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Mistry A, Leslie A, Ojha S, Sharkey D. Identifying neonatal transport research priorities: a modified Delphi consensus. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327213. [PMID: 38857987 DOI: 10.1136/archdischild-2024-327213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/15/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVES With increasing advances in neonatal transport, a focused research strategy is required to increase the evidence base towards providing optimal care. We aimed to identify the most important neonatal transport research questions as prioritised by parents and healthcare professionals (HCPs). DESIGN Key stakeholders participated in a modified three-stage Delphi consensus process. Research questions were identified and submitted through two survey stages before the final priority setting workshop. PARTICIPANTS Parents of babies who received neonatal care, neonatal HCPs and stakeholders. OUTCOME Identify the top 10 research priorities for neonatal transport. RESULTS Overall, 269 survey responses from HCPs/stakeholders (n=161) and parents (n=108) were analysed from two survey rounds. Consensus was reached on 22 of 43 research priorities for the final priority setting workshop. The agreed top research priorities covered the domains of: (1) Pain assessment and management, (2) Long-term neurological outcomes, (3) Impact of transfer on birth-related brain injury, (4) Investigating risk of transport, (5) Safety restraints for infants, (6) Optimal temperature management, (7) Respiratory management and outcomes, (8) Benchmarking of important of transport measures, (9) Understanding transport environmental exposures, (10) Mental health and burden of transfer on families. CONCLUSION We have identified the top research questions for neonatal transport through an extensive process actively engaging parents, HCPs and key stakeholders. Targeted funding and research resources, directed towards addressing these prioritised research areas, will inform evidence-based practices and international frameworks specific to neonatal transport, helping minimise research waste and ultimately improve outcomes for these high-risk infants and their families.
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Affiliation(s)
- Aarti Mistry
- Centre for Perinatal Research (CePR), School of Medicine, University of Nottingham, Nottingham, UK
| | - Andrew Leslie
- Centre for Perinatal Research (CePR), School of Medicine, University of Nottingham, Nottingham, UK
- UK-Neonatal Transport Research Collaborative (UK-NTRC), UK-Neonatal Transport Group, Nottingham, UK
| | - Shalini Ojha
- Centre for Perinatal Research (CePR), School of Medicine, University of Nottingham, Nottingham, UK
| | - Don Sharkey
- Centre for Perinatal Research (CePR), School of Medicine, University of Nottingham, Nottingham, UK
- UK-Neonatal Transport Research Collaborative (UK-NTRC), UK-Neonatal Transport Group, Nottingham, UK
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Schumacher S, Mitzlaff B, Mohrmann C, Fiedler KM, Heep A, Beske F, Hoffmann F, Lange M. Characteristics and special challenges of neonatal emergency transports. Early Hum Dev 2024; 192:106012. [PMID: 38648678 DOI: 10.1016/j.earlhumdev.2024.106012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND As a rule, newborns do not require special medical care. If unexpected complications occur peripartum or postpartum, support from and transport to specialised neonatal hospitals might be needed. METHODS In a retrospective study, all transport protocols of a supraregional paediatric‑neonatological maximum care hospital in northwestern Germany from 01.10.2018 through 30.09.2021 were analysed. The particular focus was on transports of newborns (<7 days) and the leading symptoms that led to contact. RESULTS A total of 299 patients were included (average age of 15.4 h, 61.6 % males). The average complete transport time was approximately 2 h. Five leading neonatal diseases (respiratory, infectious, asphyxia, cardiac, haematological) were found to represent the causes of >80 % of transfers. Respiratory adaptation disorders are the main reason for transferring a newborn to a centre, whereas asphyxia is the most severe condition. The various symptoms differ in their time of onset, a factor which must be taken into account in practice. Differences were also found between different types of hospitals: while a large proportion of transports were carried out from maternity hospitals (80.6 %), children transported from children's hospitals were generally more severely ill. DISCUSSION Transfers of neonates, especially from maternity hospitals to neonatal intensive care units due to special neonatal diseases, are not rare. In times of increasingly scarce resources, the effective care of sick or at-risk neonates is essential. For low-population regions, this means professional cooperation between maximum care providers and smaller children's hospitals and maternity-only hospitals.
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Affiliation(s)
- S Schumacher
- Department of Pediatrics, Klinikum Leer, Leer, Germany
| | - B Mitzlaff
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - C Mohrmann
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany
| | - K M Fiedler
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany
| | - A Heep
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany
| | - F Beske
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany
| | - F Hoffmann
- Department of Healthcare Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - M Lange
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany.
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3
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Ognean ML, Coțovanu B, Teacoe DA, Radu IA, Todor SB, Ichim C, Mureșan IC, Boicean AG, Galiș R, Cucerea M. Identification of the Best Predictive Model for Mortality in Outborn Neonates-Retrospective Cohort Study. Healthcare (Basel) 2023; 11:3131. [PMID: 38132020 PMCID: PMC10743250 DOI: 10.3390/healthcare11243131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Transportation of sick newborns is a major predictor of outcome. Prompt identification of the sickest newborns allows adequate intervention and outcome optimization. An optimal scoring system has not yet been identified. AIM To identify a rapid, accurate, and easy-to-perform score predictive for neonatal mortality in outborn neonates. MATERIAL AND METHODS All neonates admitted by transfer in a level III regional neonatal unit between 1 January 2015 and 31 December 2021 were included. Infants with congenital critical abnormalities were excluded (N = 15). Gestational age (GA), birth weight (BW), Apgar score, place of birth, time between delivery and admission (AT), early onset sepsis, and sick neonatal score (SNS) were collected from medical records and tested for their association with mortality, including in subgroups (preterm vs. term infants); GA, BW, and AT were used to develop MSNS-AT score, to improve mortality prediction. The main outcome was all-cause mortality prediction. Univariable and multivariable analysis, including Cox regression, were performed, and odds ratio and hazard ratios were calculated were appropriate. RESULTS 418 infants were included; 217/403 infants were born prematurely (53.8%), and 20 died (4.96%). Compared with the survivors, the non-survivors had lower GA, BW, and SNS scores (p < 0.05); only the SNS scores remained lower in the subgroup analysis. Time to admission was associated with an increased mortality rate in the whole group and preterm infants (p < 0.05). In multiple Cox regression models, a cut-off value of MSNS-AT score ≤ 10 was more precise in predicting mortality as compared with SNS (AUC 0.735 vs. 0.775) in the entire group and in the preterm infants group (AUC 0.885 vs. 0.810). CONCLUSIONS The new MSNS-AT score significantly improved mortality prediction at admission in the whole study group and in preterm infants as compared with the SNS score, suggesting that, besides GA and BW, AT may be decisive for the outcome of outborn preterm infants.
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Affiliation(s)
- Maria Livia Ognean
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (M.L.O.); (S.B.T.); (C.I.); (I.C.M.); (A.-G.B.)
| | - Bianca Coțovanu
- Department of Neonatology, Clinical County Emergency Hospital Sibiu, 550245 Sibiu, Romania;
| | - Dumitru Alin Teacoe
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (M.L.O.); (S.B.T.); (C.I.); (I.C.M.); (A.-G.B.)
