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Shipley L, Hyliger G, Sharkey D. Temporal trends of in utero and early postnatal transfer of extremely preterm infants between 2011 and 2016: a UK population study. Arch Dis Child Fetal Neonatal Ed 2022; 107:201-205. [PMID: 34281936 DOI: 10.1136/archdischild-2021-322195] [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: 04/02/2021] [Accepted: 07/08/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Early postnatal transfer (PNT) of extremely preterm infants is associated with adverse outcomes compared with in utero transfer (IUT). We aimed to explore recent national trends of IUT and early PNT. DESIGN Observational cohort study using the National Neonatal Research Database. SETTING Neonatal units in England, Scotland and Wales. PATIENTS Extremely preterm infants 23+0-27+6 weeks' gestation admitted for neonatal care from 2011 to 2016. MAIN OUTCOME The incidence of IUT or PNT within 72 hours of life. Secondary outcomes included mortality, hospital transfer level between centres and temporal changes across two equal epochs, 2011-2013 (epoch 1 (Ep1)) and 2014-2016 (epoch 2 (Ep2)). RESULTS 14 719 infants were included (Ep1=7363 and Ep2=7256); 4005 (27%) underwent IUT; and 3042 (20.7%) had PNT. IUTs decreased significantly between epochs from 28.3% (Ep1=2089) to 26.0% (Ep2=1916) (OR 0.90, 95% CI 0.84 to 0.97, p<0.01). Conversely, PNTs increased from 19.8% (Ep1=1416) to 21.5% (Ep2=1581) (OR 1.11, 95% CI 1.02 to 1.20, p=0.01). PNTs between intensive care centres increased from 8.1% (Ep1=119) to 10.2% (Ep2=161, p=0.05). Mortality decreased from 21.6% (Ep1=1592) to 19.3% (Ep2=1421) (OR 0.90, 95% CI 0.83 to 0.97, p=0.01). Survival to 90 days of age was significantly lower in infants undergoing PNT compared with IUT (HR 1.31, 95% CI 1.18 to 1.46), with the greatest differences observed in infants <25 weeks' gestational age. CONCLUSION In the UK, IUT of extremely preterm infants has significantly decreased over the study period with a parallel increase in early PNT. Strategies to reverse these trends, improve IUT pathways and optimise antenatal steroid use could significantly improve survival and reduce brain injury for these high-risk infants.
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Affiliation(s)
- Lara Shipley
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Gillian Hyliger
- Neonatal Intensive Care Unit, Nottingham Children's Hospital, Nottingham, UK
| | - Don Sharkey
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
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Long-term outcomes of children with neonatal transfer: the Japan Environment and Children's Study. Eur J Pediatr 2022; 181:2501-2511. [PMID: 35333975 PMCID: PMC9889501 DOI: 10.1007/s00431-022-04450-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 02/04/2023]
Abstract
This study aimed to evaluate the association of neonatal transfer with the risk of neurodevelopmental outcomes at 3 years of age. Data were obtained from the Japan Environment and Children's Study. A general population of 103,060 pregnancies with 104,062 fetuses was enrolled in the study in 15 Regional Centers between January 2011 and March 2014. Live-born singletons at various gestational ages, including term infants, without congenital anomalies who were followed up until 3 years were included. Neurodevelopmental impairment was assessed using the Ages and Stages Questionnaire, third edition (ASQ-3) at 3 years of age. Logistic regression was used to estimate the adjusted risk and 95% confidence interval (CI) for newborns with neonatal transfer. Socioeconomic and perinatal factors were included as potential confounders in the analysis. Among 83,855 live-born singletons without congenital anomalies, 65,710 children were studied. Among them, 2780 (4.2%) were transferred in the neonatal period. After adjustment for potential confounders, the incidence of neurodevelopmental impairment (scores below the cut-off value of all 5 domains in the ASQ-3) was higher in children with neonatal transfer compared with those without neonatal transfer (communication: 6.5% vs 3.5%, OR 1.42, 95% CI 1.19-1.70; gross motor: 7.6% vs 4.0%, OR 1.26, 95% CI 1.07-1.49; fine motor: 11.3% vs 7.1%, OR 1.19, 95% CI 1.03-1.36; problem solving: 10.8% vs 6.8%, OR 1.29, 95% CI 1.12-1.48; and personal-social: 6.2% vs 2.9%, OR 1.52, 95% CI 1.26-1.83). Conclusion: Neonatal transfer was associated with a higher risk of neurodevelopmental impairment at 3 years of age. What is Known: • Neonatal transfer after birth in preterm infants is associated with adverse short-term outcomes. • Long-term outcomes of outborn infants with neonatal transfer in the general population remain unclear. What is New: • This study suggests that neonatal transfer at birth is associated with an increased risk of neurodevelopmental impairment. • Efforts for referring high-risk pregnant women to higher level centers may reduce the incidence of neonatal transfer, leading to improved neurological outcomes in the general population.
