Transportability of newborns at the stage of pre-transport evaluation
https://doi.org/10.52420/2071-5943-2022-21-3-51-59
Abstract
with the necessary resources and technology to improve the level and quality of care remains one of the most important tasks of emergency neonatology. Deterioration on the road may be due to suboptimal stabilization, the severity of the patient's condition, and the transportation procedure itself. Assessment of transportability is one of the most important tasks in the pre-transport preparation phase. Materials and Methods. The cohort study included data from 604 resuscitation team visits. According to the tactical decision, the subgroups of the transportable (n = 497) and non-transportable (n = 46) patients were singled out. The anamnesis data, scores according to the KSHONN, NTISS, TRIPS threat scales, the volume of intensive care, pre-transport preparation, and the outcome of the hospital stage were analyzed. Results. Non-transportable patients had significantly higher scores on the examined threatometric scales. The need for high-frequency artificial lung ventilation was associated with patient nontransportability with a risk ratio of 10.1 [6.72 to 15.18], and dopamine and adrenaline infusion increased the likelihood of nontransportability with risk ratios of 5.85 [3.44 to 9.95] and 11.38 [8.09 to 16.01], respectively. The need for correction of intensive care is associated with nontransportability with a risk ratio of 3.44 [2.29 to 5.17]. The group of nontransportable patients was characterized by significantly higher mortality, 7-day mortality, frequency of late neonatal sepsis, and longer duration of ventilatory ventilation and intensive care. Discussion. The group of patients considered untransportable at the stage of pre-transport preparation is characterized by high morbidity, the need for intensive care, and the need to correct therapy, which is regarded by the transport team as an additional risk. Conclusion. Non-transportable patients are characterized by a significantly higher need for intensive care and amount of pre-transport preparation, high morbidity and mortality
About the Authors
O. P. KovtunRussian Federation
Olga P. Kovtun – Doctor of Medicine, Professor, Correspondent Member of the Russian Academy of Sciences
Ekaterinburg
N. S. Davydova
Russian Federation
Nadezhda S. Davydova – Doctor of Medicine, Professor
Ekaterinburg
R. F. Mukhametshin
Russian Federation
Rustam F. Mukhametshin – MD
Ekaterinburg
A. A. Kurganski
Russian Federation
Andrew A. Kurganski – Senior lecturer
Ekaterinburg
References
1. Eliason S. H., Whyte H., Dow K., Cronin C. M., Lee S.; Canadian Neonatal Network. Variations in transport outcomes of outborn infants among Canadian neonatal intensive care units. Am J Perinatol. 2013; 30 (5) : 377–82. DOI:10.1055/s-0032-1324706.
2. Ratnavel N. Evaluating and improving neonatal transport services. Early Hum Dev. 2013; 89 (11) : 851–3. DOI:10.1016/ j.earlhumdev.2013.09.004.
3. Karagol B. S., Zenciroglu A., Ipek M. S., Kundak A. A., Okumus N. Impact of land-based neonatal transport on outcomes in transient tachypnea of the newborn. Am J Perinatol. 2011; 28 (4) : 331-6. DOI:10.1055/s-0030-1270115.
4. Goldsmit G., Rabasa C., Rodríguez S. [et al]. Risk factors associated to clinical deterioration during the transport of sick newborn infants. Arch Argent Pediatr. 2012; 110 (4) : 304–9. DOI:10.5546/aap.2012.304.
5. Helenius K., Longford N., Lehtonen L., Modi N., Gale C. Association of early postnatal transfer and birth outside a tertiary hospital with mortality and severe brain injury in extremely preterm infants: observational cohort study with propensity score matching. BMJ. 2019; l5678 (367) : 1–11. DOI:10.1136/bmj.l5678.
6. Shmakov A. N., Aleksandrovich Yu. S., Pshenisnov K. V., Zabolotskiy D. V., Razumov S. A. Intensive care of children who require interhospital transport (a clinical guideline draft). Almanac of Clinical Medicine. 2018; 46 (2) : 94–108. (In Russ.). DOI:10.18786/2072-0505-2018-46-2-94-108.
7. Aleksandrovich Yu. S., Gordeev V. I. Evaluation and prognostic scales in critical care medicine. Sankt-Peterburg: Sotis. 2007; 140 p. (In Russ.).
