Elective transfers of preterm neonates to regional centres on non‐invasive respiratory support is cost effective and increases tertiary care bed capacity

Zein, Hussein; Yusuf, Kamran; Paul, Renee; Kowal, Derek; Thomas, Sumesh

doi:10.1111/apa.14059

Cited by 5 publications

(8 citation statements)

References 17 publications

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“…Three of 858 patients (0.4%) required escalation of the mode of ventilation during transport ( 15 ). Five additional studies in our review demonstrated the safety of NIV in lengthy ground and air transport, in rural settings, and for preterm neonates outside the hospital setting ( 16 , 20 , 23 , 26 , 29 ). In one study, none of 118 pediatric patients on NIV during transport required intubation, despite a mean transport time of 163 min ( 20 ).…”

Section: Resultsmentioning

confidence: 83%

“…Two studies conducted in remote settings suggested that nCPAP and nHFT are safe in air transport ( 23 , 26 ). Another study reported no adverse events in the interfacility transfer of 99 preterm neonates on nCPAP and concluded that this practice was both safe and cost-effective ( 29 ).…”

Section: Resultsmentioning

confidence: 99%

“…Although in both studies providers had access to air transport and specialized transfer teams, the results suggest that implementation of NIV in transport in LMICs may be feasible. Additionally, Zein et al showed that the use of nCPAP to transfer patients from a level three hospital to a level two neonatal intensive care unit (NICU) saved 2.65 million Canadian dollars and freed up at least 848 days of NICU beds ( 29 ). This suggests that using NIV in transport for children may have financial benefits that could help maximize the use of limited resources in LMICs.…”

Section: Resultsmentioning

confidence: 99%

“…The observational studies included in this review primarily focused on the safety of NIV for children in transportation settings (15). These studies endorsed the use of NIV to provide safe and adequate respiratory support and to avoid additional risks associated with invasive ventilation (9,17,18,(20)(21)(22)(23)(24)(25)(26)(27)29). Future research should determine the requirements for healthcare systems to safely introduce NIV into transportation systems.…”

Section: Discussionmentioning

confidence: 99%

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Critical Breaths in Transit: A Review of Non-invasive Ventilation (NIV) for Neonatal and Pediatric Patients During Transportation

et al. 2021

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Respiratory illnesses are a leading cause of death for children worldwide, with the majority of these cases occurring from preterm birth complications or acute respiratory infections. Appropriate respiratory intervention must be provided quickly to lower the chances of death or permanent harm. As a result, respiratory support given in prehospital and interfacility transport can substantially improve health outcomes for these patients, particularly in areas where transportation time to appropriate facilities is lengthy. Existing literature supports the use of non-invasive ventilation (NIV), such as nasal or bilevel continuous positive airway pressure, as a safe form of respiratory support for children under 18 years old in certain transportation settings. This mini review summarizes the literature on pediatric NIV in transport and highlights significant gaps that future researchers should address. In particular, we identify the need to: solidify clinical guidelines for the selection of eligible pediatric patients for transport on NIV; explore the range of factors influencing successful NIV implementation during transportation; and apply appropriate best practices in low and middle income countries.

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Section: Resultsmentioning

confidence: 83%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Critical Breaths in Transit: A Review of Non-invasive Ventilation (NIV) for Neonatal and Pediatric Patients During Transportation

et al. 2021

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“…Zein et al. report that transferring infants between level three and level two neonatal intensive care units (NICU) in Calgary, Canada, was safe and resulted in cost savings of 2.65 million Canadian dollars during the two‐year study period. It also freed up 848 level three NICU days for potentially sick neonates.…”

Section: Optimising the Cost Savings And Clinical Outcomes Of Neonatamentioning

confidence: 99%

Highlights in this issue

Käll¹,

Lagercrantz²

2017

Acta Paediatrica

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Reading difficulties begin in the wombChildren born with foetal growth restrictions demonstrated significantly poorer performance in reading and spelling at nine years of age, compared with control children who were born appropriate for gestational age, according to a study by Partanen et al. (1). On the same topic, Yu and Garcy (2) report that individuals born small for gestational age had lower mean verbal, spatial and numerical test scores than those born appropriate or large for gestational age. In the accompanying editorial, Horowitz-Kraus provides us with an insight into new techniques that can help to distinguish between different causes of reading challenges, even before a child has failed to read at school (3).

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Morbidity and trends in length of hospitalisation of very and extremely preterm infants born between 2008 and 2021 in the Netherlands: a cohort study

de Bijl-Marcus,

Benders,

Dudink

et al. 2024

BMJ Open

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ObjectivesThis study investigated changes in the length of stay (LoS) at a level III/IV neonatal intensive care unit (NICU) and level II neonatology departments until discharge home for very preterm infants and identified factors influencing these trends.DesignRetrospective cohort study based on data recorded in the Netherlands Perinatal Registry between 2008 and 2021.SettingA single level III/IV NICU and multiple level II neonatology departments in the Netherlands.ParticipantsNICU-admitted infants (n=2646) with a gestational age (GA) <32 weeks.Main outcome measuresLoS at the NICU and overall LoS until discharge home.ResultsThe results showed an increase of 5.1 days (95% CI 2.2 to 8, p<0.001) in overall LoS in period 3 after accounting for confounding variables. This increase was primarily driven by extended LoS at level II hospitals, while LoS at the NICU remained stable. The study also indicated a strong association between severe complications of preterm birth and LoS. Treatment of infants with a lower GA and more (severe) complications (such as severe retinopathy of prematurity) during the more recent periods may have increased LoS.ConclusionThe findings of this study highlight the increasing overall LoS for very preterm infants. LoS of very preterm infants is presumably influenced by the occurrence of complications of preterm birth, which are more frequent in infants at a lower gestational age.

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Elective transfers of preterm neonates to regional centres on non‐invasive respiratory support is cost effective and increases tertiary care bed capacity

Abstract: The elective transfer of stable neonates on NCPAP from level three to level two NICUs within an established clinical network led to substantial cost savings, was safe and increased the bed capacity at the two level three NICUs.

Cited by 5 publications

References 17 publications

Critical Breaths in Transit: A Review of Non-invasive Ventilation (NIV) for Neonatal and Pediatric Patients During Transportation

Critical Breaths in Transit: A Review of Non-invasive Ventilation (NIV) for Neonatal and Pediatric Patients During Transportation

Highlights in this issue

Morbidity and trends in length of hospitalisation of very and extremely preterm infants born between 2008 and 2021 in the Netherlands: a cohort study

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