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Hirata K, Kimura T, Hirano S, Wada K, Kusuda S, Fujimura M. Outcomes of outborn very-low-birth-weight infants in Japan. Arch Dis Child Fetal Neonatal Ed 2021; 106:131-136. [PMID: 32788390 DOI: 10.1136/archdischild-2019-318594] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/29/2020] [Accepted: 06/27/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Outcomes of prenatal covariate-adjusted outborn very-low-birth-weight infants (VLBWIs) (≤1500 g) remain uncertain. OBJECTIVE To compare morbidity and mortality between outborn and inborn VLBWIs. DESIGN Observational cohort study using inverse-probability-of-treatment weighting. SETTING Neonatal Research Network of Japan. PATIENTS Singleton VLBWIs with no major anomalies admitted to a neonatal intensive care unit from 2012 to 2016. METHODS Inverse-probability-of-treatment weighting with propensity scores was used to reduce imbalances in prenatal covariates (gestational age (GA), birth weight, small for GA, sex, maternal age, premature rupture of membranes, chorioamnionitis, preeclampsia, maternal diabetes mellitus, antenatal steroids and caesarean section). The primary outcome was severe intraventricular haemorrhage (IVH). The secondary outcomes were outcomes at resuscitation, other neonatal morbidities and mortality. RESULTS The full cohort comprised 15 842 VLBWIs (668 outborns). The median (IQR) GA and birth weight were 28.9 (26.4-31.0) weeks and 1128 (862-1351) g for outborns and 28.7 (26.3-30.9) weeks and 1042 (758-1295) g for inborns. Outborn VLBWIs had a higher incidence of severe IVH (8.2% vs 4.1%; OR, 3.45; 95% CI 1.16 to 10.3) and pulmonary haemorrhage (3.7% vs 2.8%; OR, 5.21; 95% CI 1.41 to 19.2). There were no significant differences in Apgar scores, oxygen rates at delivery, intubation ratio at delivery, persistent pulmonary hypertension of the newborn, IVH of any grade, periventricular leukomalacia, chronic lung disease, oxygen at discharge, patent ductus arteriosus, retinopathy of prematurity, necrotising enterocolitis, sepsis or mortality. CONCLUSION Outborn delivery of VLBWIs was associated with an increased risk of severe IVH.
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Affiliation(s)
- Katsuya Hirata
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Takeshi Kimura
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Shinya Hirano
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Kazuko Wada
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | | | - Masanori Fujimura
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
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Partridge TJ, Morris DE, Light RA, Leslie A, Sharkey D, Crowe JA, McNally DS. Finding Comfortable Routes for Ambulance Transfers of Newborn Infants. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5905-5908. [PMID: 33019318 DOI: 10.1109/embc44109.2020.9175873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Early inter-hospital ambulance transport of premature babies is associated with more severe brain injury. The mechanism is unclear, but they are exposed to excessive noise and vibration. Smart-routing may help minimise these exposure levels and potentially improve outcomes.An app for Android smartphones was developed to collect vibration, noise and location data during ambulance journeys. Four smartphones, with the app installed, were provided to the local neonatal transport group to attach to their incubator trolleys. An example of route comparison was performed on the roads used between Nottingham City Hospital (NCH) and Leicester Royal Infirmary (LRI).Almost 1,700 journeys were recorded over the space of a year. 39 of these journeys travelled from NCH to LRI, comprising of 9 different routes. Analysis was performed on all recorded data which travelled along each road. For routes from NCH to LRI, the route with least vibration was also the quickest. Noise levels, however, were found to increase with vehicle speed. Ambulance drivers in the study did not tend to take the quickest, smoothest or quietest route.Android smartphones are a practical method of gathering information about the in-ambulance environment. Routes were found to vary in vibration, noise and speed, suggesting these could be minimised. The next step is to combine recorded and clinical data to try and define an ideal neonatal comfort metric which can then be fed into the routing. Roll-out of the app around the UK is also planned.Clinical relevance-Transferring preterm neonatal infants to specialist units lead to worse outcomes. By reducing the levels of vibration and noise the infants are exposed to during transport, we hope to improve outcomes.
