made. RESULTS:In total, 22 studies were included looking at nicotine's effect on the vestibular system. Overall, the studies showed an impact on the vestibular system and the induction of nystagmus through different delivery methods of nicotine. The effects of nicotine on nystagmus appear within minutes and can persist for up to 30 min, and nicotine blood concentrations are measurable more than 2 h after exposure. DISCUSSION:We suggest that pilot applicants be advised to abstain from nicotine products for a specified period of 12-24 h before undergoing ear-nose-throat examinations to minimize test interference. Further studies are needed to uncover the effect nicotine can have on in-flight performance. Kahlhofen N, Lindgaard K. Nicotine effects on vestibular function in pilot selection. Aerosp Med Hum Perform. 2026; 97(8):638-643.
INTRODUCTION:Modern DNA technologies have substantially advanced disaster victim identification. The advances are summarized while stressing privacy, security, and psychological values of victim identification. Identification of victims in fatal aircraft accidents demonstrated the effectiveness of DNA profiling. Initially based on minisatellite or microsatellite loci (i.e., short tandem repeats), DNA analyses are moving toward high-throughput massively parallel sequencing (MPS) that enables analysis of genome-wide single nucleotide polymorphisms, permitting typing of highly degraded samples with increased sensitivity. MPS has made it possible to analyze highly degraded samples. Adoption of MPS also has led to the emergence of a new discipline for human identification known as forensic genetic genealogy. Compared with short tandem repeat typing and mitochondrial DNA sequencing, forensic genetic genealogy substantially expands the analytical space for identification of human remains. The elements of data privacy and security with mass disasters are also important considerations for adopting this technology. Vuorio A, Sajantila A, Bor R, Budowle B. Advances in aircraft accident disaster victim identification using DNA techniques. Aerosp Med Hum Perform. 2026; 97(8):648-650.
INTRODUCTION:Fatigue poses a significant safety risk in helicopter operations; however, subjective assessments of fatigue based on an individual's perception, awareness, and insight, such as self-perceived tiredness, may not accurately reflect objective performance impairment as identified by standardized tests or measurement tools. In this context, the present study investigated the relationship between subjective drowsiness and objective alertness performance among helicopter pilots during operational tasks using a computerized psychomotor vigilance task (PVT). METHODS:This observational field study initially included 20 helicopter pilots. Complete pre- and postflight measurements were available for 15 pilots and were included in the final analysis. Subjective sleepiness was assessed before testing using the Karolinska Sleepiness Scale. Objective alertness was measured pre- and postflight using a PVT; mean reaction time (ms) was used as the primary outcome variable. RESULTS:The mean subjective sleepiness score was 3.98 ± 1.27 (range: 2.0-6.9). Mean PVT reaction time increased from 461.2 ± 118.1 ms preflight to 516.3 ± 100.8 ms postflight (an 11.9% increase), reaching statistical significance with a medium-to-large effect size (Cohen's dz = 0.65). Considerable interindividual variability was observed. Correlation analysis revealed a weak association between subjective sleepiness and postflight PVT reaction time (r = 0.16, P = 0.573), with prolonged reaction times observed in some pilots reporting low subjective sleepiness. DISCUSSION:Combining objective alertness measures with subjective scales may improve fatigue risk management. Gevrek I, Eroglu C. Psychomotor alertness and subjective fatigue in helicopter pilots. Aerosp Med Hum Perform. 2026; 97(8):633-637.
