title: Review of respiratory management of extremely premature neonates during transport.
abstract: BACKGROUND
  The objective was to evaluate the respiratory management of neonates of 23 to 26 weeks' gestation transported after birth outside a tertiary center. Another objective was to collect data regarding survival, intraventricular hemorrhage (IVH), and chronic lung disease.
  
  
  METHODS
  This was a retrospective study of transports from a statewide dedicated neonatal and pediatric transport service over a 3-year period. Data were collected from the local databases. Neonates with and without transcutaneous carbon dioxide (TcCO2) monitoring were compared. Outcomes were compared with the inborn group from the same period.
  
  
  RESULTS
  A total of 43 mechanically ventilated neonates were included. Significant hypocarbia and/or hypercarbia were seen in 49%. Hyperoxia was noted in 46.5%. Despite the moderate correlation between PCO2 and TcCO2 readings, no clinical benefit was seen with TcCO2 monitoring. Survival was 65.1%. Rates of IVH were 60% for any IVH and 27.5% for severe IVH. IVH was more common in the study cohort.
  
  
  CONCLUSIONS
  Neonates born at 23 to 26 weeks' gestation outside tertiary centers have high rates of mortality and morbidity. The avoidance of hypocarbia, hypercarbia, and hyperoxia is challenging in the transport environment. Transcutaneous monitoring is an imperfect tool for following PCO2 levels.
authors.affiliation: New South Wales Newborn and Paediatric Emergency Transport Service, Westmead, New South Wales, Australia. Electronic address: nisharaj31@yahoo.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Maheshwari
authors.affiliation: New South Wales Newborn and Paediatric Emergency Transport Service, Westmead, New South Wales, Australia.
authors.forename: Melissa
authors.initials: M
authors.lastname: Luig
mesh_terms: D017732:Air Ambulances; D016208:Databases, Factual; D006470:Hemorrhage; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D012131:Respiratory Insufficiency / Q000628:therapy*; D013534:Survival