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Marsinyach Ros I, Sanchez García L, Sanchez Torres A, Mosqueda Peña R, Pérez Grande MDC, Rodríguez Castaño MJ, Elorza Fernández MD, Sánchez Luna M. Evaluation of specific quality metrics to assess the performance of a specialised newborn transport programme. Eur J Pediatr 2020; 179:919-928. [PMID: 31993775 PMCID: PMC7223594 DOI: 10.1007/s00431-020-03573-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 12/20/2019] [Accepted: 01/10/2020] [Indexed: 12/02/2022]
Abstract
There is a lack of consensus on quality indicators suitable for neonatal transport. The aim of this study is to make a proposal for specific quality indicators for newborn transport. A retrospective descriptive study was performed (2009 to 2015) where twenty-four indicators were selected, evaluated and classified according to the 6 dimensions of quality of the Institute of Medicine. Among the 24 evaluated quality metrics, there were 3 of them which needed a correction when evaluating neonatal transport performance, because they were significantly correlated with gestational age. They were (a) stabilisation time, (b) prevalence of newborn arterial hypotension (defined by gestational age) and (c) unnoticed hypothermia at referral hospital.Conclusion: Quality evaluation through the definition of specific metrics in newborn transport is feasible. These indicators should be defined or adjusted for newborn population to measure the actual performance of the transport service.What is Known:• Quality indicators may help in defining metrics for clinical practice, promoting benchmarking and defining areas of improvement.• Newborn characteristics call for a specialised care, and quality measure during newborn transport require specific metrics. Quality metrics for paediatric transport have been defined using Delphi method. Some of these measures need to be specific for newborn, due to their intrinsic characteristics.What is New:• Using evidence-based literature and our newborn transport experience, specific quality indicators for newborn transport are suggested.• Data analysis shows how some indicators need to be adjusted for gestational age.
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Affiliation(s)
- Itziar Marsinyach Ros
- Newborn Specialized Transport Madrid (SUMMA 112), Neonatology Department, Gregorio Marañón Hospital, O’Donnell 48 Street, 28009 Madrid, Spain
| | - Laura Sanchez García
- Newborn Specialized Transport Madrid (SUMMA 112), Neonatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Ana Sanchez Torres
- Newborn Specialized Transport Madrid (SUMMA 112), Neonatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Rocio Mosqueda Peña
- Newborn Specialized Transport Madrid (SUMMA 112), Neonatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Maria del Carmen Pérez Grande
- Newborn Specialized Transport Madrid (SUMMA 112), Neonatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Maria José Rodríguez Castaño
- Newborn Specialized Transport Madrid (SUMMA 112), Neonatology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Manuel Sánchez Luna
- Newborn Specialized Transport Madrid (SUMMA 112), Neonatology Department, Gregorio Marañón Hospital, O’Donnell 48 Street, 28009 Madrid, Spain
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Gupta N, Shipley L, Goel N, Browning Carmo K, Leslie A, Sharkey D. Neurocritical care of high-risk infants during inter-hospital transport. Acta Paediatr 2019; 108:1965-1971. [PMID: 31321815 DOI: 10.1111/apa.14940] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/17/2019] [Accepted: 07/12/2019] [Indexed: 11/28/2022]
Abstract
The centralisation of neonatal intensive care in recent years has improved mortality, particularly of extremely preterm infants, but similar improvements in morbidity, such as neurodevelopmental impairment, have not been seen. Integral to the success of centralisation are specialised neonatal transport teams who provide intensive care prior to and during retrieval of high-risk neonates when in-utero transfer has not been possible. Neonatal retrieval aims to stabilise the clinical condition and then transfer the neonate during a high-risk period for patient. Transport introduces the hazards of noise and vibration; acceleration and deceleration forces; additional handling and temperature fluctuations. The transport team must stabilise the infant fully prior to transport as when on the move they are limited by space and movement to effectively attend to clinical deterioration. Inborn infants have better neurodevelopmental outcome compared with the outborn and aetiology of this seems to be multifactorial with the impact of transport itself during critical illness, remaining unclear. To improve the neurological outcomes for transported infants, it seems imperative to integrate the advancing intensive care neuromonitoring tools into the transport milieu. This review examines current inter-hospital transport neuromonitoring and how new modalities might be applied to the neurocritical care delivered by specialist transport teams.
