title: Long-distance air medical transport of extremely low birth weight infants with pneumoperitoneum.
abstract: OBJECTIVE
  Long-distance air transport (LDAT) of infants with pneumoperitoneum for pediatric surgical evaluation has not been previously reported. We examined whether extremely low birth weight (ELBW) infants with and without pneumoperitoneum would tolerate transport differently.
  
  
  METHODS
  A retrospective cohort study was conducted comparing ELBW infants diagnosed with pneumoperitoneum to other ELBW infants transported>2000 miles by a trained team from a US Department of Defense tertiary care neonatal intensive care unit in Okinawa, Japan.
  
  
  RESULTS
  Between 2000 and 2006, 49 air transports met study criteria. Seven of the 49 (14%) infants had pneumoperitoneum at time of transport. The average distance flown was 5346 miles per transport. The 49 infants had a median gestational age of 25 weeks and birth weight of 761+/-127 g. ELBW infants without pneumoperitoneum were transported at a median 58 days of life (DOL; range 30 to 91 days) compared to infants with pneumoperitoneum, who were transported at a median 8 DOL (range 6 to 14 days). At the time of LDAT, infants with pneumoperitoneum were significantly smaller, receiving more arterial and central venous access, more pressors for hypotension, and more mechanical ventilation compared to ELBW infants transported without pneumoperitoneum. In-flight patient-related medical issues were similar regardless of underlying diagnosis or age at the time of transport.
  
  
  CONCLUSIONS
  Successful LDAT of ELBW infants, including critically ill infants with intestinal perforation, is possible. Use of personnel, experienced and trained in aviation transport physiology, overcomes the extreme physiologic operating environment associated with LDATs.
authors.affiliation: Department of Neonatology, US Naval Hospital Okinawa and 18th Medical Group, Kadena Air Base, Japan. ryan.mcadams@med.navy.mil
authors.forename: R M
authors.initials: RM
authors.lastname: McAdams
authors.forename: S A
authors.initials: SA
authors.lastname: Dotzler
authors.forename: G L
authors.initials: GL
authors.lastname: Pole
authors.forename: J D
authors.initials: JD
authors.lastname: Kerecman
mesh_terms: D000367:Age Factors; D017732:Air Ambulances; D005260:Female; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000628:therapy*; D015931:Intensive Care, Neonatal / Q000379:methods; D007416:Intestinal Perforation / Q000401:mortality / Q000628:therapy; D007564:Japan; D008297:Male; D010348:Patient Care Team; D011027:Pneumoperitoneum / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate