Observational study on the efficiency of Neonatal Emergency Transport in reducing mortality and morbidity indexes in Sicily

Abstract

In these last 25 years, the Neonatal Emergency Transport (NET) service has been widely improved in Italy. To date, all National areas are covered by a NET service; 53 NET centers have been activated in all the Italian territory. Herein, the authors present an observational study to evaluate the rate of infantile mortality after introduction of NET in Sicily, and to study the efficiency of this service in reducing these rates of mortality in vulnerable neonates, transported from primary care birth centers to tertiary facilities to undergo to specialized NICU assistance. All neonates who required an emergency transport by NETS were included. No exclusions criteria were applied. Demographic and regional infantile mortality data, expressed as infant mortality rate, were selected by the official government database (ISTAT- National Statistic Institute—http://www.istat.it). All data were respectively divided into three groups: data concerning transport, clinical condition, and mortality of the transported patients. We transported by NET 325 neonates. The analysis of the infant mortality rate (per 1.000 live births) in Catania from 2016 to 2018 was reduced compared to the same rate calculated before NETS activation (4.41 index before 2016 vs 4.17 index after 2016). These data showed an increase in other provinces (Enna, Caltanissetta, and Agrigento). 61% of neonates showed a respiratory disease. During the study period the proportion of neonates with a Mortality Index for Neonatal Transportation—MINT < 6 has been reduced, while there was an increase of neonates with higher Transport Risk Index of Physiologic Stability-TRIPS score results. The slight decrease of infantile mortality in Catania during the first three years after introduction of NET follows the same trend of all Italian territories, showing the importance of this service in reducing infantile mortality.

Bacteriological Profile and Antibiotic Susceptibility Pattern of Neonatal Septicemia and Associated Factors of ICU Hospitalization Days

“… 44 Besides, longer hospitalization among the transfer hospitalizations appeared commensurate with the severity of patient illness. 43 We also found that TRIPS score, which was used to assess the clinical severity of infants at the time transport 45 was performed, was related to an increased hospital length of stay. Knowledge of the transfer process and the severity of disease risk associated with the transfer provides information on the assessment of the neonatal transport and may reduce the length of stay and decrease adverse outcomes.…”

Determinants of Mortality in a Neonatal Intensive Care Unit in Athens, Greece: A Case-Control Study

“…A qualitative study conducted in neonatologists documented the concerns of the specialists vis-à-vis neonatal transfers, including the need for the readiness of paramedics to undertake the transfers, the need for soundness in the referral processes, and coordination between hospital staff, paramedics, and members of the transport team [ 20 ]. The paradigm of Italy, a neighboring country to the present study, highlighted that the implementation and improvement of the Neonatal Emergency Transport (NET) service with centers activated throughout the Italian territory were effective in the reduction of infant mortality, as demonstrated in a study published in 2021 [ 21 ]. Such health system infrastructure interventions aiming to reduce infant mortality are in line with the Sustainable Development Goals, whose target is to reduce mortality under five years of age to 25 per 1000 live births globally by 2030 [ 22 ].…”

Neonatal neurologic emergencies requiring access to paediatric emergency units: a retrospective observational study

“…NETS connects Neonatal Intensive Care Units with peripheral residential birth centers, bypassing the PEU first aid filter. The implementation of NETS has played a major role in reducing the neonatal mortality rate in Italy in the last two decades 5 , 6 , and in reducing neonatal accesses to PEU 7 . This last topic has also been confirmed by a USA study, which showed that the most of neonatal transports are performed by members of the California Perinatal Transport System (CPeTS), carrying critically ill infants from home or peripheral birth centers to NICUs with a higher level of care 7 .…”