- Department of Neonatology, Clinical County Emergency Hospital Sibiu, 550245 Sibiu, Romania;
| | - Ioana Andrada Radu
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (M.L.O.); (S.B.T.); (C.I.); (I.C.M.); (A.-G.B.)
| | - Samuel Bogdan Todor
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (M.L.O.); (S.B.T.); (C.I.); (I.C.M.); (A.-G.B.)
| | - Cristian Ichim
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (M.L.O.); (S.B.T.); (C.I.); (I.C.M.); (A.-G.B.)
| | - Iris Codruța Mureșan
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (M.L.O.); (S.B.T.); (C.I.); (I.C.M.); (A.-G.B.)
| | - Adrian-Gheorghe Boicean
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (M.L.O.); (S.B.T.); (C.I.); (I.C.M.); (A.-G.B.)
| | - Radu Galiș
- Department of Neonatology, Clinical County Emergency Hospital Bihor, 410167 Oradea, Romania;
- Department of Neonatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania;
| | - Manuela Cucerea
- Department of Neonatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania;
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Vlok N, Wylie C, Stassen W. A 12-month retrospective descriptive analysis of a single helicopter emergency medical service operator in four South African provinces. Afr J Emerg Med 2023; 13:127-134. [PMID: 37275460 PMCID: PMC10238258 DOI: 10.1016/j.afjem.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Helicopter Emergency Medical Services (HEMS) is integrated into modern emergency medical services because of its suggested mortality benefit in certain patient populations, it is an expensive resource and appropriate use/feasibility in low- to middle income countries (LMIC) is highly debated. To maximise benefit, correct patient selection in HEMS is paramount. To achieve this, current practices first need to be described. The study aims to describe a population of patients utilising HEMS in South Africa, in terms of flight data, patient demographics, provisional diagnosis, as well as clinical characteristics and interventions. Methods A retrospective flight- and patient-chart review were conducted, extracting clinical and mission data of a single aeromedical operator in South Africa, over a 12-month period (July 2017 - June 2018) in Gauteng, Free State, Mpumalanga and North-West provinces. Results A total of 916 cases were included (203 primary cases, 713 interfacility transport (IFT) cases). Most patients transported were male (n=548, 59.8%) and suffered blunt trauma (n=379, 41.4%). Medical pathology (n=247, 27%) and neonatal transfers (n=184, 20.1%) follows. Flights occurred mainly in daylight hours (n=729, 79.6%) with median mission times of 1-hour 53 minutes (primary missions), and 3 hours 10 minutes (IFT missions). Median on-scene times were 26 minutes (primary missions) and 55 minutes (IFT missions). Almost half were transported with an endotracheal tube (n=428, 46.7%), with a large number receiving no respiratory support (n=414, 45.2%). No patients received fibrinolysis, defibrillation, cardioversion or cardiac pacing. Intravenous fluid therapy (n=867, 94.7%) was almost universal, with common administration of sedation (n=430, 46.9%) and analgesia (n=329, 35.9%). Conclusion Apart from the lack of universal call-out criteria and response to the high burden of trauma, HEMS seem to fulfil an important critical care transport role. It seems that cardiac pathologies are under-represented in this study and might have an important implication for crew training requirements.
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5
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Veldman A, Krummer S, Schwabe D, Diefenbach M, Fischer D, Schmitt-Kästner S, Rohrbeck C, Pannu R. Safety and Feasibility of Long-Distance Aeromedical Transport of Neonates and Children in Fixed-Wing Air Ambulance. J Pediatr Intensive Care 2023; 12:235-242. [PMID: 37565016 PMCID: PMC10411161 DOI: 10.1055/s-0041-1731681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/27/2021] [Indexed: 08/12/2023] Open
Abstract
In cases of critical injury or illness abroad, fixed-wing air ambulance aircraft is employed to repatriate children to their home country. Air ambulance aircraft also transport children to foreign countries for treatment not locally available and newborns back home that have been born prematurely abroad. In this retrospective observational study, we investigated demographics, feasibility, and safety and outcomes of long-distance and international aeromedical transport of neonates and children. The study included 167 pediatric patients, 56 of those preterm neonates. A total of 41 patients were ventilated, 45 requiring oxygen prior to the transport, 57 transferred from an intensive care unit (ICU), and 48 to an ICU. Patients were transported by using Learjet 31A, Learjet 45, Learjet 55, and Bombardier Challenger 604, with a median transport distance of 1,008 nautical miles (NM), median transport time of 04:45 hours (median flight time = 03:00 hours), flight time ≥8 hours in 15 flights, and transport time ≥8 hours in 29 missions. All transports were accompanied by a pediatric physician/nurse team. An increase in FiO 2 during the transport was documented in 47/167 patients (28%). Therapy escalation (other than increased oxygen) was reported in 18 patients, and technical adverse events in 3 patients. No patient required CPR or died during the transport. Clinical transport outcome was rated by the accompanying physician as unchanged in 163 transports, improved in 4, and deteriorated in none. In summary, international, long-distance transport of neonatal and pediatric patients performed by experienced and well-equipped transport teams is feasible. Neither major adverse events nor physician-rated clinical deteriorations were observed in this group of patients.
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Affiliation(s)
- Alex Veldman
- Jetcall Air Ambulance, Idstein, Germany
- Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia
| | - Stefanie Krummer
- Jetcall Air Ambulance, Idstein, Germany
- Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany
| | | | | | - Doris Fischer
- Jetcall Air Ambulance, Idstein, Germany
- Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany
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Momin S, Thomas S, Zein H, Scott JN, Leijser LM, Vayalthrikovil S, Yusuf K, Paul R, Howlett A, Mohammad K. Comparing Three Methods of Therapeutic Hypothermia Among Transported Neonates with Hypoxic-Ischemic Encephalopathy. Ther Hypothermia Temp Manag 2023; 13:141-148. [PMID: 36961391 DOI: 10.1089/ther.2022.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) and associated multiorgan injury are significant causes of morbidity and mortality in term and near-term neonates. Therapeutic hypothermia (TH) is the current standard of care for neuroprotection in neonates with HIE. In our experience, the majority of babies born with HIE were found in nontertiary care facilities in our region, where effective methods of cooling during transport to tertiary care centers are desirable. Most centers initiate passive TH at referral hospitals, while active cooling is typically initiated during transport. The objective of this study was to evaluate the effectiveness of three methods of cooling during transport of neonates with HIE in southern Alberta. In this prospective cohort study, 186 neonates with HIE were transported between January 2013 and December 2021. Among the 186 neonates, 47 were passively cooled, 36 actively cooled with gel packs, and 103 cooled with a servo-controlled cooling device. The clinical characteristics were comparable for the three groups, with no difference in adverse events. Fifteen neonates (8%) died and 54 neonates (29%) suffered radiologically determined brain injury. Servo-controlled cooling was found to be superior to other methods in maintaining a target temperature without significant fluctuation during transport and with temperature in the target range on arrival at tertiary care facilities. The rate of overcooling was also lower in the servo-controlled group compared with other groups. There were no statistically significant differences between the groups in relation to mortality and brain MRI changes associated with HIE. Adjusting for GA, 10-minute Apgar score, base excess, HIE stage, and need for intubation during transport, passive cooling increased the odds of temperature fluctuation outside the range by 12-fold and gel pack cooling by 13-fold compared with servo-controlled cooling. The use of servo-controlled TH devices should be the preferred practice wherever feasible. (REB17-1334_REN3).
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Affiliation(s)
- Sarfaraz Momin
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - Sumesh Thomas
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - Hussein Zein
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - James N Scott
- Department of Diagnostic Imaging, Division of Neuroradiology, University of Calgary, Calgary, Canada
| | - Lara M Leijser
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - Sakeer Vayalthrikovil
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - Kamran Yusuf
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - Renee Paul
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - Alexandra Howlett
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
| | - Khorshid Mohammad
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, Canada
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Ali A, Miller MR, Cameron S, Gunz AC. Pediatric Transport Safety Collaborative: Adverse Events With Parental Presence During Pediatric Critical Care Transport. Pediatr Emerg Care 2022; 38:207-212. [PMID: 34693934 DOI: 10.1097/pec.0000000000002561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In Canada, critically ill pediatric patients require transfer to a tertiary care center for definitive medical and surgical management. Some studies suggest that family accompaniment could compromise care; currently, limited research has examined patient safety and outcomes during pediatric critical care transport with family presence, and no Canada-specific data currently exists. The primary objective of this study was to compare the rate of adverse events during the transport of pediatric patients by a specialized pediatric critical care transport team with parental accompaniment to those without parental accompaniment. Secondary objectives included whether geographic or patient-specific factors affected rates of parental accompaniment and if parental presence during transport was related to patient outcomes. METHODS Retrospective cohort study in a pediatric critical care unit convenience sample at an academic children's hospital. Inclusion criteria constituted all patients younger than 18 years who were admitted to the pediatric critical care unit after interfacility transport by the London Health Sciences Center Neonatal Pediatric Transport Team between April 1, 2018, and April 30, 2020, inclusive. Adverse event rates, patient characteristics, and clinical outcomes were compared. RESULTS There were 357 transports eligible for analysis. Of these, there were 180 transports with, and 177 without, parental accompaniment. The primary outcome was adverse event occurrence using the composite definition of adverse events, previously defined by a Canadian consensus process, which included patient-, transport provider-, laboratory-, and system/vehicle-related safety factors. The occurrence of adverse events was not significantly different between transports with and without parental accompaniment, 49.4% and 54.8%, respectively (odds ratio, 0.80; P = 0.311). CONCLUSIONS This is the first study to compare the effect on adverse event rate and clinically relevant outcomes between transports with and without parental presence during interfacility pediatric critical care transport. Our study found no significant difference in the adverse event rate between transports with and without parental presence.
