A study on status of neonatal transport to a level III neonatal intensive care unit

Sampathkumar, Priya; Gobinathan, S

doi:10.18203/2349-3291.ijcp20181538

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…Research by Sampathkumar et al found causes of referral to be preterm 41%, birth asphyxia 27% and RDS 21%. 13 RDS was at 35.9% in the study by Jajoo et al 14 Research by Kumar et al found 32.6% referred for birth asphyxia with HIE; and 13.4% for prematurity with LBW. 15 In the study by Shalini et al 50% were referred for LBW/preterm, 22% for meconium aspiration and 15% for birth asphyxia.…”

Section: Discussionmentioning

confidence: 90%

Timely referral and safe transport of neonates admitted to neonatal intensive care unit of tertiary care government hospital of Agra district: a cross sectional study

Negi¹,

Agrawal²,

Kaushal³

et al. 2019

Int J Community Med Public Health

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Background: Timely referral and safe transport form a crucial link for the survival and safety of sick newborn. Thus the study aimed at assessing referral and transport of sick neonates admitted to NICU of a tertiary care government hospital and the factors associated with direct referral and safe final transport.Methods: A hospital based cross-sectional study was carried out in among 450 neonates and was based on face to face interview with caregivers. The data was analyzed using proportions and mean values Chi square test of significance and independent t test were appropriately applied and p<0.05 was taken to be statistically significant. Odds ratios were calculated for dichotomous variables.Results: 72.6% of high risk pregnancies were transferred timely in utero to district hospitals. Around two thirds (65.8%) of neonates were referred by doctors. Treatment during transportation was administered to 29.6% of the neonates. 50.2% of neonates have used the services of an ambulance at some point of time during their travel. Highly significant association of direct referral was observed with earlier age at admission (2.3 days), early development of neonatal symptoms (1.45 days), lesser gestational age (33.1 weeks) and lesser total distance travelled (15.7 km). The odds of final transport of newborns in ambulance was significantly more in males (OR=1.5), rural residents (OR=1.5) and registered pregnancies (OR=4.3).Conclusions: Wide variations remain in neonatal referral and transport with some glaring gaps which need to be adequately addressed.

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Section: Discussionmentioning

confidence: 90%

Timely referral and safe transport of neonates admitted to neonatal intensive care unit of tertiary care government hospital of Agra district: a cross sectional study

Negi¹,

Agrawal²,

Kaushal³

et al. 2019

Int J Community Med Public Health

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“…Hence the increased risk of vehicle breakdown. In other developing countries such as India, Sampathkumar et al (36) stated that in resource-poor settings, most of the available ambulances are not sufficiently equipped to handle critically ill neonates.…”

Section: The Literature Reviewmentioning

confidence: 99%

Critical Issues Underpinning the Safe Transfer of Ill Neonates: A Review of the Literature

Bhagwan

2021

Australasian Journal of Paramedicine

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Introduction Critically ill neonates often require urgent transport to a neonatal care facility shortly after birth. The safe transfer of ill neonates is a critical part of their continuum of care. Methods A review of the empirical work and literature around the safe transfer of ill neonates was undertaken to explore what factors influence a safe transfer. Results What emerged was that a multitude of adverse events influence the clinical deterioration of the neonate, including the physiological condition of the neonate, equipment-related challenges and the unpreparedness of those involved to deal with neonatal clinical emergencies. Conclusion This review highlights the necessary equipment required, the nature of clinical emergencies that may arise, and the need to consider utilising specialised neonatal transfer units to effect the safe transfer of the critically ill neonate.

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“…There is enough evidence to support that transport by a skilled organized team reduces neonatal morbidity and mortality [ 9 , 13 , 14 ]. The goal of all neonatal transport teams should be transporting a well-stabilized neonate.…”

Section: Introductionmentioning

confidence: 99%

Referral challenges and outcomes of neonates received at Muhimbili National Hospital, Dar es Salaam, Tanzania

et al. 2022

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Background Functional referral system including pre referral care, access to emergency transport and ensuring continuity of care between facilities is critical for improved newborn health outcome. The neonatal transport system is quite undervalued in many sub Saharan countries, Tanzania included. This study assessed the pre referral care, transport process, ambulance characteristics, admission clinical status and outcomes of referred neonates at Muhimbili National Hospital Upanga, a tertiary facility in Dar es Salaam, Tanzania. Methods A descriptive cross sectional study with a longitudinal follow up was conducted from September 2020 to February 2021 including neonates referred to Muhimbili National Hospital. A structured questionnaire was used to collect demographic characteristics and transport factors including pre referral care extracted from the referral documents and through interviewing caregivers or escorting person/nurse. Ambulances were directly observed using a structured checklist on presence, absence and functionality of supportive equipment. All enrolled neonates had a clinical assessment at admission and 48 hours post admission to determine admission clinical status and 48 hours’ clinical outcome as either survived/died. Results Out of the 348 neonates assessed during the study period, the median gestation age was 38 weeks (IQR 32, 39) with the mean birth weight of 2455 ± 938 g. Pre referral documentation showed that temperature was measured in 176 (57.1%), oxygen saturation and random blood glucose in only 143 (46.6%) and 116 (36.2%) neonates respectively. Ambulance was used as a means of transportation in 308 (88.5%) neonates. While no ambulance had an incubator only 7 (2.0%) neonates were kept on a Kangaroo Mother Care position. Monitoring enroute was done to only 94 (27%) of the transferred neonates with 169 (54.9%) of health care professionals escorting the neonates lacking training on essential newborn care. On arrival, 115 (33%) were hypothermic, 74 (21.3%) hypoxic, 30 (8.6%) with poor perfusion and 49 (14.1%) hypoglycemic. Hypothermic neonates had an increased chance of dying compared to those who were normothermic (OR = 2.09, 95% CI (1.05–4.20), p = 0.037). The chance of dying among those presenting with hypoxia was almost three times (OR = 2.88, 95%CI (1.44–5.74), p = 0.003) while those with poor perfusion was almost five times (OR = 4.76, 95%CI (1.80–12.58), p = 0.002). Additionally, neonates who had hyperglycemia (RBG > 8.3mmol/l) on arrival had a higher probability of dying compared to those who were euglycemic [(OR = 3.10, 95% CI (1.19–8.09) p = 0.021]. Overall mortality was 22.4% within 48 hours of admission and risk of dying increased as the presence of poor clinical status added on. Conclusion Neonatal transportation in Dar es Salaam, Tanzania was observed to be challenging. Pre transfer care and monitoring during transportation was inadequate and this contributed to poor clinical status on admission. Hypothermia, hypoglycemia, hyperglycemia, hypoxia and poor perfusion on admission were associated with increased mortality. Effective referral network is needed for improved neonatal health outcomes. Pre referral supportive care, training of health care professionals, transportation with improved monitoring, clear communication protocol and referral documentation should be invested and effectively utilized.

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A study on status of neonatal transport to a level III neonatal intensive care unit

Cited by 4 publications

References 10 publications

Timely referral and safe transport of neonates admitted to neonatal intensive care unit of tertiary care government hospital of Agra district: a cross sectional study

Timely referral and safe transport of neonates admitted to neonatal intensive care unit of tertiary care government hospital of Agra district: a cross sectional study

Critical Issues Underpinning the Safe Transfer of Ill Neonates: A Review of the Literature

Referral challenges and outcomes of neonates received at Muhimbili National Hospital, Dar es Salaam, Tanzania

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