Utility of transport risk index of physiological stability score for predicting likely outcome of extramural neonates transferred to NICU
DOI:
https://doi.org/10.18203/2349-3291.ijcp20201643Keywords:
Neonatal mortality, Transport risk index of physiological stability, TransferAbstract
Background: To accomplish ‘Mission Twenty - Twenty’ and to achieve ‘Sustainable Development Goal 3’, now we need to focus our attention more towards neonates being transported to higher centre in this very fragile period. We planned this study to assess demographic, transport and clinical characteristics of referred neonates and to determine whether TRIPS score serves as predictor of early neonatal mortality i.e. mortality within the first seven days after admission in these babies.
Methods: This cross sectional descriptive study with analytic components was carried out in a tertiary care teaching hospital. All neonates ≥1 kg, born outside of this hospital, and referred here during study period for further management were included. All the data pertaining to clinical, demographic and transport characteristics were recorded. TRIPS score was applied at admission and was related with the final outcome within first seven days of admission; expired or survived. The association between the outcome and TRIPS score was tested using chi square test or fisher’s exact test. ROC curve analysis was done to find out optimum TRIPS score to predict mortality.
Results: Neonatal mortality within first 7 days after admission is related to the TRIPS rating. The score of the survivors and neonatal deaths show a significant difference which is also even reflected by its individual components (p< 0.001). For a score of >18.5, a sensitivity of 89.47% and a specificity of 91.47%; area under the curve of 0.954 was determined.
Conclusions: TRIPS score is a valid predictor of early neonatal mortality. The components of TRIPS score also correlate with early neonatal death. It is important to establish measures to improve physiological stability of the newborn before, during and after the transfer in order to reduce neonatal mortality.
References
UNICEF. Neonatal Mortality. Available at: URL: https://data.unicef.org/topic/childsurvival/neonatal-mortality/ Accessed 18 May 2019.
Neonatal mortality rate: India is 12th worst in the world. Available at:
URL:https://qrius.com/neonatal-mortality-rate-in-india-2018/. Accessed 18 May 2019.
Kamath SS. Reducing the infant mortality rate of India to 20 by 2020: together we can do. Indian Paediatr. 2015;52(3):193-4.
You D, Hug L, Ejdemyr S, Idele P, Hogna D, Mathers C, et al. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet. 2015;386(10010):2275-86.
An analysis of levels and trends in infants and child mortality rates in India: 2014. National institute of public cooperation and child development New Delhi. Available at: http://nipccd.nic.in/reports/imr.pdf. Accessed 14 May 2019.
Rakholia R, Rawat V, Bano M, Singh G. Neonatal morbidity and mortality of sick newborns admitted in a teaching hospital of Uttarakhand. Chrismed J Health Res. 2014;1:228-34.
United Nations. Sustainable Development Goals. Available at: URL: https://sustainabledevelopment.un.org/sdgs Accessed 18 May 2019.
Singh M. Care of the newborn. 7th ed. New Delhi: CBS publication; 2007:30.
Lupton BA, Pendray MR. Regionalized Neonatal Emergency Transport. Seminars Neonatol. 2004;9(2):125-33.
Richardson DK, Gray JE, McCormick MC, Workman K, Goldman DA. Score for Neonatal Acute Physiology: a physiologic severity index for neonatal intensive care. Paediatr. 1993;91(3):617-23.
Parry G, Tucker J, Tarnow-Mordi W. CRIB II: an update of the clinical risk index for babies score. Lancet. 2003;361(9371):1789-91.
Lee SK, Zupancic JA, Pendray M, Thiessen P, Schmidt B, Whyte R, et al. Transportrisk index of physiologic stability: A practical system for assessing infant transport care. J Pediat. 2001;139(2):220-6.
Mehta N, Sharma MK. Correlation of acute physiological parameters with immediate outcomes among neonates transported to special care newborn unit: A prospective study. Indian J Child Health. 2018;5(4):280-3.
Verma SK, Nagaura CP, Goyal VK, Raheja KK, Singh A, Sharma P, et al. Status of Transported Neonates and Evaluation of TOPS as a Survival Score. Indian J Neonatal Med Res. 2017;5(2):P001-5.
Buch PM, Makwana AM, Chudasama RK, Doshi SK. Status of newborn transport in periphery and risk factors of neonatal mortality among referred newborns. J Phram Biomed Sci. 2012;16:1-6.
Narang M, Kaushik JS, Sharma AK, Faridi MM. Predictors of mortality among the neonates transported to referral centre in Delhi, India. Indian J Public Health 2013; 57:100-4.
Begum A, Ashwani N, Kumar CS. TOPS: a reliable and simplified tool for predicting mortality in transported neonates. IOSR J Dental Medical Sci. 2016;15(2):43-58.
Romanzeira JC, Sarinho SW. Quality Assessment of Neonatal Transport performed by the Mobile Emergency Medical Services (SAMU). J Pediatr (Rio J) 2015;91(4):380-5.
Luna-Hernández G, Varela-Cardoso M, Palacios-Blanco JC. Utility of a physiologic stability index based on Transport Risk Index of Physiologic Stability (TRIPS) for the evaluation of infants transferred to a specialized hospital. Bol Med Hosp Infant Mex. 2015;72(1):45-54.
Lee SK, Aziz K, Dunn M, Clarke M, Kovacs L, Ojah C, et al. Transport Risk Index of Physiologic Stability, version II (TRIPS-II): a simple and practical neonatal illness severity score. Am J Perinatol. 2013;30(5):395-400.