Impact of land-based neonatal transport on outcomes in transient tachypnea of the newborn
Division of Neonatology, Sami Ulus Maternity, Children's Education and Research Hospital, Ankara, Turkey.American Journal of Perinatology (Impact Factor: 1.91). 04/2011; 28(4):331-6. DOI: 10.1055/s-0030-1270115
We sought to determine the effect of neonatal transport on the incidence of adverse events of transient tachypnea of the newborn (TTN) in term neonates. A retrospective study was performed of neonates who had TTN and were admitted to Neonatal Intensive Care Unit (NICU) of Sami Ulus Maternity, Children's Education and Research Hospital by land-based transport. Data from 208 newborns with TTN were evaluated, and clinical and laboratory findings were compared between patients who were transported from within the city (group 1) or from outside of the city (group 2). In the present study, long-distance land-based neonatal transport increased the adverse effects of TTN in newborns. Arterial blood gas parameters of the neonates in both groups before transport were similar, and these parameters and Downes' scores were comparable in both groups, implying that patients from outside the city had greater respiratory insufficiency than those from inside the city at admission to NICU. Respiratory support in the NICU and pulmonary air leak syndrome ratios were found to be significantly higher in the group from outside the city. Long-distance land-based transport in neonates with TTN increases the severity of illness. Furthermore, adverse events and the outcome of such infants depend on the effectiveness of the neonatal transport system.
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ABSTRACT: To evaluate the performance of the Transport Risk Index of Physiologic Stability (TRIPS) score at admission for early mortality prediction. The study included all consecutive outborn infants admitted to a single neonatal intensive care unit (NICU) over a 3-year period. The data collected included demographic variables, 7-day NICU mortality, and severe (≥ grade 3) intraventricular hemorrhage (IVH), TRIPS score at admission, and Score for Neonatal Acute Physiology II (SNAP-II) and SNAP-Perinatal Extension-II (SNAPPE-II) scores. A total of 175 neonates were enrolled. TRIPS at admission discriminated 7-day mortality from survival with a receiver operating characteristic (ROC) area of 0.80, and predictive performance of TRIPS for severe IVH showed a ROC area of 0.67. The TRIPS had good calibration for all strata (p = 0.49). For gestational age (GA) >32 weeks, the area under the curve (AUC) for TRIPS was 0.71, whereas the AUC for GA ≤32 weeks was 0.99 for 7-day mortality. Predictive performance of TRIPS for 7-day mortality was similar to that of SNAP-II and SNAPPE-II. TRIPS score at admission had a good performance to discriminate high-risk patients for 7-day mortality, mainly infants with GA ≤32 weeks. TRIPS might be a useful triage tool if applied at the time of first contact with a transport service.American Journal of Perinatology 04/2012; 29(7):509-14. DOI:10.1055/s-0032-1310521 · 1.91 Impact Factor
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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.American Journal of Perinatology 05/2013; 31(3). DOI:10.1055/s-0033-1345259 · 1.91 Impact Factor
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