Neonatal Respiratory Support on Transport

XIII Consenso SIBEN sobre Traslado Neonatal: Establecer protocolos estructurados para el proceso del traslado neonatal podría mejorar los desenlaces

La centralización de los partos de alto riesgo en los hospitales con el más alto nivel de atención es fundamental para ampliar el margen de seguridad materno-neonatal y mejorar los desenlaces. Por lo tanto, es altamente recomendable trasladar oportunamente a las pacientes gestantes portadoras de embarazos de alto riesgo y/o con amenazas de parto pretérmino a centros de atención terciaria, sin embargo, no siempre es posible anticipar los riesgos antenatalmente, lo cual resulta en la necesidad de trasladar a neonatos en estado crítico. Lamentablemente, la movilización de los recién nacidos compromete aún más su estado de salud, especialmente en los países latinoamericanos. El presente trabajo resume los resultados del XIII Consenso Clínico de SIBEN de Traslado Neonatal, en el cual colaboraron 65 miembros de SIBEN, neonatólogos y licensiados en enfermería de 14 países de Iberoamérica, que participaron activamente durante el 2022, antes, durante y después de la reunión presencial que se llevó a cabo en Mérida, Yucatán, México el 12 de noviembre del 2022. En esta reunión se consensuaron las recomendaciones aquí vertidas.

Stabilization, respiratory care and survival of extremely low birth weight infants transferred on the first day of life

OBJECTIVE

To assess stabilization, respiratory care and survival of extremely low birth weight (ELBW, <1000 g at birth) infants requiring emergency transfer to tertiary NICUs on the first day of life.

STUDY DESIGN

Retrospective cohort study of 55 ELBW infants transported by a dedicated neonatal transport service over a 65-month period. Ventilator data were downloaded computationally.

RESULTS

95% of infants were intubated and received surfactant prior to transfer. Median expired tidal volume was 5.0 mL/kg (interquartile range: 4.6-6.2 mL/kg). Infants ventilated with SIPPV had significantly higher mean airway pressure and minute ventilation, but similar FiO2 compared to babies on SIMV. Blood gases showed significant improvement during transport. 55% of infants survived to discharge from NICU.

CONCLUSION

Most ELBW infants transferred on the first day of life require mechanical ventilation and can be ventilated with 5 mL/kg tidal volume.

A two-year retrospective study of the neonatal emergency transport service in Northeast Italy

BACKGROUND

Some newborns require acute transport to a Neonatal Intensive Care Unit (NICU) due to unpredicted or unpredictable reasons.

OBJECTIVE

To describe the activity of the Neonatal Emergency Transport Service (NETS) in Northeast Italy.

METHODS

An observational retrospective study was performed between 1 January 2018, and 31 December , 2019.

RESULTS

A total of 133 transports were collected, with a neonatal transport index of 1.4%. Infants ≤2500 grams were more frequently transferred by NETS than those in the normal group (n = 34/563, 6.0% vs. n = 99/8,437, 1.2%; p < .001). The incidence of preterm birth among transferred newborns was 42/133 (31.6%). For the newborns with >2500 grams, there was a low incidence of a cesarean birth compared to vaginal delivery (23.2% versus 63.5%; p = .001), while the percentages were reversed in the group of infants ≤2500 grams (67.7% versus 20.6%) (p = .001). Infant stabilization time was higher in the underweight group compared to those weighed >2500 grams (31.5 versus 23.0 min; p < .001), as well as the median length of stay in NICU (18.0 versus 8.0 days, respectively, p < .001). The group of infants ≤2500 grams received more intravenous therapy (47.1% vs. 26.2%) and invasive ventilation (26.5% vs. 8.1%), compared to the group of infants who weighed >2500 grams.

CONCLUSIONS

This study described a local reality by showing the characteristics of the neonatal transports that took place in a metropolitan area in Northeast Italy. Wider database is necessary to achieve a better knowledge in the field of perinatal outcomes.