8. Morozova I. A., Yakirevich A. S., Popov N. Ya., Zubkov V. V., Burov A. A., Podurovskaya Yu. L., Degtyatev D. N. Sanitary aviation emergency medical care for children in the neonatal period. Neonatology: news, opinions, training. 2017; 15 (1) : 39–46 (In Russ.).
9. Bushtyrev V. A., Budnik V. A., Kuznetsova N. B. Criteria for the transportability of premature newborns. Akusherstvo i ginekologiya. 2015; 7 : 74–77 (In Russ.).
10. Bushtyrev V. A., Laura N. B., Zakharova I. I. Score assessment of the health status of premature newborns with perinatal infections. Rossiyskiy Vestnik Perinatologii i Pediatrii. 2006; 51 (3) : 11–15 (In Russ.).
11. Aleksandrovich Yu. S., Pshenisnov K. V., Cherevatenko R. I., Kopylov V. V., Andreev V. V., Parshin E. V. Features of intensive care for children at transhospital transportation. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2011; 3 : 9–15 (In Russ.).
12. Narli N., Kırımi E., Uslu S. Turkish Neonatal Society guideline on the safe transport of newborn. Turk Pediatri Ars. 2018; 25 (53) : 18–31. DOI:10.5152/TurkPediatriArs.2018.01804.
13. Savvina V. A., Varfolomeev A. R., Nikolaev V. N., Burtsev E. I., Kozlova I. N. The role of a resuscitation counseling center in availability of high-tech medical aid to newborn babies with surgical pathology. Detskaya khirurgiya. 2013; 6 : 49–52 (In Russ.).
14. Alexandrovich Y. C., Pshenisov K. B., Parshin E. V., Nurmagambetova B. K., Cherevatenco R. I. Hospital-to-hospital transportation of the newborns with multiple organ insufficiency. Emergency medical care. 2009; 10 (1) : 9–13. (In Russ.).
15. Insoft R. M., Schwartz H. P. American Academy of Pediatrics. Section on transport medicine. Equipment and medications. Guidelines for air and ground trans port of neonatal and pediatric patients. 4rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015. 488 р.
16. Kinsella J. P., Truog W. E., Walsh W. F. [et al]. Randomized multicenter trial of inhaled nitric oxide and high-frequency oscillatory ventilation in severe persistent pulmonary hypertension of the newborn. J Pediatr. 1997; 131 : 55–62.
17. Mainali E. S., Greene C., Rozycki H. J., Gutcher G. R. Safety and efficacy of high-frequency jet ventilation in neonatal transport. J Perinatol. 2007; 78 (10) : 609–13. DOI:10.1038/sj.jp.7211799.
18. Goldsmith J. P., Karotkin E. H., Keszler M., Suresh G. Assisted Ventilation of the Neonate (Sixth Edition). Philadelphia, PA : Elsevier; 2017. 500 р.
19. Honey G., Bleak T., Karp T., MacRitchie A., Null D. Jr. Use of the Duotron Transporter high frequency ventilator during neonatal transport Neonatal Netw. 2007; 26 : 167–174. DOI:10.1891/0730-0832.26.3.167.
20. Kumar P. P., Kumar C. D., Shaik F., Yadav S., Dusa S., Venkatlakshmi A. Transported neonates by a specialist team – how STABLE are they. Indian J Pediatr. 2011; 78 (7) : 860-2. DOI:10.1007/s12098-010-0362-0.
21. Leung K. K. Y., Lee S. L., Wong M. S. R., Wong W. H., Yung T. C. Clinical outcomes of critically ill infants requiring interhospital transport to a paediatric tertiary centre in Hong Kong. Pediatr Respirol Crit Care Med. 2019; 3 : 28–35. DOI:10.4103/prcm.prcm_6_19.
22. Xu X. J., Li L. N., Wu W. Y. Importance of stabilization of the neonatal transport network in critically ill neonates. J Int Med Res. 2019; 47 (8) : 3737–3744. DOI:10.1177/0300060519853948/.
23. Musialik-Swietlińska E., Bober K., Swietliński J., Górny J., Krawczyk R., Owsianka-Podleśny T. Evaluation of sick neonates' medical interventions in maternity units before transport to reference centres. Med Wieku Rozwoj. 2011; 15 (1) : 84–90.
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Review
For citations:
Kovtun OP, Davydova NS, Mukhametshin RF, Kurganski AA. Transportability of newborns at the stage of pre-transport evaluation. Ural Medical Journal. 2022;21(3):51-59. (In Russ.) https://doi.org/10.52420/2071-5943-2022-21-3-51-59