Effect of Current Neonatal Transport Services on Short Term Outcome of Outborn Neonates

Abstract

BACKGROUND Neonatal transport is the most important component of regionalized perinatal health care system, but still there are no legal regulations on regionalized perinatal care and transport of sick new-borns in our country. Although hospital-based deliveries have increased, level I & II centers still have extremely limited resources. The need for the systematic transport from these far situated, level I & II centers with inadequate staffing and equipment, indicates the need for better regionalization with special care newborn units at district level. The present study was done to assess the effect of available Neonatal Transport System on morbidity and mortality of out born neonates; including modes, organized transport, special needs and care during transport. MATERIALS AND METHODS In this prospective observational study, we included all neonates (from birth to 28 days of life) born outside SAIMS hospital and referred to SAIMS, Neonatal Intensive Care Unit (NICU) for tertiary care centre for a period of one year. Cases who were found to be dead at the time of arrival to the institute were excluded from the study. RESULTS We observed that immediate and long-term outcome varies with the place of delivery, mode of transport, travelling distance and initial stabilization of the baby. We also found that biochemical and temperature disturbances are more common in babies transported on their own and a specialized neonatal transport service could improve the survival of these new-borns. CONCLUSION All Neonatal health care facilities should have some basic referral guidelines so that events like hypothermia, hypoglycaemia and hypoxia can be prevented.

The neonatal transfer process through the lens of neonatologists at public hospitals in South Africa

“…Hence, whilst paramedic expertise was a factor, the requisite equipment was critical to supporting paramedic expertise. These findings correlated with those of Sundrani et al ( 2019 ) who indicated that improving transport conditions of sick neonates should include the prevention of hypothermia by ensuring the availability of incubators, radiant heaters, heated water-filled mattresses and kangaroo mother care. They added that neonatal hypoglycaemia causes long-term neurological sequelae, which can be prevented by giving IV boluses before transport, maintaining IV access and continuous fluid infusion during transport and feeding of a stable neonate.…”

“…A successful transport system thus involves two transitions of care of neonates, from the referring hospital staff to the transport team and from the transport team staff to the accepting hospital staff. Transportation of the sick or preterm babies to a centre with expertise and facilities for the provision of multi-organ intensive care has been shown to improve outcomes (Sundrani et al 2019 ). It is within the context of proper coordination that sound decisions can be made through consultation with all stakeholders involved in the process.…”

“…High risk neonates who are transferred have a significantly greater risk of death because of severe respiratory distress syndrome, intraventricular haemorrhage and nosocomial infections. These neonates are often critically ill and their outcomes hinge on the effectiveness of the transport system (Sundrani et al 2019 ). This calls for a greater scrutiny of the transport system in South Africa.…”

Incidence and predictors of mortality among neonates referred to comprehensive and specialized hospitals in Amhara regional state, North Ethiopia: a prospective follow-up study

“…Neonates who have hypoglycemia at admission was 1.8 time at high risk of death than those who were not hypoglycemic. The study conducted in Ethiopia [25], India [40,42] supports the present study. This may be due to long-distance travel without feeding babies during transportation (If feeding is not contraindicated for some disease pathology), especially for those > 120 mins of distance.…”

Critical Issues Underpinning the Safe Transfer of Ill Neonates: A Review of the Literature

“…They pointed to chronic under-resourcing which has resulted in neonatal intensive care units operating at full capacity most of the time. More recently Sundrani et al (16) wrote that the neonatal transfer system is the most crucial component of regionalised perinatal care. Their study found that immediate and long term outcomes for neonates were related to mode of transport used for the transfer, travelling distance and stabilisation of the infant.…”