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Affiliation(s)
- Neelam Gupta
- University of Southampton Southampton UK
- Wessex Southampton Oxford Neonatal Transport (SONeT) & Neonatal Intensive Care Services University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Lara Shipley
- Academic Child Health School of Medicine University of Nottingham Nottingham UK
| | - Nitin Goel
- Neonatal Intensive Care Unit University Hospital of Wales Cardiff Wales UK
| | - Kathryn Browning Carmo
- Faculty of Medicine and Healthcare University of Sydney Sydney NSW Australia
- Grace Centre for Newborn Intensive Care Children's Hospital at WestmeadSCHN and NETS NSW Sydney NSW Australia
| | - Andrew Leslie
- CenTre Neonatal Transport Service University Hospitals of Leicester NHS Trust Leicester UK
| | - Don Sharkey
- Academic Child Health School of Medicine University of Nottingham Nottingham UK
- CenTre Neonatal Transport Service Nottingham University Hospitals NHS Trust Nottingham UK
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Risk of Severe Intraventricular Hemorrhage in the First Week of Life in Preterm Infants Transported Before 72 Hours of Age. Pediatr Crit Care Med 2019; 20:638-644. [PMID: 31013263 DOI: 10.1097/pcc.0000000000001937] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Evaluate the risk of severe intraventricular hemorrhage, in the first week of life, in preterm infants undergoing early interhospital transport. DESIGN Retrospective cohort study. SETTING Tertiary neonatal centers of the Trent Perinatal Network in the United Kingdom. PATIENTS Preterm infants less than 32 weeks gestation, who were either born within and remained at the tertiary neonatal center (inborn), or were transferred (transported) between centers in the first 72 hours of life. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Multivariable logistic regression models adjusting for key confounders were used to calculate odds ratios for intraventricular hemorrhage with 95% CIs for comparison of inborn and transported infants. Cranial ultrasound findings on day 7 of life. Secondary analyses were performed for antenatal steroid course and gestational age subgroups. A total of 1,047 preterm infants were included in the main analysis. Transported infants (n = 391) had a significantly higher risk of severe (grade III/IV) intraventricular hemorrhage compared with inborns (n = 656) (9.7% vs 5.8%; adjusted odds ratio, 1.69; 95% CI, 1.04-2.76), especially for infants born at less than 28 weeks gestation (adjusted odds ratio, 1.83; 95% CI, 1.03-3.21). Transported infants were less likely to receive a full antenatal steroid course (47.8% vs 64.3%; p < 0.001). A full antenatal steroid course significantly decreased the risk of severe intraventricular hemorrhage irrespective of transport status (odds ratio, 0.33; 95% CI, 0.2-0.55). However, transported infants less than 28 weeks gestation remained significantly more likely to develop a severe intraventricular hemorrhage despite a full antenatal steroid course (adjusted odds ratio, 2.84; 95% CI, 1.08-7.47). CONCLUSIONS Preterm infants transported in the first 72 hours of life have an increased risk of early-life severe intraventricular hemorrhage even when maternal antenatal steroids are given. The additional burden of postnatal transport could be an important component in the pathway to severe intraventricular hemorrhage. As timely in-utero transfer is not always possible, we need to focus research on improving the transport pathway to reduce this additional risk.
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8
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Zwissig M, Rio L, Roth-Kleiner M, Ramelet AS. Measurement of stress in stable neonates during ambulance transportation: A feasibility study. Aust Crit Care 2019; 32:28-33. [DOI: 10.1016/j.aucc.2018.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 10/28/2022] Open
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Macallister KJ, Tho LW, Epee-Bekima M, Resnick S, Davis JW. Impact of elective caesarean section on neonatal retrieval in Western Australia during a 12-year period. J Perinatol 2019; 39:34-38. [PMID: 30341400 DOI: 10.1038/s41372-018-0263-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/24/2018] [Accepted: 09/17/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine whether 2006 Australian national guidance to delay elective caesarean section until 39 weeks' gestation would reduce the need for neonatal retrieval for respiratory compromise following elective caesarean. STUDY DESIGN This is a retrospective cohort study comparing infants born by elective caesarean section who required retrieval for respiratory distress in Western Australia before and after the national guidance (2003-2006 vs. 2008-2014). RESULTS The proportion of infants born by elective caesarean section who required retrieval for respiratory distress was reduced in the later cohort (0.77% (153/19 780) vs. 0.55% (227/40 875); p = 0.0012). The diagnosis of surfactant-deficient lung disease amongst retrieved infants was also reduced (26% (40/153) vs. 17.4% (40/227); p = 0.04). CONCLUSION A reduction in the proportion of elective caesarean sections before 39 weeks in Western Australia was associated with a reduction in retrieval for respiratory compromise related to surfactant deficiency in infants born by elective caesarean section.
