Predictors of unfavorable thermal outcome during newborn emergency retrievals.
OBJECTIVE
Maintenance of normal body temperature is a challenge during transports. We aimed to identify predisposing factors for unfavorable thermal outcome during emergency retrievals of neonates.


METHODS
Demographic data and clinical variables for transports performed over a 2-year period were extracted from the Newborn Emergency Transport Service (Victoria, Australia) database. Arrival temperatures outside normothermia (36.5°-37.5°C) were defined as an unfavorable outcome.


RESULTS
Normothermia on arrival at the receiving hospital was achieved in 78% of 1,261 transports. The strongest predictor of unfavorable thermal outcome was an abnormal temperature at the start of the retrieval (odds ratio [OR] = 8.04; 95% confidence interval [CI], 5.91-10.95; P < .001) followed by very low weight on transport (< 1,500 g; OR = 2.49; 95% CI, 1.63-3.80; P < .001) and respiratory support (OR = 1.81; 95% CI, 1.29-2.54; P = .001). Medications (eg, inotropes and sedation/muscle relaxation) or central/peripheral venous/arterial lines were not significant predictors of outcome when temperature at retrieval start, weight at transport, and respiratory support were adjusted as cofactors. Mode of transport (road, fixed wing, or rotary wing aircraft) and outside temperature were not associated with thermal outcome.


CONCLUSIONS
Abnormal temperature at the start of the retrieval, very low transport weight, and respiratory support were strong predictors of unfavorable thermal outcome during neonatal emergency transports.
Newborn Emergency Transport Service, Royal Children's Hospital, Melbourne, Victoria, Australia; Royal Women's Hospital, Melbourne, Victoria, Australia.
Beatrice
B
Skiöld
Newborn Emergency Transport Service, Royal Children's Hospital, Melbourne, Victoria, Australia; Royal Women's Hospital, Melbourne, Victoria, Australia.
Michael
M
Stewart
Newborn Emergency Transport Service, Royal Children's Hospital, Melbourne, Victoria, Australia; Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia. Electronic address: Christiane.Theda@thewomens.org.au.
Christiane
C
Theda
D017732:Air Ambulances; D000700:Analgesics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D001724:Birth Weight; D001831:Body Temperature; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data; D002406:Catheterization, Peripheral / Q000706:statistics & numerical data; D004632:Emergency Medical Services; D005260:Female; D005334:Fever / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007035:Hypothermia / Q000453:epidemiology*; D062071:Infant, Extremely Premature; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D016017:Odds Ratio; D012121:Respiration, Artificial; D012307:Risk Factors; D012720:Severity of Illness Index; D013696:Temperature; D014187:Transportation of Patients; D014739:Victoria
D000700:Analgesics; D000900:Anti-Bacterial Agents; D000927:Anticonvulsants; D002316:Cardiotonic Agents; D006993:Hypnotics and Sedatives