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Affiliation(s)
- Aaisham Ali
- From the Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University
| | | | - Saoirse Cameron
- From the Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University
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Shahid S, Thabane L, Marrin M, Schattauer K, Silenzi L, Borhan S, Singh B, Thomas C, Thomas S. Evaluation of a Modified SBAR Report to Physician Tool to Standardize Communication on Neonatal Transport. Am J Perinatol 2022; 39:216-224. [PMID: 32819017 DOI: 10.1055/s-0040-1715524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE SBAR (situation, background, assessment and recommendation) is a structured format for the effective communication of critically relevant information. This tool was developed as a generic template to provide structure to the communication of clinical information between health care providers. Neonatal transport often presents clinically stressful circumstances where concise and accurate information is required to be shared clearly between multidisciplinary health care providers. A modified SBAR communication tool was designed to facilitate structured communication between nonphysician bedside care providers operating from remote sites and physicians providing decision-making support at receiving care facilities. Prospective interventional study was designed to evaluate the reliability of a "SBAR report to physician tool" in sharing clinically relevant information between multidisciplinary care providers on neonatal transport. STUDY DESIGN The study was conducted between 2011 and 2014 by a dedicated neonatal transport service based at McMaster Children's Hospital which provides care for approximately 500 infants in Southern Ontario annually. In the preintervention phase, 50 calls were randomly selected for the evaluation and 115 consecutively recorded transport calls following adoption of the reporting tool. The quality of calls prior to and after the intervention was assessed by reviewers independently. Inter-rater agreement was also assessed for both periods. RESULTS Inter-rater agreement between raters was moderate to perfect in most components of the SBAR "report to the physician tool" except for the assessment component, which showed fair agreement during both preintervention and postintervention periods. There was an improvement in global score (primary outcome) with a mean difference of 0.95 (95% confidence interval [CI]: 0.77-1.14; p < 0.001) and in cumulative score with a mean difference of 8.55 (95% CI: 7.26-9.84; p < 0.001) in postintervention period. CONCLUSION The use of the SBAR report to physician tool improved the quality of clinical information shared between nonphysician members of the neonatal transport team and neonatal transport physicians. KEY POINTS · Long-Accurate and concise information sharing is crucial for decision-making in neonatal transport.. · Information sharing between multidisciplinary teams can be enhanced by using a commonly understood information sharing template.. · The SBAR report to physician tool improves the quality of information shared between multidisciplinary team members in neonatal transport..
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Affiliation(s)
- Shaneela Shahid
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Pediatrics, McMaster University, Hamilton, Canada.,Department of Anesthesia, McMaster University; Biostatistics Unit, St Joseph's Healthcare, Hamilton, Canada
| | - Michael Marrin
- Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, Canada
| | - Karen Schattauer
- Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, Canada
| | - Laurel Silenzi
- Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, Canada
| | - Sayem Borhan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Family Medicine, McMaster University, Canada
| | - Balpreet Singh
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cherian Thomas
- Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, Ontario, Canada
| | - Sumesh Thomas
- Department of Pediatrics, University of Calgary, Calgary, Canada
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Delacrétaz R, Fischer Fumeaux CJ, Stadelmann C, Rodriguez Trejo A, Destaillats A, Giannoni E. Adverse Events and Associated Factors During Intrahospital Transport of Newborn Infants. J Pediatr 2022; 240:44-50. [PMID: 34480917 DOI: 10.1016/j.jpeds.2021.08.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the frequency, type, and severity of adverse events (AEs) during intrahospital transport of newborn infants and to identify associated factors. STUDY DESIGN We conducted a prospective observational study in a tertiary care academic neonatal unit. All patients hospitalized in the neonatal unit and undergoing intrahospital transport between June 1, 2015, and May 31, 2017 were included. Transports from other hospitals and the delivery room were not included. RESULTS Data from 990 intrahospital transports performed in 293 newborn infants were analyzed. The median postnatal age at transport was 13 days (Q1-Q3, 5-44). Adverse events occurred in 25% of transports (248/990) and were mainly related to instability of cardiovascular and respiratory systems, agitation, and temperature control. Adverse events were associated with no harm in 207 transports (207/990, 21%), mild harm in 37 transports (37/990, 4%), and moderate harm in 4 transports (4/990, 0.4%). There was no severe or lethal adverse event. Hemodynamic support with catecholamines, the presence of a central venous catheter, and a longer duration of transport were independent predictors for the occurrence of adverse events during transport. CONCLUSIONS Intrahospital transports of newborns are associated with a substantial proportion of adverse events of low-to-moderate severity. Our data have implications to inform clinical practice, for benchmarking and quality improvement initiatives, and for the development of specific guidelines.
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Affiliation(s)
- Romaine Delacrétaz
- Department of Pediatrics, eHnv Yverdon-les-Bains, Yverdon-les-Bains, Switzerland; Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Céline J Fischer Fumeaux
- Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Corinne Stadelmann
- Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Adriana Rodriguez Trejo
- Mother-Child Research Unit, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alice Destaillats
- Mother-Child Research Unit, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eric Giannoni
- Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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10
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Abdelmawla M, Hansen G, Narvey M, Whyte H, Ilodigwe D, Lee KS. Evaluation of transport-related outcomes for neonatal transport teams with and without physicians. Paediatr Child Health 2021; 26:e290-e296. [PMID: 34880960 DOI: 10.1093/pch/pxab019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/18/2021] [Indexed: 11/14/2022] Open
Abstract
Objective The aim of this study was to evaluate if the presence of a physician in the neonatal transport team (NTT) affects transport-related outcomes and procedural success. Design Retrospective cohort study with propensity score matching. Setting Canadian national study. Patients Neonatal transports from nontertiary centres between January 2014 and December 2017. Interventions Comparison of transports conducted by NTTs with physicians (MD Group) and without physicians (noMD Group). Main outcome measures The primary outcome was the change in patient acuity as measured by the transport risk index of physiologic severity (TRIPS) score. Secondary outcomes included mortality within 24 hours of NICU admission, clinical complications during transport, procedural success, and stabilization time. Results Among 9,703 eligible cases, 899 neonatal transports attended by NTTs with physicians were compared to 899 neonatal transports without physicians using propensity score matching. No differences were seen in the improvement of TRIPS score or mortality ≤24 hours of NICU admission. The MD Group had more clinical complications (7.7% versus 5.0%, P=0.02). No differences were seen in success rates of invasive procedures. The MD Group had shorter stabilization times. In multivariable analysis, the MD Group was not a significant predictor for the improvement in TRIPS score after adjustment for covariates. Conclusions Neonatal transports conducted by teams including physicians compared to teams without physicians, did not have higher improvement in TRIPS scores and had similar success rates for procedures. These results provide insights for the planning of the structure and training of specialized interfacility neonatal transport programs.
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Affiliation(s)
- Mohamed Abdelmawla
- Division of Neonatology, Children's Hospital of Manitoba, Winnipeg, Manitoba, Canada
| | - Gregory Hansen
- Division of Critical Care, Royal University Hospital, Saskatoon, Saskatchewan, Canada.,Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Michael Narvey
- Division of Neonatology, Children's Hospital of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hilary Whyte
- Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Don Ilodigwe
- Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kyong-Soon Lee
- Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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11
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Bhagwan R, Ashokcoomar P. An exploratory study of the experiences and challenges faced by advanced life support paramedics in the milieu of neonatal transfers. Health SA 2021; 26:1562. [PMID: 34858641 PMCID: PMC8603084 DOI: 10.4102/hsag.v26i0.1562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background The safe transfer of critically ill neonates is important for their survival. This calls for greater preparedness on the part of paramedics to effect these transfers safely. Aim To understand the experiences and the challenges faced by advanced life support (ALS) paramedics during neonatal transfers. Setting The study setting consisted of advanced life support paramedics from urban and rural areas in KwaZulu-Natal. It comprised of a network of district hospitals as well air and ground transfer facilities, both public and private. Method Using a qualitative research approach, the study sought the views of ALS paramedics who were involved in neonatal transfers in KwaZulu-Natal. A purposive sample of n = 8 ALS paramedics was selected. Data were collected using in-depth semi-structured interviews. The data were analysed through the process of thematic analysis. Results The study found that paramedics faced multiple complex challenges related to neonatal transfers. Poor pre-transfer preparation of the neonate, equipment related challenges, lack of clinical support available during transfers and pressure to effect inappropriate transfers were some of the challenges they faced. These challenges coupled with insufficient education and the lack of sub-speciality programmes to capacitate, rendered them unprepared to deal with neonatal transfers effectively. Conclusion Emergency medicine needs to provide greater attention towards preparing all stakeholders for successful neonatal transfers. Contribution The findings provide recommendations for a programme that will limit risks involved with, and support the inter-healthcare facility transfer of critically ill neonates in South Africa.
