Risk factors associated to clinical deterioration during the transfer of sick newborns

Abstract

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.

Comparison of Neonatal Transport Scoring Systems and Transport-Related Mortality Score for Predicting Neonatal Mortality Risk

“…Therefore, it is critical to optimize care strategies during all neonatal transports. 7 The parameters used in scoring systems for predicting mortality in neonates are diverse such as gestational age, birth weight, ethnicity, sex, body temperature, heart rate, blood pressure, blood gas values, mechanical ventilation status, medications, diuresis, and other physiological data. 5,6,8,9 However, to ensure an appropriate and reliable prediction, data should be easily obtained, and the cost amount should be low.…”

Intra‐hospital mortality among neonates transported by ambulance in Colombia

“…Therefore, the transport of neonates is an important health service activity . It is well known that prognostic markers of morbimortality include the conditions for transporting neonates and their status when arriving at the intensive care unit to which they are referred …”

The Art of Supporting Families Faced with Neonatal Transport

“…Therefore, these specific family fears should be validated and not taken lightly. Goldsmit et al (2012) recognize that adequate neonatal transport is a key component of caring for the sick newborn infant who requires referral to tertiary care centers that provide higher levels of care. Yet the reality is that despite the need for higher levels of care to decrease mortality and morbidity rates, "risks need to be considered and managed effectively to ensure safety for all involved" (Teasdale & Hamilton, 2003).…”