Impact of Interhospital Transport on the Physiologic Status of Very Low-Birth-Weight Infants

Abstract

Objectives To evaluate the change in physiologic stability of very low-birth-weight (VLBW) infants following transport using TRIPS (transport risk index of physiologic stability) score as a measure of physiologic stability and compare changes in TRIPS score in groups of VLBW infants who underwent shorter versus longer transport.

Study Design Retrospective chart review.

Results Our cohort of 106 infants, 44 (41%) of whom were females, had a mean birth weight of 777 g (standard deviation [SD] 159) and median gestational age of 26 weeks (range 23 to 32 weeks). Mean weight at transfer was 1,610 g (SD 924) and mean postnatal age at transfer was 56 days (SD 45). Median time on transport was 15 minutes (range 10 to 85 minutes). All 106 transports were ground transports. Of the 106 infants, 57 (54%) had deterioration, 20 (19%) had improvement, and 29 (27%) had no change in their physiologic status during transport. Comparison of the two transport duration groups based on median transport time as a cutoff point (i.e., ≤ 15 minutes and > 15 minutes) revealed a higher proportion of infants with deterioration in their physiologic status in the prolonged transport (>15 minutes) group (65% versus 45%; p = 0.03). Temperature change, either alone or in combination with other indices, was responsible for change in TRIPS score (deterioration or improvement) in 79% of these infants.

Conclusions Interhospital transport of VLBW infants may cause deterioration in their physiologic status, the likelihood of which is increased with longer duration of transport. Better temperature regulation during interhospital transport may decrease the chances of deterioration in physiologic status of VLBW infants.

Keywords

neonatal transport - TRIPS score - transport duration

• References

• 1 Leslie AJ, Stephenson TJ. Audit of neonatal intensive care transport. Arch Dis Child Fetal Neonatal Ed 1994; 71: F61-F66
• 2 Greene WT. Organization of neonatal transport services in support of a regional referral center. Clin Perinatol 1980; 7: 187-195
• 3 American Academy of Pediatrics Committee on Hospital Care. American Academy of Pediatrics Committee on Hospital Care: guidelines for air and ground transportation of pediatric patients. Pediatrics 1986; 78: 943-950
• 4 Mori R, Fujimura M, Shiraishi J , et al. Duration of inter-facility neonatal transport and neonatal mortality: systematic review and cohort study. Pediatr Int 2007; 49: 452-458
• 5 Lee SK, Zupancic JA, Pendray M , et al; Canadian Neonatal Network. Transport risk index of physiologic stability: a practical system for assessing infant transport care. J Pediatr 2001; 139: 220-226
• 6 Lee SK, Zupancic JA, Sale J , et al. Cost-effectiveness and choice of infant transport systems. Med Care 2002; 40: 705-716
• 7 Lucas da Silva PS, Euzébio de Aguiar V, Reis ME. Assessing outcome in interhospital infant transport: the transport risk index of physiologic stability score at admission. Am J Perinatol 2012; 29: 509-514
• 8 Lerner EB, Billittier AJ, Dorn JM, Wu YW. Is total out-of-hospital time a significant predictor of trauma patient mortality?. Acad Emerg Med 2003; 10: 949-954
• 9 Bartolacci RA, Munford BJ, Lee A, McDougall PA. Air medical scene response to blunt trauma: effect on early survival. Med J Aust 1998; 169: 612-616
• 10 Karagol BS, Zenciroglu A, Ipek MS, Kundak AA, Okumus N. Impact of land-based neonatal transport on outcomes in transient tachypnea of the newborn. Am J Perinatol 2011; 28: 331-336
• 11 Mohamed MA, Aly H. Transport of premature infants is associated with increased risk for intraventricular haemorrhage. Arch Dis Child Fetal Neonatal Ed 2010; 95: F403-F407
• 12 Arad I, Gofin R, Baras M, Bar-Oz B, Peleg O, Epstein L. Neonatal outcome of inborn and transported very-low-birth-weight infants: relevance of perinatal factors. Eur J Obstet Gynecol Reprod Biol 1999; 83: 151-157
• 13 Towers CV, Bonebrake R, Padilla G, Rumney P. The effect of transport on the rate of severe intraventricular hemorrhage in very low birth weight infants. Obstet Gynecol 2000; 95: 291-295
• 14 Sehgal A, Roy MS, Dubey NK, Jyothi MC. Factors contributing to outcome in newborns delivered out of hospital and referred to a teaching institution. Indian Pediatr 2001; 38: 1289-1294