with the necessary resources and technology to improve the level and quality of care remains one of the most important tasks of emergency neonatology. Deterioration on the road may be due to suboptimal stabilization, the severity of the patient's condition, and the transportation procedure itself. Assessment of transportability is one of the most important tasks in the pre-transport preparation phase. Materials and Methods. The cohort study included data from 604 resuscitation team visits. According to the tactical decision, the subgroups of the transportable (n = 497) and non-transportable (n = 46) patients were singled out. The anamnesis data, scores according to the KSHONN, NTISS, TRIPS threat scales, the volume of intensive care, pre-transport preparation, and the outcome of the hospital stage were analyzed. Results. Non-transportable patients had significantly higher scores on the examined threatometric scales. The need for high-frequency artificial lung ventilation was associated with patient nontransportability with a risk ratio of 10.1 [6.72 to 15.18], and dopamine and adrenaline infusion increased the likelihood of nontransportability with risk ratios of 5.85 [3.44 to 9.95] and 11.38 [8.09 to 16.01], respectively. The need for correction of intensive care is associated with nontransportability with a risk ratio of 3.44 [2.29 to 5.17]. The group of nontransportable patients was characterized by significantly higher mortality, 7-day mortality, frequency of late neonatal sepsis, and longer duration of ventilatory ventilation and intensive care. Discussion. The group of patients considered untransportable at the stage of pre-transport preparation is characterized by high morbidity, the need for intensive care, and the need to correct therapy, which is regarded by the transport team as an additional risk. Conclusion. Non-transportable patients are characterized by a significantly higher need for intensive care and amount of pre-transport preparation, high morbidity and mortality
Introduction. Improving the disease severity scoring systems at the stages of inter-hospital transportation remains an actual in neonatal intensive care. Therapeutic scales remain poorly studied and their predictive value and practical applicability. The aim of the work is to determine the predictive value of the NTISS scale at the stage of pre-transport preparation in relation to the treatment outcomes of newborns.Materials and methods. The cohort study included data from 604 visits of the resuscitation and consultation center transport team. The evaluation was performed on the NTISS scale, and the outcomes were studied. The AUC ROC curve of the NTISS scale was calculated in relation to the binary outcomes. The correlation analysis of the quantitative data was performed by Spearman's criterion.Results. AUC greater than 0.8 was observed for the risk of death (AUC=0,823 (0,758-0,888)), 7-day mortality (AUC=0,827 (0,752-0,901)), late onset sepsis (AUC=0,808 (0,737-0,879)), bronchopulmonary dysplasia (AUC=0,810 (0,763-0,856)), severe intraventricular hemorrhage (AUC=0,847 (0,804-0,889)) иocclusivehydrocephalus(AUC=0,830 (0,757-0,904)). Similarresultswereobtained analyzing the outcomes among the surviving patients. For other binary outcomes, the scale shows an AUC of less than 0.8. The analysis of outcomes among the surviving patients showed a weak correlation between the NTISS score and the duration of intensive care, r=0.492, p<0.0001, and the duration of hospitalization, r=0.498, p<0.0001.Discussion. The NTISS scale demonstrated an acceptable level of accuracy (AUC>0.8) in predicting hospital mortality, late neonatal sepsis, bronchopulmonary dysplasia, severe intraventricular hemorrhage, and the formation of occlusive hydrocephalus, among both surviving patients and general sample. The observed results are comparable with the information content of other neonatal scales of various types.Conclusion. The predictive value of NTISS in relation to the outcomes of the hospital stage is comparable to the physiological scales described in the literature.
Purpose. To evaluate the predictive value of the parameters of respiratory support for newborn patients with respiratory insufficiency in assessing non-transportability.Materials and methods. The observational, cohort, retrospective study included data from 284 trips of the transport team to ventilated newborns from August 1, 2017 to December 31, 2018, a subgroup of transportable patients (n=244) and newborns recognized as untransportable due to the presence of respiratory insufficiency (n=40) was identified. The assessment and comparison of anamnesis, the status at the time of arrival of the transport team, intensive care, the parameters of respiratory support and its correction, monitored parameters, as well as assessments on scales — KSHONN, NTISS and TRIPS.Results. Тhe calculated respiratory parameters have a high predictive value for the non-transportability of newborns: the AUC ROC for the mean airway pressure is 0.858 [0.785–0.931], for the saturation index of oxygenation — 0.931 [0.893–0.970], for the SpO2/FiO2 ratio — 0.937 [0.901–0.973]. These indicators demonstrate significantly higher values of AUC ROC in comparison with the KSHONN scales (AUC=0.812 (0.742–0.882)), NTISS (AUC=0.848 (0.793–0.904)), TRIPS (AUC=0.802 (0.726–0.879)) scales. The high predictor value of the mean airway pressure and the saturation index of oxygenation for nontransportability remains high regardless of the need for catecholamine infusion.Conclusion. Mean airway pressure, saturation oxygenation index and SpO2/FiO2 ratio demonstrate a high predictive value for the patient’s non-transportability, exceeding the accuracy of the scales (KSHONN, NTISS, TRIPS).
3 первый Московский государственный медицинский университет им. И. М. Сеченова (Сеченовcкий университет), Российская Федерация 4 Ставропольский государственный медицинский университет, Российская Федерация 5 приволжский научно-исследовательский медицинский университет Министерства здравоохранения Российской Федерации, Нижний Новгород, Российская Федерация Medical news of north caucasus 2021. Vоl. 16. iss. 2 МЕДИЦИНСКИЙ ВЕСТНИК СЕВЕРНОГО КАВКАЗА 2021. Т. 16. № 2
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