BACKGROUND:This case report details the diagnostic, therapeutic, and aeromedical trajectory of a 58-yr-old pilot diagnosed with squamous cell carcinoma exhibiting perineural invasion and orbital floor involvement with treatment goal of return to flight. The malignancy presented with insidious symptoms of fascial swelling, numbness, and tingling, complicated by initial diagnostic anchoring bias. The patient had a relevant past medical history of squamous and basal cell carcinomas, including a Mohs micrographic surgery for a lesion on the left nares 10 yr prior. CASE REPORT:Treatment necessitated a total maxillectomy with multiple skin flaps, and orbital floor reconstruction initially using a titanium implant and later an autologous scapular bone graft. Postoperative management addressed complex ocular manifestations, including mechanical diplopia and inferior rectus muscle dysfunction, alongside the challenges caused by multiple skin-flap failures. DISCUSSION:From an aeromedical perspective, the case highlights the rigorous standards of the Federal Aviation Administration for First-Class medical certification, focusing on binocular fusion, visual acuity, and auditory thresholds. The report outlines the regulatory pathway for Special Issuance and the eventual return to flight duty, emphasizing the balance between aggressive oncological control and the preservation of critical sensory functions required for aviation safety. This case provides an example of a structured framework for managing high-stakes professional requirements in the context of advanced midfacial malignancy and complex reconstructive surgery. Krebsbach SK, Fredricks TR. Ocular management and aeromedical certification of maxillary squamous cell carcinoma. Aerosp Med Hum Perform. 2026; 97(8):644-647.
INTRODUCTION:The objective of this study was to establish a quantitative relationship between the occurrence of certain auditory impairments in Chinese military pilots and their flight hours. The investigation will determine whether the prevalence of left-ear vulnerability necessitates the implementation of cockpit noise control measures. METHODS:Cross-sectional pure-tone audiometry (0.125-8 kHz) was performed in 155 active-duty aviators with an average time of 2241 h in 2024. Hearing loss (HL) was defined as pure tone average (4, 6, 8 kHz) ≥25 dB. Asymmetry was tested with paired t-tests. RESULTS:Prevalence of high-frequency HL rate was 14.2% unilateral and 12.9% bilateral. Aircraft type correlated with threshold differences at 0.125, 2, and 6 kHz in the left ear and at 8 kHz in the right ear. Flight hours showed strong associations with elevated thresholds at 4, 6, and 8 kHz in both ears. A two-way analysis of variance indicated no significant interaction between flight hours and aircraft type on hearing thresholds. An asymmetry existed between the two ears, with left-ear thresholds exceeding the right by 2.9 ± 0.73 dB at 0.25-4 kHz. DISCUSSION:This study found that age and flight time were statistically significant risk factors for noise-induced HL in military pilots. Early detection strategies are of critical importance for hearing protection. The consistent inferiority of the left ear indicates the necessity of optimizing active noise reduction for the left helmet cup. Hao M, Zheng X, Chen D, Ma X, Yu W, Liu L, Bai Y. A cross-sectional audiometric analysis of noise-induced hearing loss in military aviators. Aerosp Med Hum Perform. 2026; 97(8):618-626.
INTRODUCTION:Short-haul aviation pilots often operate irregular schedules that encroach on the biological night and disrupt sleep, alertness, fatigue, and cognitive performance, posing a potential safety risk. Regulatory limits and industry practices exist to mitigate such impairments, but few studies have examined the impact of circadian-disrupted schedules. METHODS:Commercial passenger pilots from four U.S. airlines collected data during, and 1-3 d before and after, two trip types: one with circadian disruption (i.e., ≥1 duty day encroaching on the biological night); and one without. Sleep was measured using actigraphy and sleep logs. Subjects completed a 5-min psychomotor vigilance task, Karolinska Sleepiness Scale, and Samn-Perelli fatigue scale 3x/day on days off and after waking, pre-duty, at top-of-descent for each flight, post-duty, and before bed on duty days. We compared outcomes with mixed-effects models adjusted for multiple comparisons. RESULTS:Subjects (N = 159) provided valid data for analysis. We found small but significant differences (all d values <0.30) between circadian-disrupted and nondisrupted trips, with greater sleepiness (4.77 ± 2.16 vs. 4.43 ± 2.11), greater fatigue (3.64 ± 1.38 vs. 3.37 ± 1.34), slower response speed (1000/reaction time; 3.86 ± 0.63 vs. 3.94 ± 0.61), and less total daily sleep time (6.28 ± 1.73 h vs. 6.75 ± 1.28 h) during the circadian-disrupted trips. DISCUSSION:Our findings suggest that there is a small but significant reduction in alertness and performance when working during the biological night that remains, even when prescriptive limitations and existing airline mitigations are in place. Flynn-Evans EE, Bathurst N, Pradhan S, Gregory KB, Barger LK, Lamp ACM, Glaros Z, Arsintescu L, Jansen RA, Baumgartner HM, Nesthus TE, Hilditch CJ. Characterizing pilot fatigue during circadian-disrupted short-haul aviation operations. Aerosp Med Hum Perform. 2026; 97(8):607-617.
