title: Risk factors associated to clinical deterioration during the transport of sick newborn infants.
abstract: Adequate neonatal transport is a key component in the care of newborn infants that require transfer. Objective. To determine the characteristics and risk of clinical deterioration during neonatal transport. Material and Methods. This was an observational and prospective study that consecutively included newborn infants transferred to the Neonatal Intensive Care Unit (NICU) of the Hospital Garrahan. The TRIPS (Transport Risk Index of Physiology Stability) risk score was measured pre- and post-transport. A diagnosis of clinical deterioration was made when the post-transport TRIPS score was higher than the pre-transport score. Newborns characteristics, transport distance, newborns status upon admission, need for immediate cardiorespiratory support (ICRS), and death before the 7th day and at discharge were recorded. Bivariate and multivariate analyses were used to assess the associations with clinical deterioration . Results. A total of 160 transferred newborn infants were enrolled, gestational age (GA) was 35 ± 3 weeks; birth weight (BW) 2482 ± 904 g and median age 2 days. Most were referred due to cardiorespiratory (50%) or surgical (34%) illnesses. Of them, 91 (57%) had clinical deterioration and 46% hypothermia. Forty nine neonates required ICRS and 28 died (twelve before 7 days after admittance). Variables assessed were not associated with the risk of clinical deterioration. Mortality was higher in the group with clinical deterioration (OR: 3.34; 95% CI: 1.2-8.7), even when severity of the clinical picture was considered (OR A: 3; 95% CI: 1.2-8.3). Clinical deterioration during transport was associated with the need for ICRS (OR: 2.4; 95% CI: 1.2-5). Conclusions. In our experience transferred newborn infants often suffered loss of stability or clinical deterioration, regardless of their characteristics, and this was related to a higher mortality. Therefore, it is critical to optimize care strategies during all neonatal transports.
authors.affiliation: Neonatal Intensive Care Unit, Hospital de Pediatría SAMIC Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina. gusgold@ciudad.com.ar
authors.forename: Gustavo
authors.initials: G
authors.lastname: Goldsmit
authors.forename: Cecilia
authors.initials: C
authors.lastname: Rabasa
authors.forename: Susana
authors.initials: S
authors.lastname: Rodríguez
authors.forename: Yanina
authors.initials: Y
authors.lastname: Aguirre
authors.forename: Martín
authors.initials: M
authors.lastname: Valdés
authors.forename: Damián
authors.initials: D
authors.lastname: Pretz
authors.forename: Daniela
authors.initials: D
authors.lastname: Carmona
authors.forename: Susana
authors.initials: S
authors.lastname: López Tornow
authors.forename: Diana
authors.initials: D
authors.lastname: Fariña
mesh_terms: D001118:Argentina; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D010360:Patient Transfer; D012017:Referral and Consultation; D012307:Risk Factors