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Bills H, Woodward L, Martin S. Long-distance transfer of unwell neonates: A case series. J Paediatr Child Health 2023; 59:1039-1046. [PMID: 37302132 DOI: 10.1111/jpc.16451] [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: 05/25/2022] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023]
Abstract
AIM The Northern Territory Neonatal Emergency Transport Service (NETS NT) pilot was created in April 2018 to expedite the transfer of critically unwell neonates to specialised interstate centres. The aim of this paper is to describe long-distance retrievals undertaken during the first 3 years of operation of the service. METHODS A case series is described comprising neonates requiring long-distance aeromedical transfer (>2500 km) by NETS NT between April 2018 and June 2021. Data were obtained from hospital and transport service documentation. This was supplemented by four semi-structured interviews with transport staff. RESULTS Thirty neonates were transferred via NETS NT during the investigation period, including 19 transfers >2500 km. Of these, 18/19 (94.7%) required respiratory support, 8/19 (42.1%) were intubated and 4/19 (21.1%) required inotropic support. The average length of transport was 7.5 h (5.6-8.9). Twelve patients had in-flight documentation available. Eight required increased oxygen administration 8/12 (66.6%). The median change in FiO2 was an increase of 0.02 (-0.05 to 0.45). CONCLUSIONS The NETS NT has been successfully established to transport high-risk neonates to interstate quaternary health services when required. Future recommendations for the service include ongoing implementation of systems and processes to strengthen all aspects of governance and operations using suitably adapted resources from established Australian retrievals services.
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Affiliation(s)
- Hannah Bills
- Paediatric and Neonatal Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Louise Woodward
- Paediatric and Neonatal Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Simone Martin
- Paediatric and Neonatal Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Cirstoveanu C, Georgescu C, Bizubac M, Heriseanu C, Vasile CM, Margarint I, Filip C. Impact of Bedside Balloon Atrial Septostomy in Neonates with Transposition of the Great Arteries in a Neonatal Intensive Care Unit in Romania. Life (Basel) 2023; 13:life13040997. [PMID: 37109527 PMCID: PMC10145815 DOI: 10.3390/life13040997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
(1) Background: Transposition of the great arteries (TGA) is the most common congenital heart disease, accounting for 5-7% of all cardiac anomalies, with a prevalence of 0.2-0.3 per 1000 live births. (2) Aim: Our main objectives were to evaluate the clinical safety of balloon atrial septostomy in neonates and the possible complications. Furthermore, we tried to establish whether the procedure should be performed in all TGA patients with small atrial septal defects, regardless of oxygen saturation, within a center where corrective surgery cannot be performed on an emergency basis due to the lack of a permanent cardiac surgery team for arterial switch surgery. (2) Methods: We conducted an observational, retrospective, single tertiary-care center study between January 2008 and April 2022, which included 92 neonates with TGA transferred to our institution for specialized treatment. (3) Results: The median age at the time of the Rashkind procedure was four days. The rate of immediate complications after balloon atrial septostomy (BAS) was high (34.3%), but most were transient (metabolic acidosis and arterial hypotension-21.8%). Twenty patients with TGA managed in our hospital underwent definitive and corrective surgical intervention (arterial switch operation) at a median age of 13 days. Most patients (82.6%) were term neonates, but 16 were born preterm. (4) Conclusions: Urgent balloon atrial septostomy is often the only solution to restore adequate systemic perfusion. Bedside balloon atrial septostomy is a safe, effective, and initial palliative intervention in neonates with TGA, which can be performed in the neonatal unit.