INTRODUCTION:Intraocular pressure (IOP) changes with acute microgravity exposure defy easy explanation. IOP increases above supine levels acutely in weightlessness, but studies show both central venous pressure and intracranial pressure (ICP) fall below supine values. These reductions would be expected to reduce IOP in weightlessness. We developed and validated a physiologically relevant numerical model of the eye to investigate how these ocular changes could occur. METHODS:A finite element numerical model of the 50th percentile adult human globe, optic nerve, and surrounding tissues was constructed. The model incorporated 4 fluids and 12 different structures/tissues, with physical properties derived from the literature. The model included both hydrostatic gradients and tissue compressive forces, which are eliminated in weightlessness. We demonstrated model function using published clinical data from intravitreal injection and dark room provocation testing and then applied the model to predict acute microgravity-induced changes. RESULTS:Elimination of gx hydrostatic pressures increased episcleral venous pressure (EVP) at the eye and ICP at the lamina cribrosa despite overall reductions in central venous pressure and ICP compared to supine. IOP predictions were within 0.7 mmHg and 0.3 mmHg of experimental supine and parabolic flight values, respectively. A sensitivity analysis of factors increasing IOP showed a 0.75 mmHg increase from aqueous humor dynamics. Eliminating hydrostatic gradients produced a 0.55 mmHg increase from ICP and a 2.75 mmHg increase from EVP. DISCUSSION:The elevated IOP observed initially in short-duration microgravity may be caused by the loss of hydrostatic gradients and associated effects on EVP and ICP. Carroll DJ, Rothrock SA, Phillips SD, Knaus DA, Kattamis NT, Hayman APA, Fellows AM, Zegans ME, Buckey JC. Numerical model of the eye for understanding acute microgravity-induced ocular changes. Aerosp Med Hum Perform. 2026; 97(8):584-591.
INTRODUCTION:Next-generation air force operations increasingly depend on advanced flight systems, which raises questions about their impact on aircrew workload. Physiological measures enable continuous, objective, and unobtrusive assessments, overcoming some limitations of self-report measures. We investigated whether electroencephalogram, electrocardiogram, and electrodermal activity predicted subjective Rating Scale of Mental Effort (RSME) ratings of fighter pilots during an operationally relevant mission in an F-16 simulator. METHODS:The mission included three flight segments expected to induce increasingly higher workload, with a mathematical task of two arithmetic difficulty levels added to each segment. This approach allowed us to explore whether physiology distinguished workload both across and within flight segments. RESULTS:Subjective ratings confirmed an increase in workload throughout the mission (ΔRSME = 22). However, our manipulation of arithmetic difficulty was less effective: neither subjective ratings nor arithmetic performance significantly differentiated simple and complex calculations (ΔRSME = 5; Δreaction time = 0.02 s, Δunsuccessful trials = 0.5). None of our physiological measures-frontal theta power (Δ0.08, Δ-0.07 mV), parietal alpha power (Δ-0.16, Δ0.14 mV), heart rate (Δ0.01, Δ-0.02 bpm), skin conductance response (Δ0.0, Δ0.0 mS), and skin conductance peaks (Δ0.3, Δ0.2)-systematically distinguished flight segments or arithmetic difficulty, respectively. Physiology also did not significantly predict subjective workload (R2 = 2.2%). DISCUSSION:Large interindividual variability, use of workload management strategies, and relatively small task demand differences may explain the null results. Our study underscores the complexity of workload assessment in an operational setting and offers methodological insights that may inform future ecologically valid research. Reuten AJC, Bruin J, Ledegang WD, Groen EL, Houben MMJ, Cornelisse E-J, Bottenheft C. Physiological and subjective assessment of fighter pilot mental workload. Aerosp Med Hum Perform. 2026; 97(8):592-600.