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Affiliation(s)
- Raisuyah Bhagwan
- Department of Community Health Studies, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Pradeep Ashokcoomar
- Department of Emergency Medical Care, KwaZulu-Natal Department of Health's Emergency Medical Services College, Durban, South Africa
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12
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Ashokcoomar† P, Bhagwan R. The neonatal transfer process through the lens of neonatologists at public hospitals in South Africa. Health SA 2021. [DOI: 10.4102/hsag.v26i0.1617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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13
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Lyng JW, Braithwaite S, Abraham H, Brent CM, Meurer DA, Torres A, Bui PV, Floccare DJ, Hogan AN, Fairless J, Larrimore A. Appropriate Air Medical Services Utilization and Recommendations for Integration of Air Medical Services Resources into the EMS System of Care: A Joint Position Statement and Resource Document of NAEMSP, ACEP, and AMPA. PREHOSP EMERG CARE 2021; 25:854-873. [PMID: 34388053 DOI: 10.1080/10903127.2021.1967534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Air medical services involves providing medical care in transit while using either fixed wing (airplane) or rotor wing (helicopter) aircraft to move patients between locations. The modern use and availability of air medical services has expanded access to various health system resources, including specialty care. While this is generally beneficial, such expansion has also contributed to the complexity of health care delivery systems.(1, 2) Since the publication of the 2013 joint position statement Appropriate and Safe Utilization of Helicopter Emergency Medical Services,(3) research has shown that patient benefit is gained from the clinical care capabilities of air medical services independent of potential time saved when transporting patients.(4-6) Because the evidence basis for utilization of air medical services continues to evolve, NAEMSP, ACEP, and AMPA believe that an update regarding the appropriate utilization of air medical services is warranted, and that such guidance for utilization can be divided into three major categories: clinical considerations, safety considerations, and system integration and quality assurance considerations.
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Affiliation(s)
- John W Lyng
- University of Minnesota School of Medicine, Department of Emergency Medicine (NAEMSP)
| | - Sabina Braithwaite
- Washington University in Saint Louis School of Medicine, Department of Emergency Medicine (NAEMSP)
| | | | - Christine M Brent
- University of Michigan, Department of Emergency Medicine (NAEMSP, AMPA)
| | - David A Meurer
- University of Florida College of Medicine, Department of Emergency Medicine (NAEMSP)
| | - Alexander Torres
- Cleveland Clinic Florida, Department of Emergency Medicine (NAEMSP)
| | - Peter V Bui
- Augusta University, Department of Emergency Medicine (NAEMSP)
| | - Douglas J Floccare
- Maryland Institute for EMS Systems (MIEMSS), Maryland State Police Aviation Command, University of Maryland, Department of Emergency Medicine (AMPA)
| | - Andrew N Hogan
- UT Southwestern Medical Center, Department of Emergency Medicine (AMPA)
| | - Justin Fairless
- Texas Christian University and University of North Texas Health Science Center School of Medicine, Department of Emergency Medicine (ACEP)
| | - Ashley Larrimore
- The Ohio State University, Department of Emergency Medicine (NAEMSP)
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14
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Chen WH, Su CH, Lin LC, Lin HC, Lin YJ, Hsieh HY, Sheen JM, Lee CT. Neonatal mortality among outborn versus inborn babies. Pediatr Neonatol 2021; 62:412-418. [PMID: 33967008 DOI: 10.1016/j.pedneo.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/20/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Most previous studies reported there were higher survival rates if low birth weight babies were born in tertiary perinatal centers (inborn) than elsewhere (outborn). The objective of this study is to examine whether the number and ratio of outborn babies decrease and the neonatal mortality differs between inborn and outborn babies. METHODS We used the pooled data of the Taiwan Clinical Effectiveness Index for the years 2011-2016 obtained from the Joint Commission of Taiwan to study the outborn/inborn number and neonatal mortality rate. RESULTS We found that the number of outborn babies did not decrease year by year. The ratio of outborn to total babies was lower in the groups of birth body weight 750-999 g and ≧ 2500 g than the other groups. The neonatal mortality rate in outborns was significantly higher than the inborns in the groups of birth body weight 1000-1499 g, 2000-2499 g and ≧ 2500 g (6.9 ± 2.4 vs. 3.8 ± 0.9, P = 0.009, 2.6 ± 0.6 vs. 0.6 ± 0.3, P = 0.002 and 1.52 ± 0.67 vs. 0.08 ± 0.02, P = 0.002, respectively) in medical centers. CONCLUSION Improved maternal transport which promotes in utero transfer of patients may further improve neonatal outcome.
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Affiliation(s)
- Wan-Hsuan Chen
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Chung-Hao Su
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Li-Chun Lin
- Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hsin-Ching Lin
- Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ying-Jui Lin
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Yi Hsieh
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jiunn-Ming Sheen
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan; Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Chien-Te Lee
- Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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15
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Jordán Lucas R, Boix H, Sánchez García L, Cernada M, Cuevas IDL, Couce ML. Recommendations on the skills profile and standards of the neonatal transport system in Spain. An Pediatr (Barc) 2021; 94:420.e1-420.e11. [PMID: 34049845 DOI: 10.1016/j.anpede.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/08/2021] [Indexed: 11/16/2022] Open
Abstract
The first hours of life of a sick or premature newborn are crucial for its prognosis and therefore delivery should take place in a center prepared for that degree of complexity. When this condition is not met, the newborn must be transferred in an optimal and safe way to the center that can offer the necessary care. The training, staffing, organization and coordination of the neonatal transport team are essential to guarantee a safe transfer. Being aware of the interest and the advances that are currently taking place in this area of pediatrics, the Standards Commission and the Neonatal Transport Commission of the Spanish Society of Neonatology have prepared this document. In it, both the provision of human and material resources necessary as well as the bases of clinical stabilization in transport to carry out the neonatal transfer in a safe way and proportionate to the needs of the critical newborn have been exhaustively reviewed and detailed.
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Affiliation(s)
- Raquel Jordán Lucas
- Servicio de Neonatología, Hospital Universitari Vall d'Hebron, Comisión de Transporte Neonatal, Barcelona, Spain.
| | - Hector Boix
- Servicio de Neonatología, Hospital Universitari Vall d'Hebron, Comisión de Estándares, Barcelona, Spain
| | - Laura Sánchez García
- Servicio de Neonatología, Hospital Universitario La Paz, Comisión de Transporte Neonatal, Madrid, Spain
| | - María Cernada
- Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Comisión de Estándares, Valencia, Spain
| | - Isabel de Las Cuevas
- Hospital Universitario Marqués de Valdecilla, Departamento de Ciencias Médicas y Quirúrgicas Universidad de Cantabria, Comisión de Transporte Neonatal, Santander, Spain
| | - Maria L Couce
- Servicio de Neonatología, Hospital Clínico Universitario de Santiago, IDIS, Universidad de Santiago de Compostela, Comisión de Estándares, Santiago de Compostela, Spain
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Bellini C, De Angelis LC, Gente M, Bellù R, Minghetti D, Massirio P, Andreato C, Mosca F, Ramenghi LA. Neonatal Air Medical Transportation Practices in Italy: A Nationwide Survey. Air Med J 2021; 40:232-236. [PMID: 34172230 DOI: 10.1016/j.amj.2021.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/10/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022]
Abstract
The present article shows the current neonatal air transport organization and activity in Italy. The results were obtained on the basis of a recent 2019 survey (year of activity 2018) performed by the Neonatal Transport Study Group of the Italian Society of Neonatology. The total number of newborn transports during the year 2018 was 6,464. The air-suitable transports were 512 of 5,852 (8.74%), and among them, 101 of 512 (19.72%) were performed by helicopter and 34 by airplane. Besides the availability of air transport, the interfacility distance, weather and traffic conditions, and rural mountainous roads were the main factors in determining the vehicle choice. Neonatal air transport in Italy is not homogeneously distributed and needs organizational corrections. The high density of neonatal emergency transport services on the national territory indicates the need to overcome the limits imposed by regional administrative borders, thus expanding the geographic area of competence.