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Affiliation(s)
- Catalin Cirstoveanu
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, M.S. Curie Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Carmina Georgescu
- Neonatal Intensive Care Unit, M.S. Curie Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Mihaela Bizubac
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, M.S. Curie Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Carmen Heriseanu
- Neonatal Intensive Care Unit, M.S. Curie Children's Clinical Hospital, 041451 Bucharest, Romania
- Ph.D. School Department, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France
- Department of Pediatric Cardiology, M.S. Curie Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Irina Margarint
- Ph.D. School Department, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Cardiovascular Surgery, M.S. Curie Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Cristina Filip
- Department of Pediatric Cardiology, M.S. Curie Children's Clinical Hospital, 041451 Bucharest, Romania
- Department of Pediatrics, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Thomas C, Yu S, Lowery R, Zampi JD. Timing of Balloon Atrial Septostomy in Patients with d-TGA and Association with Birth Location and Patient Outcomes. Pediatr Cardiol 2022:10.1007/s00246-022-03079-5. [PMID: 36565310 DOI: 10.1007/s00246-022-03079-5] [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: 02/23/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
Patients with d-looped transposition of the great arteries (d-TGA), especially those without an adequate atrial septal defect, can experience severe hypoxemia and hemodynamic compromise in the neonatal period. This can be mitigated by urgent balloon atrial septostomy (BAS). However, some patients with d-TGA are born at centers without this capability. The aim of this retrospective study of d-TGA patients who had urgent or emergent BAS at our institution between 2010 and 2021 was to evaluate time from birth to BAS for infants born at a tertiary care center as compared to those requiring transport from other institutions and to examine correlation between time to BAS and patient outcomes. Our primary outcome was time from birth to BAS. Secondary outcomes included hospital and ICU length of stay, mortality, and evidence of pulmonary or neurologic abnormalities including pulmonary hypertension, abnormal neuroimaging, or seizures. Of 96 patients, 67 (70%) were born at our institution. The median time to BAS was 4 h for patients born at our institution vs. 14.1 h for those born elsewhere (p < .0001). A longer time from birth to BAS was associated with longer ICU (r = 0.21, p = 0.046) and hospital length of stay (r = 0.24, p = 0.02) and increased likelihood of elevated right ventricular pressure on post-operative discharge echocardiogram (p = 0.01). There were no differences in mortality between the groups. Therefore, prenatal planning for patients with known d-TGA should include a delivery plan with access to urgent BAS.
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Affiliation(s)
- Courtney Thomas
- CS Mott Children's Hospital, University of Michigan Congenital Heart Center, Ann Arbor, MI, USA.
| | - Sunkyung Yu
- CS Mott Children's Hospital, University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Ray Lowery
- CS Mott Children's Hospital, University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Jeffrey D Zampi
- CS Mott Children's Hospital, University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
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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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Do infants with transposition of the great arteries born outside a specialist centre have different outcomes? Cardiol Young 2019; 29:1030-1035. [PMID: 31272514 DOI: 10.1017/s1047951119001367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Infants born with undiagnosed transposition of the great arteries continue to be born in district general hospitals despite the improvements made in antenatal scanning. Evidence indicates improved outcomes with early definitive treatment after birth, hence the recommendation of delivery in a tertiary centre. The role of specialist paediatric and neonatal transport teams, to advise, stabilise, and transport the infants to a tertiary centre in a timely manner, is critical for those infants born in a district general hospital. This pilot study aims to compare outcomes between infants born in district general hospitals and those who were born in a tertiary maternity unit in South West England and South Wales. METHODS This was a secondary data analysis of data collected from the local Paediatric Intensive Care Audit Network and the local transport database. Infants born with a confirmed diagnosis of transposition of the great arteries, that required an arterial switch operation as the definitive procedure between April, 2012 and March 2018 were included. RESULTS Forty-five infants with a confirmed diagnosis of transposition of the great arteries were included. Statistical analysis demonstrated there were no significant differences in the time to balloon atrial septostomy (p = 0.095), time to arterial switch operation (p = 0.461), length of paediatric ICU stay (p = 0.353), and hospital stay (p = 0.095) or mortality between the two groups. CONCLUSIONS We found no significant differences in outcomes between infants delivered outside the specialist centre, who were transferred in by a specialist team.