INTRODUCTION:Long-duration spaceflight exposes crews to isolated, confined, and extreme environments where chronic stress and limited real-time support heighten interpersonal tensions. Large language models (LLMs) could serve as onboard artificial intelligence teammates for de-escalation, but could also exacerbate tensions by endorsing hostility or exclusion. This study evaluates whether LLMs demonstrate prosocial conflict mediation behaviors vs. failure modes that could elevate interpersonal risk. METHODS:We tested four LLMs (GPT-5, Claude Sonnet 4, Grok 4, Gemini 2.5 Pro) using a Dartmouth PATH Program scenario where one crewmember criticizes an absent teammate and tries to recruit another against him. Models were evaluated across seven test batteries: adversarial framing, backstory manipulation, team role variations, aggressor identity variations, target identity variations, mental health sensitivity, and direct ethics questions. We scored 196 responses using a three-point rubric (defended excluded teammate, neutral, or endorsed exclusion). RESULTS:Claude Sonnet 4 achieved perfect scores (3.0). GPT-5 averaged 2.97. Gemini 2.5 Pro (2.81) showed vulnerability to narrative capture, shifting from defending the excluded crewmember to endorsing criticism when given unfavorable backstory. Grok 4 (2.85) exhibited significant failure under social proof pressure, explicitly endorsing exclusion. All models showed consistent prosocial responses regardless of demographic factors and correctly identified ethical issues when questioned directly. DISCUSSION:LLMs show promise as behavioral health teammates but have critical vulnerabilities. They can be manipulated into endorsing teammate exclusion through backstory reframing, peer pressure, or authority hierarchies, requiring safety protocols before deployment. Dvorak C, Buckey JC Jr. Large language models as behavioral health teammates in long-duration spaceflight. Aerosp Med Hum Perform. 2026; 97(7):516-523.
INTRODUCTION:Flight-related neck pain (FRNP) is common among fast-jet pilots. The neck flexor endurance test (NFET) provides a reliable measure of isometric neck flexor muscles endurance. This study aimed to establish NFET performance values for Royal Air Force Typhoon pilots and explore the relationship between endurance and FRNP. METHODS:There were 81 Royal Air Force pilots who completed an FRNP survey and undertook the NFET. The associations between NFET and FRNP over the last 3 and 12 mo were assessed with Pearson's correlation. One-way analysis of variance with Bonferroni correction was used for categorical variables. RESULTS:FRNP prevalence was 86% in the last 12 mo and 61% in the last 3 mo. NFET performance did not show statistically significant correlations with FRNP; however, pilots with the highest neck flexor endurance (>150.7 s) were 24% less likely to report FRNP than those with the lowest performance (<83.2 s). Pilots with the highest NFET scores self-reported increased levels of neck strength, stability, and endurance exercises weekly or more frequently. Greater cumulative Typhoon hours were associated with reduced FRNP during flight. Pilots wearing the Mk10 helmet were more likely to experience FRNP after flight. Repetitive high +Gz (>+6) maneuvers wearing a helmet-mounted symbology system were an attributable cause of FRNP both during and after flight for all. DISCUSSION:Despite high NFET performance, FRNP remained high in this cohort. Higher neck flexor endurance was linked to reduced likelihood and frequency of FRNP. More objective measurement of flight-related loading and fatigue could help refine injury-prevention and performance-enhancement strategies. Magill J, Kelly A, McRobert C, Slungaard E. Relationship between neck flexor endurance and flight-related neck pain in typhoon pilots. Aerosp Med Hum Perform. 2026; 97(7):478-487.