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Affiliation(s)
- Carlo Bellini
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother and Child, Territorial Social Health Company (IRCCS) Gaslini, Genoa, Italy.
| | - Laura Costanza De Angelis
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother and Child, Territorial Social Health Company (IRCCS) Gaslini, Genoa, Italy
| | - Maurizio Gente
- Neonatal Emergency Transport Service, Maternal Infant Department, Sapienza University of Rome, Rome, Italy
| | | | - Diego Minghetti
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother and Child, Territorial Social Health Company (IRCCS) Gaslini, Genoa, Italy
| | - Paolo Massirio
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother and Child, Territorial Social Health Company (IRCCS) Gaslini, Genoa, Italy
| | - Chiara Andreato
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother and Child, Territorial Social Health Company (IRCCS) Gaslini, Genoa, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca A Ramenghi
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother and Child, Territorial Social Health Company (IRCCS) Gaslini, Genoa, Italy; University of Genoa, Genoa, Italy
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17
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Jordán Lucas R, Boix H, Sánchez García L, Cernada M, de Las Cuevas I, Couce ML. [Recommendations on the skills profile and standards of the neonatal transport system in Spain]. An Pediatr (Barc) 2021. [PMID: 33771458 DOI: 10.1016/j.anpedi.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The first hours of life of a sick or premature newborn are crucial for its prognosis and therefore delivery should take place in a center prepared for that degree of complexity. When this condition is not met, the newborn must be transferred in an optimal and safe way to the center that can offer the necessary care. The training, staffing, organization and coordination of the neonatal transport team are essential to guarantee a safe transfer. Being aware of the interest and the advances that are currently taking place in this area of pediatrics, the Standards Commission and the Neonatal Transport Commission of the Spanish Society of Neonatology have prepared this document. In it, both the provision of human and material resources necessary as well as the bases of clinical stabilization in transport to carry out the neonatal transfer in a safe way and proportionate to the needs of the critical newborn have been exhaustively reviewed and detailed.
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Affiliation(s)
- Raquel Jordán Lucas
- Servicio de Neonatología, Hospital Universitari Vall d'Hebron, Barcelona, España. Comisión de Transporte Neonatal.
| | - Hector Boix
- Servicio de Neonatología, Hospital Universitari Vall d'Hebron, Barcelona, España. Comisión de Estándares
| | - Laura Sánchez García
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España. Comisión de Transporte Neonatal
| | - María Cernada
- Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Valencia, España. Comisión de Estándares
| | - Isabel de Las Cuevas
- Unidad Neonatal, Servicio de Pediatría, Hospital Universitario Marqués de Valdecilla, Departamento de Ciencias Médicas y Quirúrgicas Universidad de Cantabria, Santander, España. Comisión de Transporte Neonatal
| | - María L Couce
- Servicio de Neonatología, Hospital Clínico Universitario de Santiago, IDIS, Universidad de Santiago de Compostela, Santiago de Compostela, España. Comisión de Estándares
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18
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Improving transport time for babies with antenatally diagnosed transposition of the great arteries reduces the need for ECMO. J Perinatol 2020; 40:1570-1575. [PMID: 32393830 DOI: 10.1038/s41372-020-0679-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/15/2020] [Accepted: 04/25/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the effect of reducing retrieval team response time on the outcomes of babies born outside a cardiac centre (outborn) with antenatally diagnosed transposition of the great arteries. STUDY DESIGN Retrospective cohort study of all outborn babies with antenatally diagnosed TGA anticipated to require transfer for urgent balloon atrial septostomy over a 6-year period (15 babies pre intervention and 27 post intervention). The intervention involved a collaborative multicomponent practice change aiming to reduce retrieval team response time. RESULT The mean (SD) time from birth to cardiac ICU arrival was 159 (12) min pre intervention and 103 (6) min post intervention (mean difference -57 min [95% CI, -81 to -32]). There was a significant decrease in need for extracorporeal membrane oxygenation (33% versus 4%), RR 0.11 [95% CI, 0.02-0.65]), with a number needed to treat of 3.4 to prevent one ECMO episode. CONCLUSION Reducing retrieval time is achievable with collaborative systems, and significantly improves clinical outcomes.
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Mohammad K, Dharel D, Abou Mehrem A, Esser MJ, Paul R, Zein H, Scott JN, Fiedrich E, Murthy P, Dossani S, Kopores K, Kowal D, Montpetit J, Al Awad E, Thomas S. Impact of outreach education program on outcomes of neonates with hypoxic ischemic encephalopathy. Paediatr Child Health 2020; 26:e215-e221. [PMID: 34938377 DOI: 10.1093/pch/pxaa075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/14/2020] [Indexed: 11/14/2022] Open
Abstract
Aim To evaluate the impact of outreach education targeting neuroprotection on outcomes of outborn infants with moderate-to-severe hypoxic ischemic encephalopathy (HIE). Methods A retrospective cohort study of infants admitted with moderate-to-severe HIE was conducted following the implementation of outreach education in January 2016. Key interventions were early identification and referral of infants with encephalopathy utilizing telemedicine and a centralized communication system, hands-on simulation, and interactive case discussion and dissemination of clinical management guidelines and educational resources. The association between the intervention and a composite outcome of death and/or severe brain injury on brain magnetic resonance imaging (MRI) was tested controlling for the confounding factors. Results Of 165 neonates, 37 (22.4%) died and/or had a severe brain injury. This outcome decreased from 35% (27/77) to 11% (10/88) following the implementation of outreach education (P<0.001). Eligible infants not undergoing therapeutic hypothermia within 6 hours from birth decreased from 19.5% (15/77) to 4.5% (4/88). The use of inotropes decreased from 49.3% (38/77) to 19.6% (13/88). Any core temperature below 33°C was recorded for 20/53 (38%) before and 16/78 (21%) after, while those within the target range of 33°C to 34°C at admission to a tertiary care facility increased from (15/53) 28% to (51/88) 58%. Outreach education was independently associated with decreased composite outcome of death and/or severe brain injury on MRI (adjusted odds ratio 0.2; 95% confidence interval 0.07 to 0.52). Conclusion Outreach education targeting neuroprotection for infants with moderate-to-severe HIE was associated with a reduction in death and/or severe brain injury.
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Affiliation(s)
- Khorshid Mohammad
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Dinesh Dharel
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Ayman Abou Mehrem
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Michael J Esser
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Renee Paul
- Foothills Medical Centre, Alberta Health Services, Calgary, Alberta
| | - Hussein Zein
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - James N Scott
- Department of Radiology, University of Calgary, Calgary, Alberta.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta
| | - Elsa Fiedrich
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Prashanth Murthy
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Salma Dossani
- Foothills Medical Centre, Alberta Health Services, Calgary, Alberta
| | - Kaley Kopores
- Foothills Medical Centre, Alberta Health Services, Calgary, Alberta
| | - Derek Kowal
- Foothills Medical Centre, Alberta Health Services, Calgary, Alberta
| | - John Montpetit
- Foothills Medical Centre, Alberta Health Services, Calgary, Alberta
| | - Essa Al Awad
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Sumesh Thomas
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
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Ashokcoomar P, Bhagwan R. The forgotten needs of mothers during neonatal transfers: A quest for greater sensitivity. S Afr Fam Pract (2004) 2020; 62:e1-e8. [PMID: 32787384 PMCID: PMC8378043 DOI: 10.4102/safp.v62i1.5091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 11/30/2022] Open
Abstract
Background The transfer of critically ill neonates has escalated in developing countries. This calls for greater awareness of the needs of mothers who are often overlooked while clinical attention is prioritised in relation to the neonate. The objective of the study was to understand the emotional and clinical needs of mothers during the transfer process. Methods Using a qualitative research approach, the study sought the views of mothers who were involved in emergency transfers. In-depth interviews were held with seven mothers. In addition, data from interviews with seven neonatologists and data from focus group discussions with 35 advanced life paramedics, were included. Results What emerged was that both the clinical and emotional needs of mothers were overlooked during the transfer which resulted in acute distress. Moreover, the study found that paramedics lacked preparedness to deal with the psychological needs of mothers and often overlooked their physiological condition as well. Conclusion It is crucial that greater sensitivity towards both the clinical and emotional needs of mothers be prioritised during neonatal transfers.
