Predictive score for clinical complications during intra-hospital transports of infants treated in a neonatal unit

Abstract

OBJECTIVE:To develop and validate a predictive score for clinical complications during intra-hospital transport of infants treated in neonatal units.METHODS:This was a cross-sectional study nested in a prospective cohort of infants transported within a public university hospital from January 2001 to December 2008. Transports during even (n = 301) and odd (n = 394) years were compared to develop and validate a predictive score. The points attributed to each score variable were derived from multiple logistic regression analysis. The predictive performance and the score calibration were analyzed by a receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test, respectively.RESULTS:Infants with a mean gestational age of 35±4 weeks and a birth weight of 2457±841 g were studied. In the derivation cohort, clinical complications occurred in 74 (24.6%) transports. Logistic regression analysis identified five variables associated with these complications and assigned corresponding point values: gestation at birth [<28 weeks (6 pts); 28-34 weeks (3 pts); >34 weeks (2 pts)]; pre-transport temperature [<36.3°C or >37°C (3 pts); 36.3-37.0°C (2 pts)]; underlying pathological condition [CNS malformation (4 pts); other (2 pts)]; transport destination [surgery (5 pts); magnetic resonance or computed tomography imaging (3 pts); other (2 pts)]; and pre-transport respiratory support [mechanical ventilation (8 pts); supplemental oxygen (7 pts); no oxygen (2 pts)]. For the derivation and validation cohorts, the areas under the ROC curve were 0.770 and 0.712, respectively. Expected and observed frequencies of complications were similar between the two cohorts.CONCLUSION:The predictive score developed and validated in this study presented adequate discriminative power and calibration. This score can help identify infants at risk of clinical complications during intra-hospital transports.

Adverse Events and Associated Factors During Intrahospital Transport of Newborn Infants

“…Newborn infants are vulnerable to unintentional hypothermia, which can occur during surgical procedures or diagnostic studies performed outside the neonatal unit, and during transport (25). The proportion of neonates who underwent accidental hypothermia during intra-hospital transport is lower in our study (3%) than the 12-27% reported in the literature (24,27,28). The proportion of equipment-related AEs in our study (1%) is lower than previously reported in neonates, children, and adults (5-34%) (7,24,26).…”

The interfacility transport of critically ill newborns

“…There is no scoring tool for the accurate prediction of intratransport morbidity, although one simple method of stratifying patients who develop complications during transport has been published. (21) Another study failed to show enhanced outcomes when a neonatal fellow attended the delivery of high-risk infants before their transport. (22) Adams et al (23) found greater success with intubations performed by RTs rather than residents, with an overall success of 92% versus 77%.…”

Pesquisas em pneumologia recentemente publicadas em revistas brasileiras

“…Vieira et al (24) developed and validated a predictive score for clinical complications during intra-hospital transport of infants treated in neonatal units. That score presented adequate discriminative power and calibration.…”