INTRODUCTION:A lumbar puncture (LP) is a diagnostic and therapeutic procedure for wide-ranging conditions terrestrially with additional applications in the microgravity environment of human spaceflight. LP has been performed on astronauts postflight in an attempt to answer lingering health questions, like the causes of spaceflight-associated neuro-ocular syndrome. However, an LP has not been performed in space or microgravity before due to the operational constraints of the procedure, including infection risk, air entrance, and fluid management difficulties in microgravity. This has prevented in-flight intracranial pressure measurements and important characterizations of cerebrospinal fluid (CSF) composition during spaceflight. METHODS:We developed a closed-system LP design by introducing an injection port between the typical needle-stylet LP device and using an electronic pressure transducer (eliminating gravity-based manometry). An initial proof of concept demonstration of the new device was conducted by performing mock LPs using an LP trainer with known fluid pressures. RESULTS:Closed-system LP was successfully demonstrated with no loss of fluid external to the system and no appreciable entrance of air. The new closed system showed accurate (r = 0.995) and precise (SD = 0.406 mmHg) results when measuring pressures in the typical CSF range of 8-15 mmHg. DISCUSSION:This initial demonstration serves as the first step in testing a novel LP system that mitigates risks of conducting the procedure during spaceflight. An in-flight LP would enable the collection of vital data on intracranial pressure and CSF composition under microgravity. Development of custom equipment and in vivo testing are needed for further validation. Adams B, Levinson Z, Alexandrov P, Mampre D. A closed-system lumbar puncture design for microgravity. Aerosp Med Hum Perform. 2026; 97(7):534-538.
INTRODUCTION:Acute hypoxia can impair cognitive performance, yet the underlying systemic and cerebral physiological mechanisms remain unclear. The objective of this study was to elucidate the systemic and cerebral physiological responses associated with changes in cognitive performance during acute hypoxia. METHODS:There were 11 healthy subjects (5 females) who completed a cognitive test during baseline normoxia (21% fraction of inspired oxygen, FIO2) followed by 2 randomized hypoxia trials: 11.8% FIO2 (moderate hypoxia) and 7.7% FIO2 (severe hypoxia). Subjects were instrumented with an arterial catheter, transcranial doppler ultrasound, and near-infrared spectroscopy to measure systemic (arterial O2 saturation) and cerebral oxygenation (cerebrovascular conductance and cerebral tissue saturation). RESULTS:Moderate hypoxia reduced arterial O2 saturation and cerebral tissue saturation, with no change in cerebrovascular conductance. Severe hypoxia decreased arterial O2 saturation, cerebrovascular conductance, and cerebral tissue saturation. Cognitive performance did not differ from baseline during either hypoxia condition (omission rate, errors/min: baseline 0 ± 1 vs. moderate hypoxia 1 ± 1; baseline 1 ± 1 vs. severe hypoxia 1 ± 1). No associations were observed between physiological changes and cognitive performance during moderate hypoxia. During severe hypoxia, smaller declines in arterial O2 saturation (r = 0.643) and greater declines in cerebrovascular conductance (r = -0.651) were associated with increased omission rates. DISCUSSION:Cognitive performance during acute severe hypoxia correlated with cerebral oxygenation and blood flow. Associations differed between moderate and severe hypoxia, suggesting that both duration and severity of hypoxia influence the relationship between physiological responses and cognitive performance.
INTRODUCTION:As lunar missions increase in frequency and duration, astronauts will conduct more extravehicular activities (EVAs) under demanding conditions that elevate workload, reduce situational awareness, and heighten the risk of operational errors. Despite extensive use in other high-risk fields, eye-tracking technology has not yet been applied to assess gaze behavior during EVAs. We evaluated the feasibility of using mobile eye-tracking within analog EVA suits, focusing on implementation, data quality, livestreaming capability, and the ability to compare gaze behavior across tasks and suits. METHODS:A trained subject performed locomotion, tool-cart navigation, and regolith sampling tasks under lunar-analog conditions while wearing different EVA training suits and a mobile eye-tracker fitted prior to donning the helmet. Data quality was evaluated in terms of robustness, reliability, and accuracy, while data quantity reflected the availability of sufficient data for analysis of fixations, saccades, and head movement. RESULTS:In total, 4.5 h of stable and accurate eye-tracking data were recorded, with no data loss and successful livestreaming between the subject and mission control. Post hoc descriptive analysis indicated task-dependent gaze behavior, with mean fixation durations across suits ranging from 231-367 ms during locomotion, 316-380 ms during tool-cart navigation, and 417-2260 ms during regolith sampling. DISCUSSION:Conducted in a representative EVA environment, this study demonstrates the feasibility of mobile eye-tracking within spacesuit helmets and its potential as an objective measure of cognitive workload and as a live monitoring tool between astronauts and mission control, enabling new possibilities for astronaut training and EVA operations. Maltese F, Steinberg J, Schultz J, Hodkinson P, Runswick OR. Feasibility of real-time astronaut eye-tracking during analog extravehicular activities. Aerosp Med Hum Perform. 2026; 97(7):543-549.
