Neonatal Transport: The Long Drive has Not Even Begun.

Sir,

Transporting a sick newborn to an equipped health facility is a challenge in India due to scarce and inequitably distributed health facilities and underdeveloped transport network. Though in utero transport of the newborn and delivery at an adequately equipped center are ideal, a preterm delivery and all the subsequent perinatal problems cannot always be anticipated. This results in a burgeoning need to transfer such babies after birth.[123] Stabilization of newborn during and before transportation has been shown to improve the condition of newborn in terms of temperature, blood glucose, oxygenation, and blood pressure, thereby improving the outcome of such critically sick neonate.[4567]

We conducted a prospective descriptive study enrolling 220 consecutive neonates who were transferred to extramural level III neonatal Intensive Care Unit (NICU) of our hospital with the objective of analyzing the characteristics of transport and identifying the various indications of referral and complications present at the time of admission.

Data were collected regarding the indication of referral, gestational age, place and mode of delivery, means of transport used, type of vehicle, distance traveled, time taken in transportation, accompanying personnel, facilities such as oxygen, intravenous fluids, and medications, pulse oximeter, transport ventilators, and warming and monitoring methods available during transport.

A total of 170 (77.3%) neonates arrived at the emergency department by private vehicles such as auto/cycle rickshaw (40%), car (23.5%), two-wheeler (22.3%), and bus/train (14%). About 61 (36%) came directly from home without any accompanying doctor/paramedic and the remaining 109 (64%) were referred from some hospital/nursing home. Only fifty (22.7%) neonates were transported by ambulance. However, warming and oxygen facility were available in only 23 (46%) and 24 (48%) of the ambulances, respectively. Only twenty (40%) of these neonates were accompanied by medical personnel. Pretransport stabilization and monitoring sheet were not available for any patient, and the record of evaluation and management done outside was present in only 12 (24%) neonates.

Distance traveled was<3 km in 25 (11.36%), 3–30 km in 163 (74.09%), and more than 30 km in 32 (14.54%) neonates. Time taken for transportation was <30 min in 86 (39.09%), 30 min to 2 h in 110 (50%), and more than 2 h in 24 (10.90%) of the neonates.

The sociodemographic profile of the neonates revealed that almost all (92%) belonged to lower/upper socioeconomic class (modified Kuppuswamy scale). The average monthly income of the family ranged from Rs. 1300–9400. Sixty-four (29%) were home deliveries. The mean day of life and weight at admission were 5.0 days and 2167 g, respectively. The mean gestational age was 34.28 weeks. Male-to-female ratio was 1.2:1.

The various indications for referral of the neonates were respiratory distress syndrome (35.9%), meconium aspiration syndrome (8.18%), perinatal asphyxia (18.6%), neonatal jaundice (32.2%), neonatal sepsis (49.5%), and surgical conditions (6.36%). Evaluation of the neonates at admission in NICU revealed the presence of hypothermia in 51 (23.18%), hypoxia in 41 (18.6%), and hypoglycemia in 16 (7.27%) cases. Mean duration of hospital stay was 7.18 days. During hospital stay, 58 (26.3%) required assisted ventilation and 23 (10.45%) neonates expired.

Findings in the present study indicate that transport conditions of neonates are still the same as two decades before as observed by Singh et al.[8] The overall mortality of referred neonates is high, and a significant number of these deaths can be avoided by promotion of institutional deliveries, early identification and appropriate prereferral stabilization, communication regarding care of newborns during transport, and provision of adequate equipment, skilled workforce, and monitoring facilities during transport of neonates.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.