DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20194707

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

Karthik Ram Mohan, Rajesh Kumar

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 care

Results: 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.


Keywords


Complications, Indications, Neonatal transport, Outcomes, Skilled team

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References


Fernandes CJ. Neonatal Transport. In: Cloherty JP, Eichenwald EC, Hansen AR, Stark AR, eds. Manual of Neonatal Care. 7th Ed. Philadelphia: Lippincott Williams & Wilkins; 2012: 192-202.

Cornette L. Contemporary neonatal transport: problems and solutions. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2004 May 1;89(3):F212-4.

Bang AT, Bang RA, Reddy HM. Home-based neonatal care: summary and applications of the field trial in rural Gadchiroli, India (1993 to 2003). J Perinatol. 2005 Mar 18;25(S1):S108.

Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet. 1999 Dec 4;354(9194):1955-61.

Kler N, Soni A, Gupta N. Neonatal Transport. In: Choudhury P, Bagga A, Chugh K, Ramji S, Gupta P. Principles of pediatric and neonatal emergencies. 3rd ed. New Delhi: Jaypee Brothers medical publishers; 2011:632-641.

Lee SK, Zupancic JA, Pendray M, Thiessen P, Schmidt B, Whyte R, et al. Transport risk index of physiologic stability: a practical system for assessing infant transport care. J Pediatrics. 2001 Aug 1;139(2):220-6.

Lee SK, Zupancic JA, Sale J, Pendray M, Whyte R, Brabyn D, et al. Cost-effectiveness and choice of infant transport systems. Med Care. 2002 Aug 1:705-16.

Sehgal A, Roy MS, Dubey NK, Jyothi MC. Factors contributing to outcome in newborns delivered out of hospital and referred to a teaching institution. Indian pediatrics. 2001 Nov 1;38:1289-94.

Singh H, Singh D, Jain BK. Transport of referred sick neonates: How far from ideal?. Indian pediatrics. 1996 Oct;33:851-3.

Mir NA, Javied S. Transport of sick neonates: practical considerations. Indian pediatrics. 1989 Aug;26(8):755-64.

Kumar PP, Kumar CD, Shaik F, Yadav S, Dusa S, Venkatlakshmi A. Transported neonates by a specialist team-how STABLE are they. The Indian Journal of Pediatrics. 2011 Jul 1;78(7):860-2.

Leslie AJ, Stephenson TJ. Audit of neonatal intensive care transport–closing the loop. Acta paediatrica. 1997 Nov;86(11):1253-6.

Kristin M, Gary P. Transport of the Ventilated Infant. In: Goldsmith JP, Karotk in EH, eds. Assisted ventilation of the neonate. 5th ed. St. Louis: Elsevier Saunders; 2011: 531-541.

Lim MT, Ratnavel N. A prospective review of adverse events during interhospital transfers of neonates by a dedicated neonatal transfer service. Pediatric Critical Care Medicine. 2008 May 1;9(3):289-93.

Kumar PP, Kumar CD, Shaik FA, Ghanta SB, Venkatalakshmi A. Prolonged neonatal interhospital transport on road: Relevance for developing countries. The Indian Journal of Pediatrics. 2010 Feb 1;77(2):151-4.

Kumar PP, Kumar CD, Venkatlakshmi A. Long distance neonatal transport-the need of the hour. Indian pediatrics. 2008 Nov 1;45(11):920.