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21
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Goswami I, Redpath S, Langlois RG, Green JR, Lee KS, Whyte HEA. Whole-body vibration in neonatal transport: a review of current knowledge and future research challenges. Early Hum Dev 2020; 146:105051. [PMID: 32464450 DOI: 10.1016/j.earlhumdev.2020.105051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022]
Abstract
Interfacility transport to tertiary care for high-risk neonates has become an integral part of equitable access to optimal perinatal healthcare. Excellence in clinical care requires expertise in transport medicine and the coordination of safe transport processes. However, concerns remain regarding environmental stressors involved in the transportation of sick high-risk neonates, including noise and vibration. In order to mitigate the potential deleterious effects of these physical stressors during transport, further knowledge of the burden of exposure, injury mechanisms and engineering interventions/modifications as adjuncts during transport would be beneficial. We reviewed the current literature with a focus on the contribution of new and emerging technologies in the transport environment with particular reference to whole-body vibration. This review intends to highlight what is known about vibration as a physical stressor in neonates and areas for further research; with the goal to making recommendations for minimizing these stressors during transport.
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Affiliation(s)
- I Goswami
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - S Redpath
- Department of Paediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada
| | - R G Langlois
- Department of Mechanical and Aerospace Engineering, Carleton University, Canada
| | - J R Green
- Department of Systems and Computer Engineering, Carleton University, Canada
| | - K S Lee
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - H E A Whyte
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
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22
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Chakkarapani AA, Whyte HE, Massé E, Castaldo M, Yang J, Lee KS. Procedural Interventions and Stabilization Times During Interfacility Neonatal Transport. Air Med J 2020; 39:276-282. [PMID: 32690304 DOI: 10.1016/j.amj.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Transport teams perform multiple procedural interventions during the stabilization of critically ill neonates. The setting of this study was a national cohort of interfacility neonatal transports from nontertiary centers. METHODS A retrospective cohort study of neonatal transports having interventional procedures using the Canadian Neonatal Transport Network database during 2014 to 2016. Demographics and procedures associated with stabilization times ≤ 120 versus > 120 minutes were analyzed. Predictors of stabilization time were evaluated using multivariable logistic regression analysis. RESULTS Among 3,350 neonatal transports analyzed, the 3 most frequently performed procedures were peripheral intravenous insertion, arterial blood gas sampling, and endotracheal tube insertion, with success rates of 85.2%, 89.1%, and 95.3%, respectively. The frequency of procedures varied across gestational age subgroups, and success rates were lower for umbilical arterial catheter insertions. After adjustment for confounders, more invasive procedures and a higher number of interventions were associated with longer stabilization times. CONCLUSION The type and frequency of procedures performed had a significant impact on stabilization time. Any procedures that are nonessential for stabilization at the nontertiary center, such as umbilical arterial catheter insertion, could be minimized to promote timely admission to tertiary centers. The demonstrated variations in procedural success among teams provide useful information for benchmarking and promote the sharing of training practices.
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Affiliation(s)
- Aravanan Anbu Chakkarapani
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Neonatology, Sidra Medicine, Doha, Qatar, United Arab Emirates; Department of Pediatrics, Weill Cornell Medicine, Doha, Qatar, United Arab Emirates
| | - Hilary E Whyte
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Edith Massé
- Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michael Castaldo
- Division of Neonatology, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Junmin Yang
- Maternal-Infant Care Research Centre, Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Kyong-Soon Lee
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
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Abstract
OBJECTIVE The aim of this study was to assess national pediatric/neonatal specialty transport teams' composition and training requirements to determine if any current standardization exists. METHODS This was a survey of the transport teams listed with the American Academy of Pediatrics via SurveyMonkey. RESULTS While most of the teams maintain internal criteria for team competency and training, there is large variation across team compositions. The vast majority of the teams have a nurse-led team with the addition of another nurse, medic, and/or respiratory therapist regardless of mode of transport. Many of the teams report adjusting team composition based on acuity. Fewer than 15% of teams have a physician as a standard team member. More than 80% required a minimum number of supervised intubations prior to independent practice; however, the number varied largely from as little as 3 to as many as 30. Eighty-eight percent of the teams report using simulation as part of their education program, but again there were marked differences between teams as to how it was used. CONCLUSIONS There is tremendous variability nationally among pediatric/neonatal transport teams regarding training requirements, certifications, and team composition. The lack of standardization regarding team member qualifications or maintenance of competency among specialized transport teams should be looked at more closely, and evidence-based guidelines may help lead to further improved outcomes in the care of critically ill pediatric patients in the prehospital setting.
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The Transport and Outcome of Sick Outborn Neonates Admitted to a Regional and District Hospital in the Upper West Region of Ghana: A Cross-Sectional Study. CHILDREN-BASEL 2020; 7:children7030022. [PMID: 32244943 PMCID: PMC7140801 DOI: 10.3390/children7030022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/06/2020] [Accepted: 03/08/2020] [Indexed: 11/17/2022]
Abstract
Optimum care of sick neonates often involves transporting them across different levels of care. Since their condition may deteriorate over time, attention needs to be paid to travel distances and how they are transferred. We examined the mode of transport, distances travelled, condition on arrival and outcome of outborn neonates admitted to a district and a regional hospital in Ghana using a cross-sectional study involving caregivers of neonates admitted to these hospitals. Information on referral characteristics and outcome were obtained from questionnaires and the child’s case notes. Overall, 153 caregivers and babies were studied. Twelve deaths, 7.8%, occurred. Neonates who died spent a median duration of 120 min at the first health facility they visited compared with 30 min spent by survivors; they travelled mostly by public buses, (41.7%), compared with 36.0% of survivors who used taxis. Majority of survivors, 70.2%, had normal heart rates on arrival compared with only 41.7% of neonates who died; hypothermia was present in 66.7% compared with 47.6% of survivors. These findings indicate that the logistics for neonatal transport were inadequate to keep the neonates stable during the transfer process, thus many of them were compromised especially those who died. Further studies are warranted.
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Neonatal Transport in the Practice of the Crews of the Polish Medical Air Rescue: A Retrospective Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030705. [PMID: 31978982 PMCID: PMC7037463 DOI: 10.3390/ijerph17030705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 01/01/2023]
Abstract
The aim of the study was to present characteristics of patients transported in incubators by crews of Helicopter Emergency Medical Service (HEMS) and Emergency Medical Service (EMS) of the Polish Medical Air Rescue as well as the character of their missions. The study was based on the method of retrospective analysis of neonatal transports with the use of transport incubators by the crews of HEMS and EMS of the Polish Medical Air Rescue. The study covered 436 medical and rescue transports of premature babies and full-term newborns in the period between January 2012 and December 2018. The study group consisted mainly of male patients (55.05%) who, on the basis of the date of delivery, were qualified as full-term newborns (54.59%). During the transport their average age was 37.53 (standard deviation, SD 43.53) days, and their average body weight was 3121.18 (SD 802.64) grams. A vast majority of neonatal transports were provided with the use of a plane (84.63%), and these were medical transports (79.36%). The average transport time was 49.92 (SD 27.70) minutes with the average distance of 304.27 km (SD 93.05). Significant differences between premature babies and full-term newborns were noticed in terms of age and body weight at the moment of transport, diagnosis based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10), the most commonly used medications (prostaglandin E1, glucose, furosemide, vitamins), National Advisory Committee for Aeronautics (NACA) scale rate as well as the mission type and the presence of an accompanying person.
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Ringham CL, MacKinnon K. Mothering Work and Perinatal Transfer: An Institutional Ethnographic Investigation. Can J Nurs Res 2019; 53:27-38. [PMID: 31684752 DOI: 10.1177/0844562119884388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While maternal or infant transfer is generally the safest course of action when health complications arise, the process of shifting from one hospital to another is stressful for mothers and their infants. There is limited understanding of how institutional processes coordinate patient transfer in ways that increase tensions for women and their families who are trying to navigate the institutional systems during health crises. METHODS This institutional ethnographic study explored womens' experience of transfer. Interviews were conducted with a purposive sample of six childbearing women. The analysis highlights tensions and contradictions between patient care and institutional demands and shows how ordinary institutional decision-making practices impacted participants in unexpected ways. RESULTS Women experienced uncertainty and stress when trying to convince health-care providers they needed care. Before, during, and after transfer, participants navigated home responsibilities, childcare, and getting care closer to home in difficult circumstances. CONCLUSION The effort and skill women need to care for their infants and families as they are transferred is extraordinary. This study offers insight into the resources and support childbearing women need to accomplish the work of caring for their families in the face of perinatal crisis and multiple transfers.
