The ability to use a clinical neonatal assessment scale to make a decision about transportability

Introduction. Perinatal routing ensures increased survival among preterm infants. Early admission to a highlevel neonatal care facility is also associated with lower morbidity in this patient population. A significant number of scales have been proposed to assess neonatal severity, predicting morbidity and risk of death. However, the comparison of the decision of the transport team with the recommendations of the scales is poorly understood. Materials and methods. The cohort study included data from 604 resuscitation team visits. The CASPN (clinical assessment scale for the premature newborn) was assessed, and a subgroup of patients with a CASPN score of 6-8 (n = 98) was taken for further analysis: 73.47 % of neonates (n = 72) were rated as transportable, 22.45 % of patients (n = 22) were considered nontransportable, and 4 patients (4.08 %) were left due to lack of indications for evacuation. The parameters and type of respiratory and hemodynamic support, monitoring data, volume of pre-transport preparation were studied. Results. Analysis of intensive care revealed significant differences in the frequency of high-frequency ventilation (2.78 % [0.34–9.68] and 22.73 % [7.82–45.37] among the transportable and nontransportable, respectively, p = 0.007), the frequency of adrenaline infusion (1.39 % [0.04–7.50] and 27.27 % [10.73–50.22] among the transportable and nontransportable, respectively, p = 0.0005). There was a higher requirement for supplemental oxygen, a higher mean airway pressure value, and a higher value of the oxygenation index in the nontransportable subgroup. Patients who were considered untransportable were significantly more likely to require prescription or adjustment of catecholamine dose (1.39 % [0.04–7.50] and 22.73 % [7.82–45.37], p = 0.002) and correction of respiratory support parameters (23.61 % [14.40–35.09] and 54.55 % [32.21–75.61], p = 0.009). Discussion. The results of the study indicate significant internal heterogeneity of the group with a score of 6–8 on the CASPN by the severity of respiratory and hemodynamic disorders. With a similar structure by weight and gestational age, there is a significant difference in the need for respiratory function replacement and medication management of hemodynamics. Conclusion. The CASPN score does not allow a detailed description of the severity of a newborn patient by the severity of respiratory and circulatory insufficiency in the pre-transport preparation phase and cannot be applied as a tool for assessing transportability.

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