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Frid I, Ågren J, Kjellberg M, Normann E, Sindelar R. Critically ill neonates displayed stable vital parameters and reduced metabolic acidosis during neonatal emergency airborne transport in Sweden. Acta Paediatr 2018; 107:1357-1361. [PMID: 29480945 DOI: 10.1111/apa.14295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/02/2018] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
Abstract
AIM This study evaluated the medical quality of acute airborne transports carried out by a neonatal emergency transport service in a Swedish healthcare region from 2012 to 2015. METHODS The transport charts and patient records of all infants transported to the regional centre were reviewed for transport indications and vital parameters and outcomes. RESULTS We identified 187 acute airborne transports and the main indications for referral were therapeutic hypothermia after perinatal asphyxia, extremely preterm birth and respiratory failure. There were 37 deaths, but none of these occurred during transport and none of the deaths that occurred within 24 hours after transport were found to be related to the transport per se. No differences were found in vital parameters or ventilator settings before and after transport, except for an improvement in blood pH (7.22 ± 0.13 versus 7.27 ± 0.13, mean ± SD, p < 0.01), due to a decrease in base deficit (-8.0 ± 6.8 versus -5.4 ± 6.3 mmol, p < 0.001), while the partial pressure of carbon dioxide remained unchanged. CONCLUSION During air transport, critically ill neonates displayed stable vital parameters and reduced metabolic acidosis. No transport-related mortality was found, but the high number of extremely preterm infants transported indicates the potential for improving in-utero transport.
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Affiliation(s)
- Ingrid Frid
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Johan Ågren
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Mattias Kjellberg
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Erik Normann
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Richard Sindelar
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
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Bellini C, Serveli S, A L, M P, S D, Ramenghi LA, Cinti T, Campone F. Long-Distance, Nonstop Neonatal Transport From Shanghai, China, to Genoa, Italy. Air Med J 2018; 37:67-70. [PMID: 29332782 DOI: 10.1016/j.amj.2017.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/13/2017] [Accepted: 09/02/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this article is to describe the long-distance, nonstop intercontinental transport of a severely ill, mechanically ventilated newborn from Shanghai, China, to Genoa, Italy focusing in particular on the clinical and planning difficulties. The aircraft equipment, the assessment and preparation for transport are discussed.
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Affiliation(s)
- Carlo Bellini
- Neonatal Intensive Care UnitNeonatal Emergency Transport ServiceIRCCS Istituto Giannina GasliniGenoaItaly.
| | - Simona Serveli
- Neonatal Intensive Care UnitNeonatal Emergency Transport ServiceIRCCS Istituto Giannina GasliniGenoaItaly
| | | | | | | | - Luca A Ramenghi
- Neonatal Intensive Care UnitNeonatal Emergency Transport ServiceIRCCS Istituto Giannina GasliniGenoaItaly
| | - Tiziana Cinti
- Neonatal Intensive Care UnitNeonatal Emergency Transport ServiceIRCCS Istituto Giannina GasliniGenoaItaly
| | - Francesco Campone
- Neonatal Intensive Care UnitNeonatal Emergency Transport ServiceIRCCS Istituto Giannina GasliniGenoaItaly
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Séguéla PE, Roubertie F, Kreitmann B, Mauriat P, Tafer N, Jalal Z, Thambo JB. Transposition of the great arteries: Rationale for tailored preoperative management. Arch Cardiovasc Dis 2016; 110:124-134. [PMID: 28024917 DOI: 10.1016/j.acvd.2016.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 11/17/2022]
Abstract
As preoperative morbi-mortality remains significant, care of newborns with transposition of the great arteries is still challenging. In this review of the literature, we discuss the different treatments that could improve the patient's condition into the preoperative period. Instead of a standardized management, we advocate personalized care of these neonates. Considering the deleterious effects of hypoxia, special attention is given to the use of non-invasive technologies to assess oxygenation of the tissues. As a prolonged preoperative time with low cerebral oxygenation is associated with cerebral injuries, distinguishing neonates who should undergo early surgery from those who could wait longer is crucial and requires full expertise in the management of neonatal congenital heart disease. Finally, to treat these newborns as soon as possible, we support a planned delivery policy for foetuses with transposition of the great arteries.
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Affiliation(s)
- Pierre-Emmanuel Séguéla
- Pediatric and Congenital Cardiology Unit, Bordeaux University Hospital, Bordeaux, France; Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France.
| | | | - Bernard Kreitmann
- Cardiac Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | - Philippe Mauriat
- Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France
| | - Nadir Tafer
- Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France
| | - Zakaria Jalal
- Pediatric and Congenital Cardiology Unit, Bordeaux University Hospital, Bordeaux, France
| | - Jean-Benoit Thambo
- Pediatric and Congenital Cardiology Unit, Bordeaux University Hospital, Bordeaux, France
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