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Affiliation(s)
- Catherine L Ringham
- Faculty of Nursing and Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Karen MacKinnon
- School of Nursing, University of Victoria, Victoria, BC, Canada
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Jagła M, Grudzień A, Starzec K, Tomasik T, Zasada M, Kwinta P. Lung ultrasound in the diagnosis of neonatal respiratory failure prior to patient transport. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:518-525. [PMID: 31361036 DOI: 10.1002/jcu.22766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/07/2019] [Accepted: 07/14/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Lung ultrasound (LUS) at the point-of-care is a new method that is increasingly used in neonatology. The aim of this study was to determine the utility of the addition of LUS prior to the interhospital transport of neonates with respiratory failure. METHODS LUS was performed on 50 newborns with respiratory failure prior to transport to a tertiary neonatal intensive care unit. We analyzed the performance of LUS for diagnosing the cause of respiratory failure, the concordance between LUS, chest X-ray (CXR) and final clinical diagnosis, and the impact of LUS on clinical decision making before transport. RESULTS LUS sensitivity for the diagnosis of respiratory distress syndrome was 91.3% (95%CI: 70.5-98.5%), and specificity was 92.6% (95%CI: 74.2-98.7%), whereas sensitivity and specificity of CXR were 69.6% (95%CI: 47.0-85.9%) and 81.5% (95%CI: 61.2-92.9%), respectively. For the recognition of pneumothorax (PTX) LUS had a sensitivity of 83.3% (95%CI: 36.5-99.1%) and a specificity of 100% (95%CI: 89.9-100%). For CXR, sensitivity was 16.7% (95%CI: 0.01-63.5%) and specificity was 97.7% (95%CI: 86.4-99.9%). The agreement between LUS and CXR in diagnosing the cause of respiratory failure was substantial (κ of 0.57 [95%CI: 0.40-0.74]) and the agreement between LUS and the final clinical diagnosis was very good (κ of 0.86 [95%CI: 0.74-0.98]). In 42% of the patients, a LUS examination prior to transport indicated the need for endotracheal tube repositioning or PTX decompression. CONCLUSION LUS may be a reliable imaging technique for differentiating the causes of respiratory failure before neonatal transport. Use of LUS may optimize the care of infants during transport.
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Affiliation(s)
- Mateusz Jagła
- Neonatal Ambulance Team, Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Grudzień
- Neonatal Ambulance Team, Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Starzec
- Neonatal Ambulance Team, Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Tomasik
- Neonatal Ambulance Team, Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Zasada
- Neonatal Ambulance Team, Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Przemko Kwinta
- Neonatal Ambulance Team, Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
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Bellini C, de Biasi M, Gente M, Ramenghi LA, Aufieri R, Minghetti D, Pericu S, Cavalieri M, Casiddu N. Rethinking the neonatal transport ground ambulance. Ital J Pediatr 2019; 45:97. [PMID: 31391074 PMCID: PMC6686524 DOI: 10.1186/s13052-019-0686-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives This article describes the detailed project aimed to realize a dedicated ground ambulance for neonatal emergency transport service (NETS). To date, the European Community rules specify requirements for the design, testing, performance, and equipping of road ambulance used for transport and care of adult injured or ill patients, completely ignoring neonatal transport. Methods The project consisted of electric and gas supply planning, interior design taking into account ergonomic and occupant protection principles, both during travel and during medical care performances. Results A detailed project is presented. Main differences between European Type C ambulance and the new proposed Type D neonatal ground ambulance are the presence on board of air compressed cylinder, iNO cylinders and delivery system, phototheraphy, shock adsorbing stretcher support, cooling device, patient’s placenta (refrigeration box), and transcutaneous gas analyzer. Conclusion The European Community rules specify requirements for road ambulance used for transport and care of adult injured or ill patients, completely ignoring neonatal transport. This study describes the detailed project aimed to realize a dedicated ground ambulance for neonatal emergency transport service. This study demonstrated that it is not possible simply to adapt the currently dedicated ambulance for mobile intensive care and resuscitation services (actual type C European Community) in a modern dedicated NETS ambulance; it is of paramount importance suggesting to European Community to introduce a further ambulance type, to be identified type D, strictly reserved to neonatal transport activities.
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Affiliation(s)
- Carlo Bellini
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother & Child, IRCCS Gaslini Institute, Genoa, Italy.
| | - Martina de Biasi
- Department of Architecture and Design (DAD), University of Genoa, Genoa, Italy
| | - Maurizio Gente
- Neonatal Emergency Transport Service, Maternal Infant Department, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Luca A Ramenghi
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother & Child, IRCCS Gaslini Institute, Genoa, Italy
| | - Roberto Aufieri
- Division of Neonatology and Neonatal Intensive Care, ASL Roma 2 - Ospedale Sant'Eugenio, Rome, Italy
| | - Diego Minghetti
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother & Child, IRCCS Gaslini Institute, Genoa, Italy
| | - Silvia Pericu
- Department of Architecture and Design (DAD), University of Genoa, Genoa, Italy
| | - Martina Cavalieri
- Department of Architecture and Design (DAD), University of Genoa, Genoa, Italy
| | - Niccolò Casiddu
- Department of Architecture and Design (DAD), University of Genoa, Genoa, Italy
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Soliman Y, Paul R, Pearson K, Alshaikh B, Thomas S, Yusuf K. Neonatal transport services, a cross-sectional study. J Matern Fetal Neonatal Med 2019; 34:774-779. [PMID: 31084226 DOI: 10.1080/14767058.2019.1618823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To understand the process and challenges facing neonatal transport in Canada and to delineate their composition and working.Subjects and methodology: An online questionnaire was sent to all neonatal transport team directors/coordinators in Canada. The questionnaire covered different aspects of transport and was pilot tested prior to finalization. The responses were anonymous to the investigators.Results: All sixteen neonatal transport teams in Canada surveyed. Fifteen teams responded. Dedicated team as a model was adopted by 12 teams (80%). A combined Neonatal/pediatrics team, where the team could be assembled by either neonatal or pediatrics intensive care staff, adopted by two (13%). Team members were cross-trained in about quarter of the teams (four teams out of 15) with respiratory therapists and registered nurses performing each other's roles. Neonatal Resuscitation Program was mandatory for all teams that responded (15 teams) to become certified as a neonatal transport team member. Nine teams use a central dispatch phone call system.Conclusion: As the first to comprehensively describe the status of neonatal transport in Canada, our study shows that neonatal transport teams have similarities as well as differences. Regionalization and differences in referral practices, geography, provincial laws, and manpower are the main reasons why teams may have their individual variations in policies, protocols, and logistics. Our data can be utilized by health professionals and policy makers to improve neonatal transport logistics within their health care systems resulting in better outcomes of transported neonates.
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Affiliation(s)
- Yasser Soliman
- Division of Neonatology, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Renee Paul
- Foothills Medical Center, Alberta Health Services, Calgary, Canada
| | - Kim Pearson
- Foothills Medical Center, Alberta Health Services, Calgary, Canada
| | - Belal Alshaikh
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sumesh Thomas
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kamran Yusuf
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Gente M, Aufieri R, Agostino R, Fedeli T, Calevo MG, Massirio P, Bellini C. Nationwide survey of neonatal transportation practices in Italy. Ital J Pediatr 2019; 45:51. [PMID: 30999944 PMCID: PMC6471884 DOI: 10.1186/s13052-019-0640-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite regionalization of perinatal care provides for the "in utero" transfer of high-risk pregnancies, there will always be a number of neonates who undergo acute inter-facility transport. The presence of a well-organized Neonatal Emergency Transport Service (NETS) can prevent and reduce risks of transportation, especially for very preterm infants, and is therefore mandatory for any program of regionalization of perinatal care. Italian National Health System is highly decentralized and Regions are autonomous to structure, plan and delivery their regional health services. Consequently, organization models and resources available vary widely and significant regional differences in access and quality of health services have been reported in the past years. A national survey was conducted in 2015 by the neonatal transport study group of the Italian Society of Neonatology with the aim to describe neonatal transfer practices and to assess the Neonatal Emergency Transport Services (NETS) status in the 20 Italian regions. METHODS A questionnaire regarding neonatal transfer practices and NETS activity for the previous year (2014) was sent to the 44 NETS operating in the 20 Italian regions. Demographic data were obtained from the Italian National Statistical Institute (ISTAT). RESULTS The overall survey response rate was 100%. In 2014, only 12 (60%) of the 20 Italian regions were fully covered by NETS, 3 (15%) regions were partially covered, while neonatal transport was not available in 5 (25%) regions. Overall, in 2014, the 44 NETS operating in Italy transported a total of 6387 infants, including 522 (8.17%) having a gestational age < 28 weeks. CONCLUSIONS The organization of NETS in Italy is devolved on a regional basis, resulting in a large heterogeneity of access and quality to services across the country. Where available, NETS are generally well-equipped and organized but limited volume of activities often cannot guarantee adequate levels of skills of personnel or an appropriate cost-efficiency ratio. The regions reported with lack of NETS have managed, or are trying, to fill the gap, but continuing efforts to reduce regional differences in the availability and quality of services are still needed.