INTRODUCTION:Long-duration space missions demand reliable, portable, and autonomous medical diagnostic tools. Lung ultrasound (LUS) is ideal for space exploration due to its safety and versatility, but interpreting LUS images requires training. Artificial intelligence (AI) can assist with image interpretation by detecting lung sliding, an ultrasound sign produced by the movement of lung and chest wall during breathing. The presence of lung sliding helps to rule out pneumothorax, or a collapsed lung, which is a condition that may arise from barotrauma or rapid changes in pressurization. METHODS:LUS clips were acquired from two healthy volunteers during parabolic flight maneuvers simulating microgravity and lunar gravity, with +1-G clips used as controls. Clips were analyzed using an AI model to classify the presence of lung sliding and model performance and confidence were compared across gravity conditions. All clips were reviewed by an expert to establish whether lung sliding was present, which served as the reference standard for AI model evaluation. RESULTS:From 105 LUS clips, the model demonstrated an accuracy of 94%, with similar performance at +1 G (96%), lunar gravity (94%), and microgravity (92%). Prediction confidence varied by gravity, with median values of 93% at +1 G, 83% at lunar gravity, and 67% at microgravity. Confidence was significantly lower in microgravity compared with +1 G. DISCUSSION:These findings demonstrate that AI-assisted LUS can reliably detect lung sliding under reduced gravity, supporting its feasibility as an autonomous diagnostic support tool for spaceflight and highlighting the importance of further validation in microgravity environments. Côté M, Smith D, Orozco N, VanBerlo B, Huggard B, Arntfield R, Prager R. Artificial intelligence interpretation of point-of-care lung ultrasound in microgravity. Aerosp Med Hum Perform. 2026; 97(7):505-509.
INTRODUCTION:Long-distance neonatal air transport did not begin in hospitals, but rather in times of crisis, driven by courage, ingenuity, and humanitarian resolve. Early operations transformed aircraft into lifelines, carrying children across borders and conflict zones under austere and often perilous conditions. DISCUSSION:In early humanitarian flights, the 1939 Czech Kindertransport was the first to demonstrate aviation's potential for child rescue. This was followed by postwar efforts such as Operation Magic Carpet and Cold War evacuations such as Operation Peter Pan. Infants and children were transported with limited medical support, relying on improvisation, speed, and human determination. Operations Babylift, Moses, Joshua, and Solomon increased the scale and ambition of these efforts, incorporating newborns into long-range missions under extraordinary logistical and political constraints. Though primitive by today's medical standards, these flights proved that aircraft could be used for more than war; they could also protect and save lives. Modern neonatal aeromedical transport realizes this vision with dedicated aircraft, incubators, and specialized teams capable of sustaining critically ill neonates across continents. Programs such as the Netherlands' helicopter emergency medical service, the European Air Ambulance, and the United Kingdom's Children's Air Ambulance continue the ethical and humanitarian legacy of these pioneering missions. When an infant's life is at risk, flight is imperative. CONCLUSION:Each neonatal air mission carries forward a century of courage, innovation, and moral conviction, turning the sky into a corridor of survival for the most vulnerable. Bellini C, Davis A, Stocking JC. From humanitarian airlifts to neonatal intensive care in the sky. Aerosp Med Hum Perform. 2026; 97(7):550-560.
