Study of indications, complications and outcomes of neonatal transport by a skilled team

Abstract

Background: A skilled transport team is an essential requirement for safe and effective neonatal transport. The transport team of this level III NICU in Chennai performs a considerable number of transports every year and a need was felt to study the indications, complications and outcomes of transport.Methods: Prospective Descriptive study of neonatal transports conducted 18 months Patients were divided into 2 main groups based on transport Duration: Short (≤1hr) and Long (>1hr) transport groups. TRIPS (Transport risk index of physiologic stability) score, a risk- weighted validated neonatal transport was used as a practical system for assessing infant transport careResults: During the study period 210 transports were performed from 12 cities and towns. 60% transports were of short duration. Respiratory causes were the most common indications (43.8%) followed by CNS causes (19.5%). 44.3%(93) patients required ventilation during the transport process. Overall, there was improvement in mean TRIPS 2 score compared to TRIPS 1 in all groups of patients (Short, Prolonged, Survivors and Non-survivors). Total mortality of transported group was 31 patients (14.8%). (Including 02 patients who died enroute). There were non-significant differences in 7 day mortality (7.6% vs 8.4%) and total mortality (13.9% vs 13.4%) between the groups. Complications that occurred during transport included hyperglycemia, prolonged CFT, hypothermia, accidental extubation enroute, hypoglycemia, hyperthermia, Hypotension, and persistent Hypoxia.Conclusions: It appears, that overall, duration of transport does not adversely affect outcome. Transport Team should be able to intubate and ventilate the baby and diagnose and manage complications like hypothermia, shock and hypoglycemia at referring hospital and enroute.

Current Trends in Neonatal Morbidity and Mortality: Experiences from a Tertiary Center in Lagos, Nigeria

“…19 The importance of appropriate means of transport with a prior notification of the receiving health-care facility is also very important to improve the outcome for these infants. 19,20 Asphyxia, on the other hand, which was reported as the second highest morbidity 20 years ago, is now the fourth most common cause of morbidity in our study and also in a multicenter study on the burden of disease and risk factors for mortality among hospitalized newborns in Nigeria and Kenya. 21 This is probably a reflection of the positive effect of increased training of health-care workers on neonatal resuscitation, step-down training to other health-care workers, 22 and helping babies breathe training on newborn resuscitation.…”

Identification of the Best Predictive Model for Mortality in Outborn Neonates—Retrospective Cohort Study

“…Experts consider neonatal transport between medical institutions as part of neonatal intensive care and a major outcome predictor for sick neonates [36]. Early recognition of sick neonates, optimal resuscitation if needed, prompt recognition and treatment of hypoglycemia, seizures, and respiratory distress, prevention of hypothermia, hypoxia, hypotension, adequate monitoring before and during neonatal transport, and rapid transfer are often challenging but extremely important for optimization of neonatal outcomes [5,8,9,[13][14][15][16]30,35,37]. Efforts to improve neonatal stabilization pretransport, neonatal care during transport, and the neonatal transport system itself-organization, training, equipment-are challenging in many countries but mandatory for decreasing neonatal morbidity and mortality rates as data in the literature shows that outborn neonates are facing significantly higher morbidity and mortality rates [8,11,12].…”

“…However, using the first blood glucose instead of a random blood glucose value may increase the predictive value of the SNS score as it may better reflect the condition of the newborns at admission at our hospital and exclude corrective interventions (including parenteral or enteral administration of glucose). Choosing the first blood glucose value may help diagnose hypoglycemia, a significant risk factor for neonatal morbidity and mortality [5,9,13,30]. Using Masimo technology for peripheral oxygen saturation measuring aimed at a rapid and accurate evaluation of the infants' condition and identification of hypoxia, another important risk factor for morbidity and mortality [5,9,13,30].…”

“…The difference had limited significance in term infants (16.8 (2.4) vs. 14.8 (2.5); p = 0.050). Mann-Whitney U test showed a significant association of MSNS-AT with mortality only in preterm infants (median score 14, IQR 11-16; p = 0.042 in preterm infants; median 17 (IQR 15-18 in term infants, and 16 (13)(14)(15)(16)(17) in the whole group, p > 0.50 for both). However, an MSNS-AT score ≤ 10 demonstrates a statistically significant association with risk of death in the subgroups and the entire group when survivors are compared to non-survivors: an MSNS-AT score ≤ 10 is found in 21 survivors (10.3%) vs. 14 non-survivors (100%) in the preterm infants (p < 0.001); in 3 survivors (1.7%) vs. 1 non-survivor (16.7%) in the term infants group (p = 0.003; OR 9.1 [95%CI 1.25-61.13]), and in 24 survivors (6.3%) and 15 non-survivors (75%) in all patients (p < 0.001, OR 28.0 [10.7-72.89]).…”

“…Early recognition of sick neonates, optimal resuscitation if needed, prompt recognition, and immediate competent interventions are needed to treat hypoglycemia, seizures, and respiratory distress, prevention and treatment of hypothermia, hypoxia, hypotension, adequate monitoring before and during neonatal transport, and rapid transfer are extremely important for optimization of neonatal outcome [5,8,9,[13][14][15][16]. A regionalized, specialized neonatal transport system may reduce neonatal complications and improve survival rates [11,14,17,18].…”