Pre Transport Factors and Transport Quality a Ffecting the Neonatal Outcome

Abstract

AIM:To study the determinant of mortality on extramural arrival of sick newborns and mode of neonatal transport at tertiary care Centre. BACKGROUND: Neonatal transport system in our country is major gap in holistic newborn care and acute neonatal physiology is deranged during transport which adversely affects the mortality and morbidity of sick newborns. MATERIAL & METHODS: This is prospective observational cohort study carried out in out born neonatal intensive care unit over a period of one year. Inclusion criteria were age up to 28 days, delivered at home or private nursing home or any health centre; and exclusion criteria were age more than 28 days, abandoned newborns and those delivered in the institution of study. A predesigned and tested proforma was used to record information by the pediatric resident on duty at time of neonatal admission. Data were analysed and tabulated, for analysis of data software STATISTIX was used, chisquare test for dichotomous variables and multiple logistic regression for predictors of mortality. RESULT: Out of 200 newborns 146 were male and 54 were female, 140 were term and 59 were preterm, 39 newborns expired and common mode of transport was taxi 47%, bus 16%, auto 16% and ambulance 2.5%. The common factors determining the outcome were low admission weight, prematurity, longer duration of transport and deranged physiological factors e.g. hypothermia, respiratory distress, prolonged CRT and central cyanosis. CONCLUSION: This study concludes that neonatal transport in our country is self-supported; the ideal element of neonatal transport is major gap in holistic neonatal care. Thus we suggest RUSH-IN FACILITY for neonatal transport.

Timely referral and safe transport of neonates admitted to neonatal intensive care unit of tertiary care government hospital of Agra district: a cross sectional study

“…24 In our study there was a greater proportion of neonates travelling less than 6 km from last referral point (45.7%) as compared to those travelling a total distance of less than 6 km indicating that the last referral points were located closer to the NICU. In our study as far as distance from last referral to NICU is concerned 45.7% travelled <6 km, 27 16,20,22,[25][26][27] Similarly autos contributed 10.6% and 16% towards transportation in studies by Thenmozhi et al and Rao et al 23,28 Also in our study there was an increase in ambulances contributing 31.5% to initial transport to them constituting 48.8% of final transport. Still a lack of use of ambulance as a means of transport in 68.5% neonates initially and 51.2% neonates finally represents a gap in safe neonatal transport.…”

“…Total mean duration spent on transport was 1.08hr in our study in comparison to 1.45 hr in the study by Mehta et al 29 37.7% spent 30 minutes in total transportation in the present study which is similar to 39.09% spending <30 minutes in study by Jajoo et al 14 In congruence to our study where 13.6% spent >2 hours on total transportation; research by Rao et al puts this percentage at 16%. 28 In studies by Akhani et al and Shalini et al transportation duration of less than one hour is in 76.6% and 58% respectively. 19,16 Similarly our study puts this percentage as 62.3% for total time spent on transportation up to an hour.…”

Impact of mode of transport on the outcome of extramural newborns in a tertiary care centre

“…Here the mode of transport were mostly self-transported by payment and all of them were not supported by transport team while transport. 13 This study concluded that neonatal transport was selfsupported and the transport system is a major gap in holistic newborn care. In our study, even the medical person accompanied while transport there was no significant difference in the outcome.…”

“…12 Even with the facility of neonatal transport in our country is a major gap in holistic care. 13 The present study has been carried out to identify the determinant of mortality on extramural arrival of sick newborns and status of neonatal transport in tertiary care centre.…”

Transport Factors Affecting the Outcome of Referred Neonates Admitted in A Tertiary Care Hospital

“…Mori et al 11 found that neonates with long duration of transport (undefined) had 79% higher odds of death than those with short duration (95% confidence intervals [CI]: 1.38 -8.42) after adjusting for the confounding effects of admission weight, hypothermia, hypoglycemia, delayed capillary filling time, cyanosis and prematurity. Another cross-sectional study conducted in an urban area in India reported that there was strong evidence that those transported for >90 min had more than twice the rate of neonatal death (RR 1.81, 95%CI: 1.07 -3.06) and some evidence that those transported for between 60 and 89 min had an 80% higher rate of neonatal death both compared with those transported for between 30 and 59 min, after adjusting for the confounding effects 13 .These were the evidence of an association between duration of transport and increased neonatal mortality. In this study it was observed that there was significant difference of time took >3 hours to reach the hospital (DSH) (RR: 1.36 [95% CI]: (1.09-1.69) (p<0.05).…”