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  • Meeting abstract
  • Open Access

Stabilization of the critically ill neonate awaiting transport

  • 1Email author,
  • 2,
  • 2,
  • 3,
  • 3 and
  • 4
Italian Journal of Pediatrics201541 (Suppl 1) :A15

https://doi.org/10.1186/1824-7288-41-S1-A15

  • Published:

Keywords

  • Risk Index
  • Multinomial Logistic Regression
  • Stabilization Time
  • Multinomial Logistic Regression Model
  • Frequent Diagnosis

Introduction

An appropriate stabilization before transport is essential to reduce adverse events [15]. The aim of this study was to describe the characteristics of a cohort of newborns transported and to evaluate the association between stabilization time and change of Transport Risk Index of Physiologic Stability (TRIPS score)[6].

Materials and methods

The database of the Neonatal Emergency TransportService in Lazio Region andall newborns transported within May 2009-December 2012 wereanalyzed (N=2,331). A multinomial logistic regression model was used to study the association between stabilization time and improvement and deterioration in TRIPS score in reference to no change, adjusting for potential confounders. Mortality Index for Neonatal Transportation score(MINT) [7] was analysed but not included in the multivariate model due to the covariation with the TRIPS score. In order to evaluate the potential interaction with stabilization times, the data analysis was stratified by perinatal level of care (I, II, III). Two-tailed p-values were considered at 5% significance level.

Results

Table 1 shows descriptive statistics of transport characteristics by birth centre level. Median GA was 36 weeks and 6.6% had less than 28 weeks. Median age at transport was 4.9 hours. The most frequent diagnosis was respiratory diseases in all birth centre levels (52% overall). Mean MINT score was 3.1 and increased from 1.4 to 5.4 across the three levels of care. Median stabilization times were 25 minutes in level I and III, and 30 in level II. Overall, median pre-transport TRIPS score was 6; the highest mean value was observed in level III units (11.7). Overall, 72.9% of all infants showed no TRIPS score change, 22.7% an improvement, and 4.4% a deterioration (4.9% in level III). Figure 1 shows the results from multinomial regression analysis of improvement and deterioration in TRIPS score in reference to no change. An association between stabilization time and TRIPS change was observed, depending on the level of the centre: an increase in stabilization time was associated with increased odds of deterioration (+48% for 1 SD increase, 21.6 minutes) in level I; by contrast, an increase in stabilization time was associated with increased odds of improvement (+49%) in level III. Both effects were observed in level II units.
Table 1

Infants characteristics byperinatal level of care. Lazio, 2009-December 2012

 

Birth centre level

 
 

I N=966

II N=651

III N=714

Total N=2331

Gestational age (wks)

    

22-27 (%)

8 (0.8)

30 (4.6)

117 (16.4)

155 (6.6)

28-31 (%)

37 (3.8)

52 (8.0)

212 (29.7)

301 (12.9)

32-36 (%)

313 (32.4)

200 (30.7)

280 (39.2)

793 (34.0)

37+ (%)

608 (62.9)

369 (56.7)

105 (14.7)

1082 (46.4)

Mean (SD)

37.0 (2.8)

36.1 (3.9)

31.9 (4.1)

35.2 (4.2)

Median

37

37

32

36

Age at transport (hours)

    

Mean (SD)

15.2 (16.8)

15.0 (16.1)

6.8 (11.2)

12.6 (15.6)

Median

6.6

6.9

3.1

4.9

Group of diagnosis/symptoms (%)

    

Antenatal conditions

194 (20.1)

128 (19.7)

312 (43.7)

634 (27.2)

Respiratory

511 (52.9)

370 (56.8)

340 (47.6)

1221 (52.4)

Cardiovascular

39 (4.0)

29 (4.5)

29 (4.1)

97 (4.2)

Infectious

53 (5.5)

38 (5.8)

6 (0.8)

97 (4.2)

Hematologic

66 (6.8)

33 (5.1)

5 (0.7)

104 (4.5)

Other

103 (10.7)

53 (8.1)

22 (3.1)

178 (7.6)

MINT a

    

Mean (SD)

1.4 (3.5)

3.2 (5.5)

5.4 (5.7)

3.1 (5.2)

Median

0

0

4

0

Birthplace (%)

    

Municipality of Rome

550 (56.9)

175 (26.9)

689 (96.5)

1414 (60.7)

Other

416 (43.1)

476 (73.1)

25 (3.5)

917 (39.3)

Stabilization time (minutes)

    

Mean (SD)

31.6 (20.0)

39.6 (26.3)

28.5 (17.2)

32.9 (21.6)

Median

25

30

25

30

TRIPS score pre

    

Mean (SD)

5.8 (7.4)

9.6 (10.8)

11.7 (11.3)

8.7 (10.0)

Median

5

6

6

6

TRIPS change (%)

    

Deterioration

40 (4.1)

28 (4.3)

35 (4.9)

103 (4.4)

No change

697 (72.2)

445 (68.4)

557 (78.0)

1699 (72.9)

Improvement

229 (23.7)

178 (27.3)

122 (17.1)

529 (22.7)

aThe Mortality Index for Neonatal Transportation was available for March 2010-December 2012.

Figure 1
Figure 1

Association between stabilization time and Transport Risk Index of Physiologic Stability change: results of adjusted multinomial logistic regression models stratified by birth centre level. Lazio, May 2009-December 2012.

Conclusion

The findings suggest that specialized level of care contribute to improve the prognosis of sick infants, although the transportation may alter neonatal physiology. Future research may include also other process and outcomes measures.

Authors’ Affiliations

(1)
Department of Pediatrics and Infant Neuropsychiatry, Neonatal Emergency Transport Service, Sapienza University of Rome, Rome, Italy
(2)
Regional Health Department of Lazio, Rome, Italy
(3)
Division of Neonatology and Neonatal Intensive Care, Casilino General Hospital, Rome, Italy
(4)
Department of Paediatrics and Infant Neuropsychiatry, University of Rome “Sapienza”, Rome, Italy

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