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Affiliation(s)
- Kathryn J Macallister
- Neonatal Intensive Care Unit, Perth Children's and King Edward Memorial Hospitals, Perth, WA, Australia
| | - Lye W Tho
- Neonatal Intensive Care Unit, Perth Children's and King Edward Memorial Hospitals, Perth, WA, Australia
| | - Mathias Epee-Bekima
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, WA, Australia.,Department of Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, WA, Australia
| | - Steven Resnick
- Neonatal Intensive Care Unit, Perth Children's and King Edward Memorial Hospitals, Perth, WA, Australia.,Centre for Neonatal Research and Education, University of Western Australia, Perth, WA, Australia.,Newborn Emergency Transport Service, Perth Children's Hospital, Perth, WA, Australia
| | - Jonathan W Davis
- Neonatal Intensive Care Unit, Perth Children's and King Edward Memorial Hospitals, Perth, WA, Australia. .,Centre for Neonatal Research and Education, University of Western Australia, Perth, WA, Australia. .,Newborn Emergency Transport Service, Perth Children's Hospital, Perth, WA, Australia.
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10
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Hennequin Y, Grevesse L, Gylbert D, Albertyn V, Hermans S, Van Overmeire B. Skin-to-skin back transfers provide a feasible, safe and low-stress alternative to conventional neonatal transport. Acta Paediatr 2018; 107:163-164. [PMID: 28898475 DOI: 10.1111/apa.14071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Boyle MA, Dhar A, Chaudhary R, Kent S, O'Hare SS, Dassios T, Broster S. Introducing high-flow nasal cannula to the neonatal transport environment. Acta Paediatr 2017; 106:509-512. [PMID: 27977876 DOI: 10.1111/apa.13702] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 12/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Michael A. Boyle
- Acute Neonatal Transfer Service; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Arunava Dhar
- Acute Neonatal Transfer Service; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Rajiv Chaudhary
- Acute Neonatal Transfer Service; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Susan Kent
- Acute Neonatal Transfer Service; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - S Samantha O'Hare
- Acute Neonatal Transfer Service; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Theodore Dassios
- Acute Neonatal Transfer Service; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Susan Broster
- Acute Neonatal Transfer Service; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
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Priyadarshi A, Quek WS, Luig M, Lui K. Is it feasible to identify preterm infants with respiratory distress syndrome for early extubation to continuous positive airway pressure post-surfactant treatment during retrieval? J Paediatr Child Health 2015; 51:321-7. [PMID: 25196918 DOI: 10.1111/jpc.12724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 11/27/2022]
Abstract
AIM Preterm infants with respiratory distress syndrome (RDS) requiring surfactant treatment are often retrieved mechanically ventilated to the receiving hospital. INSURE (INtubate, SURfactant, Extubate) technique is not routinely performed by Newborn and Pediatric Emergency Transport Services NSW (NETS) during retrieval. This study aims to evaluate the likelihood of using INSURE technique during retrieval. We attempted to study the clinical characteristics of preterm infants with RDS who were favourably extubated (FE) shortly after admission to the receiving hospital. METHODS Retrospective study of preterm infants, gestational age (GA) > 28 weeks with RDS requiring retrieval by NETS. RESULTS Two hundred twenty-three infants, median GA of 33 weeks (range 29-36), median birthweight 2200 g (1000-4080) were examined. A percentage of 49.7 received CPAP, and 50.3% required MV. Eighteen (16%) infants were FE (<6 h) at receiving hospital. FiO2 on stabilisation (FiO2 (st)) by NETS correlated with FiO2 on admission to receiving hospital (r = 0.863). A percentage of 81 of ventilated infants received premedications including morphine. No significant differences were noted for GA, stabilisation ventilator settings, surfactant dose (mean 155 mg/kg) and mode of transport between FE and non-FE groups. FiO2 (st) post-surfactant treatment was significantly lower in FE compared with non-FE group (mean 0.28 vs. 0.41 respectively). The area under the curve from receiver operating characteristic based on FiO2 (st) was 0.646 (P = 0.050), the sensitivity and specificity of FiO2 (st) cut-off points (between 0.25 and 0.30) was low. CONCLUSION FiO2 on stabilisation post-surfactant treatment has a weak predictive value and may not be adequate to be used as sole criteria to extubate to CPAP prior to transport. FiO2 at stabilisation should be included as an eligibility criteria for a randomised trial of INSURE during retrieval, but other clinical assessments are needed.
