title: The effect of transport on the physiologic stability of neonates with ductal-dependent single-ventricle lesions.
abstract: OBJECTIVE
  To compare the status of infants with hypoplastic left heart syndrome (HLHS) or pulmonary atresia-hypoplastic right heart (PA-HRH) before and following transport using the validated Transport Risk Index of Physiologic Stability (TRIPS) score.
  
  
  METHODS
  In this retrospective review of infants with HLHS or PA-HRH transported to a Children's Hospital by a pediatric transport team, an increase in TRIPS score (temperature, blood pressure, respiratory status, and response to stimuli) following transport was defined as deterioration. Statistical analyses included t-test (paired and independent), χ2, and McNemar's tests for comparisons between groups with and without deterioration and before and after transport.
  
  
  RESULTS
  Our cohort [n = 64; 39 (61%) HLHS and 25 (39%) PA-HRH] was predominantly female (61%), black (56%), and diagnosed antenatally (78%). Median transport time was 20 (10-30) min and age was <12 h in 48 (75%) infants. TRIPS scores worsened after transport in 24 (37.5%) infants, due to temperature (n = 10) or respiratory (n = 7) dysregulation. Infants who deteriorated during transport had HLH more often (83 versus 48%) and lower pH [7.27 (0.12) versus 7.33 (0.07)]. HLH was significantly predictive of deterioration during transport [OR 5.60 (95% C.I. 1.18-26.62)].
  
  
  CONCLUSIONS
  The physiologic deterioration in a third of infants with single ventricle following short transports is intriguing and may have implications on their optimal place of birth.
authors.affiliation: a Department of Pediatrics , Children's Hospital of Michigan , Detroit , MI , USA.
authors.forename: Silvestre R
authors.initials: SR
authors.lastname: Duran
authors.affiliation: a Department of Pediatrics , Children's Hospital of Michigan , Detroit , MI , USA.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: a Department of Pediatrics , Children's Hospital of Michigan , Detroit , MI , USA.
authors.forename: Girija
authors.initials: G
authors.lastname: Natarajan
mesh_terms: D000328:Adult; D000075902:Clinical Deterioration; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000002:abnormalities; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008297:Male; D018633:Pulmonary Atresia / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors; D014187:Transportation of Patients; D055815:Young Adult
keywords: Transport; hypoplastic left heart; neonate; single ventricle