Adequate neonatal transport is a key component in the care of newborn infants that require transfer. Objective. To determine the characteristics and risk of clinical deterioration during neonatal transport. Material and Methods. This was an observational and prospective study that consecutively included newborn infants transferred to the Neonatal Intensive Care Unit (NICU) of the Hospital Garrahan. The TRIPS (Transport Risk Index of Physiology Stability) risk score was measured pre-and post-transport. A diagnosis of clinical deterioration was made when the post-transport TRIPS score was higher than the pre-transport score. Newborns characteristics, transport distance, newborns status upon admission, need for immediate cardiorespiratory support (ICRS), and death before the 7 th day and at discharge were recorded. Bivariate and multivariate analyses were used to assess the associations with clinical deterioration. Results. A total of 160 transferred newborn infants were enrolled, gestational age (GA) was 35 ± 3 weeks; birth weight (BW) 2482 ± 904 g and median age 2 days. Most were referred due to cardiorespiratory (50%) or surgical (34%) illnesses. Of them, 91 (57%) had clinical deterioration and 46% hypothermia. Forty nine neonates required ICRS and 28 died (twelve before 7 days after admittance). Variables assessed were not associated with the risk of clinical deterioration. Mortality was higher in the group with clinical deterioration (OR: 3.34; 95% CI: 1.2-8.7), even when severity of the clinical picture was considered (OR A : 3; 95% CI: 1.2-8.3). Clinical deterioration during transport was associated with the need for ICRS (OR: 2.4; 95% CI: 1.2-5). Conclusions. In our experience transferred newborn infants often suffered loss of stability or clinical deterioration, regardless of their characteristics, and this was related to a higher mortality. Therefore, it is critical to optimize care strategies during all neonatal transports.

Because new effective but expensive treatments like palivizumab are available, this cost effective analysis can be an important tool in decisions about resource distribution.

Dr Sola has disclosed that he is the Vice President of Medical Affairs with Masimo Corporation. Drs Fariña and Mir have disclosed no financial relationships relevant to the article. Dr Golombek has disclosed that he is on the speakers' bureau with Mallinckrodt and a consultant with Prolacta. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. El Dr Sola es VP de Medical Affairs de Masimo Corporation. Los Dres. Fariña y Mir declaran ausencia de conflicto de interés. El Dr Golombek pertenece al Speakers' Bureau de Mallinckrodt, y es Consultor de Prolacta. Este artículo no contiene una discusión sobre el uso no aprobado / investigativo de un producto / dispositivo comercial. En este Consenso participaron 48 profesionales de 12 países de Latinoamérica y España. La coordinación y revisión estuvo a cargo de los investigadores principales Dres. Fariña, Mir y Sola quienes han condensado todo el material trabajado. Los participantes del Consenso por orden alfabético fueron:

Suspected neonatal sepsis is one of the most common diagnoses made in newborns (NBs), but very few NBs actually have sepsis. There is no international consensus to clearly define suspected neonatal sepsis, but each time that this suspected diagnosis is assumed, blood samples are taken, venous accesses are used to administer antibiotics, and the mother-child pair is separated, with prolonged hospital stays. X-rays, urine samples, and a lumbar puncture are sometimes taken. This is of concern, as generally <10% and no more than 25%-30% of the NBs in whom sepsis is suspected have proven neonatal sepsis. It seems easy to start antibiotics with suspicion of sepsis, but stopping them is difficult, although there is little or no support to maintain them. Unfortunately, the abuse of antibiotics in inpatient and outpatient NBs is foolish. Its negative impact on neonatal health and the economy is a public health problem of epidemiological and even epidemic proportions. This manuscript is a shortened version of the 10 th Clinical Consensus of the Ibero-American Society of Neonatology (SIBEN) on suspected neonatal sepsis at the end of 2018, updated with publications from its completion to February 2020. This manuscript describes useful strategies for everyday neonatal practice when neonatal sepsis is suspected, along with important aspects about the indisputable value of clinical evaluation of the NB and about obtaining and interpreting blood cultures, urine cultures, and other cultures. Likewise, the low value of laboratory tests in suspected neonatal sepsis is demonstrated with evidence and clinical recommendations are made on the appropriate use of antibiotics. EDITOR'S NOTEIn 2003, a group of physicians in Latin America observed that there was a discrepancy between neonatal delivery of care and outcomes in the Latin American region compared with other areas of the world. They formed SIBEN, the Ibero-AUTHOR DISCLOSURE Dr Golombek has been a speaker for Mallinkrodt and has a grant from Chiesi. Dr Sola receives funding from Masimo. Drs Mir, Lemus, Fariña, and Ortiz have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.