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Affiliation(s)
- Maurizio Gente
- Department of Pediatrics and Infant Neuropsychiatry, Neonatal Emergency Transport Service, Sapienza University of Rome, Rome, Italy
| | - Roberto Aufieri
- Division of Neonatology and Neonatal Intensive Care Unit, ASL Roma 2 - Ospedale Sant'Eugenio, Rome, Italy
| | - Rocco Agostino
- Division of Neonatology, Villa Margherita Private Nursing Home, Rome, Italy
| | - Tiziana Fedeli
- Neonatal Intensive Care Unit, Fondazione MBBM, Monza, Italy
| | - Maria Grazia Calevo
- Department of Epidemiology, Biostatistics and Committees, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paolo Massirio
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother&Child, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini, 5, 16147, Genoa, Italy
| | - Carlo Bellini
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother&Child, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini, 5, 16147, Genoa, Italy.
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Abstract
OBJECTIVES This study aimed to better understand the unique aspects of pediatric critical care transport programs across Canada by characterizing the current workforce of each transport program. METHODS A cross-sectional questionnaire was sent to the 13 medical directors of Canada's pediatric critical care transport teams, and to 2 nonhospital-affiliated transport services. If a children's hospital did not have a dedicated team for pediatric transport, the regional transport team providing this service was identified. RESULTS Eight of the 13 pediatric intensive care units surveyed have unit-based pediatric transport teams. The median annual transport volume for the 8 hospital-based teams was 371 (range, 45-2300) with a total of 5686 patients being transported annually. Among patients transported by the 8 teams, 45% (2579 patients) were pediatric patients (older than 28 days and younger than 18 years) and 40% (1022 patients) of the pediatric patients were admitted to the pediatric intensive care units. Eighty-eight percent of the responding teams also transported neonates (older than 28 days), and 38% transported premature infants.A team composition of registered nurse-respiratory therapist-physician was used by 6/13 teams (75%); however, it accounted for only a small proportion of the transports for most of the teams (median, 2%; range, 2%-100%).The average transport time from dispatch (from team home site) to arrival at receiving facility was reported by 6 teams, and has a median of 195 minutes (range, 90-360 minutes). The median distance from home site to the farthest referral site in the catchment area was 700 km (range, 15-2500 km). CONCLUSIONS This is the first Canadian nationwide study of pediatric critical care transport programs. It revealed a complexity and variability in transport team demographics, transport volume, team composition, and decision-making process.
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A Transparent Tracking System for Competency-Based Orientation: One Children's Hospital Transport Unit Experience. J Nurses Prof Dev 2018; 34:173-177. [PMID: 29715212 DOI: 10.1097/nnd.0000000000000422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
When nurses are hired for positions that require lengthy, highly specialized in-house orientation, their failure to complete orientation on time can lead to staffing shortages. In this article, we report the use of a transparent tracking system to monitor nurses' progress through a competency-based orientation program. By monitoring progress and detecting lapses, immediate remediation can be offered to those who need it, and staffing shortages thereby are avoided.
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Interhospital Transport of Critically Ill Children to PICUs in the United Kingdom and Republic of Ireland: Analysis of an International Dataset. Pediatr Crit Care Med 2018; 19:e300-e311. [PMID: 29432405 DOI: 10.1097/pcc.0000000000001506] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES International data on characteristics and outcomes of children transported from general hospitals to PICUs are scarce. We aimed to 1) describe the development of a common transport dataset in the United Kingdom and Ireland and 2) analyze transport data from a recent 2-year period. DESIGN Retrospective analysis of prospectively collected data. SETTING Specialist pediatric critical care transport teams and PICUs in the United Kingdom and Ireland. PATIENTS Critically ill children less than 16 years old transported by pediatric critical care transport teams to PICUs in the United Kingdom and Ireland. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A common transport dataset was developed as part of the Paediatric Intensive Care Audit Network, and standardized data were collected from all PICUs and pediatric critical care transport teams from 2012. Anonymized data on transports (and linked PICU admissions) from a 2-year period (2014-2015) were analyzed to describe patient and transport characteristics, and in uni- and multivariate analyses, to study the association between key transport factors and PICU mortality. A total of 8,167 records were analyzed. Transported children were severely ill (median predicted mortality risk 4.4%) with around half being infants (4,226/8,167; 51.7%) and nearly half presenting with respiratory illnesses (3,619/8,167; 44.3%). The majority of transports were led by physicians (78.4%; consultants: 3,059/8,167, fellows: 3,344/8,167). The median time for a pediatric critical care transport team to arrive at the patient's bedside from referral was 85 minutes (interquartile range, 58-135 min). Adverse events occurred in 369 transports (4.5%). There were considerable variations in how transports were organized and delivered across pediatric critical care transport teams. In multivariate analyses, consultant team leader and transport from an intensive care area were associated with PICU mortality (p = 0.006). CONCLUSIONS Variations exist in United Kingdom and Ireland services for critically ill children needing interhospital transport. Future studies should assess the impact of these variations on long-term patient outcomes taking into account treatment provided prior to transport.
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Abstract
Prenatal diagnosis has changed perinatal medicine dramatically, allowing for additional fetal monitoring, referral and counseling, delivery planning, the option of fetal intervention, and targeted postnatal management. Teams participating in the delivery room care of infants with known anomalies should be knowledgeable about specific needs and expectations but also ready for unexpected complications. A small number of neonates will need rapid access to postnatal interventions, such as surgery, but most can be stabilized with appropriate neonatal care. These targeted perinatal interventions have been shown to improve outcome in selected diagnoses.
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Affiliation(s)
- Elizabeth K Sewell
- Emory Children's Center Neonatalogy Offices, 2015 Uppergate Drive-3(rd) floor, Atlanta, GA 30322, USA
| | - Sarah Keene
- Emory Children's Center Neonatalogy Offices, 2015 Uppergate Drive-3(rd) floor, Atlanta, GA 30322, USA.
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Piteau S. Update in Pediatric Emergency Medicine: Pediatric Resuscitation, Pediatric Sepsis, Interfacility Transport of the Pediatric Patient, Pain and sedation in the Emergency Department, Pediatric Trauma. UPDATE IN PEDIATRICS 2018. [PMCID: PMC7123355 DOI: 10.1007/978-3-319-58027-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shalea Piteau
- Chief/Medical Director of Pediatrics at Quinte Health Care, Assistant Professor at Queen’s University, Belleville, Ontario Canada
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Abstract
The safe transport of infants in critical condition requires highly reliable inter-professional transport teams that are equipped with the expertise to provide neonatal care in unfamiliar and resource-limited environments. Increasingly, transport teams are comprised of health professionals from various disciplines. Providing didactic and experiential learning alone is insufficient to fully prepare teams that have limited exposure to rare events. Simulation-based training supplements and reinforces knowledge, skills, and the experiences of team members. This article presents the current use of simulation in the training of neonatal transport teams and critically reviews how simulation methodologies may be further incorporated into curricula and quality improvement to achieve high-reliability teams.
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Affiliation(s)
- Douglas M Campbell
- Department of Pediatrics, University of Toronto, Toronto, Ontario; Allan Waters Family Simulation Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Rita Dadiz
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
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