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Affiliation(s)
- Archana Priyadarshi
- New Born Care Centre, Royal Hospital for Women, Sydney, New South Wales, Australia
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Luna-Hernández G, Varela-Cardoso M, Palacios-Blanco JC. [Utility of a physiologic stability index based on Transport Risk Index of Physiologic Stability (TRIPS) for the evaluation of infants transferred to a specialized hospital]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2015; 72:45-54. [PMID: 29421179 DOI: 10.1016/j.bmhimx.2015.01.008] [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: 09/29/2014] [Revised: 01/23/2015] [Accepted: 01/27/2015] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Neonatal mortality is a public health priority. We review the physiological instability of the newborn after a transfer, which contributes to increased neonatal mortality. The objective of this work was to determine whether the Transport Risk Index of Physiologic Stability (TRIPS) in newborns transferred to the Neonatal Intensive Care Unit of a secondary hospital serves as a predictor of early neonatal mortality. METHODS We use the TRIPS to predict neonatal death in the first 7 days after patients' admission. RESULTS Neonatal mortality at 7 days after admission is related to the TRIPS rating. The score of the survivors and neonatal deaths show a significant difference (p: 0.009). For a score of 16, a sensitivity of 62% and a specificity of 84%; area under the curve of 0.757 was determined. CONCLUSIONS Physiological index weighting using TRIPS is a good predictor of neonatal mortality. It is important to establish measures to improve physiological stability of the newborn before, during and after the transfer in order to reduce neonatal mortality.
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Affiliation(s)
- Gerardo Luna-Hernández
- Departamento de Enseñanza del Hospital Regional de Río Blanco, Servicios de Salud de Veracruz, Río Blanco, Veracruz, México.
| | - Miguel Varela-Cardoso
- Departamento de Enseñanza del Hospital Regional de Río Blanco, Servicios de Salud de Veracruz, Río Blanco, Veracruz, México
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Snedec N, Simoncic M, Klemenc M, Ihan A, Vidmar I, Grosek S. Heart rate variability of transported critically ill neonates. Eur J Pediatr 2013; 172:1565-71. [PMID: 23828133 DOI: 10.1007/s00431-013-2081-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Determining heart rate variability (HRV) in infants is a useful measure of physiological stability. Transport of ill neonates imposes a measurable degree of stress. A prospective observational study on 58 critically ill neonates, transported to an intensive care unit (ICU) was performed. HRV during the 24-h period before, during and after transport, heart rate (HR), mean arterial pressure and transport risk index of physiologic stability (TRIPS) score were observed. The median HRV total power value of 40.80 ms(2) was set as the cutoff value, and neonates with values below this were designated as the low-HRV group (l-HRV; n=29), and those above this as the high-HRV group (h-HRV; n=29). The h-HRV group had a significantly lower HR at retrieval and 1 h after admission and a significant 2- and 4-day shorter duration of mechanical ventilation and ICU treatment compared to the l-HRV group. Spearman's correlations between total power and duration of mechanical ventilation (ρ=-0.346; P<0.01) and ICU treatment (ρ=-0.346; P<0.01) were significant. Transported neonates were also tested for differences in HRV and other physiological and demographic parameters between the transport mode and time. No differences were found, except that the nighttime ambulance group had a statistically higher HRV compared to the daytime ambulance group. CONCLUSION Higher HRV of group of neonates, who did not differ in illness severity TRIPS score from the lower HRV group, is associated with a faster and significant decrease in HR after transport and a 2- and 4-day shorter duration of mechanical ventilation and ICU treatment.
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Affiliation(s)
- Nejc Snedec
- Department of Radiology, General Hospital Celje, Oblakova ulica 5, 3000, Celje, Slovenia
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