Neonatal transport practices and effectiveness of the use of low-cost interventions on the morbidity and mortality of transported neonates in Sub-Saharan Africa: A systematic review protocol (original) (raw)

Neonatal transport practices in Ibadan, Nigeria

Pan African Medical Journal, 2016

Introduction: Neonatal transport involves moving sick neonates in optimal conditions to ensure good outcomes. It is well organized in most developed countries but receives little attention in developing countries where the highest burden of neonatal mortality exists and a large number of newborns require referrals daily for better medical care. This study sought to evaluate the modes of transport, pre-and intra-transport care of neonates referred to the University College Hospital (UCH), Ibadan, Nigeria. Methods: The methods of transporting 401 neonates presenting to the children's emergency room of the hospital were evaluated as well as the care the babies received during transport. Categorical variables were compared using the Chi square test while continuous variables were compared by the student t-test. Results: About a third presented in the first 12hours and 85% in the first week of life, all from within 80km radius. There were 67.1% term, 31.4% preterm and 1.5% post-term neonates, all without prior communication. The modes of transport included private vehicles (43.9%), commercial vehicles (40.6%), motorcycles (9.0%), ambulance (4.0%) and on foot (2.5%). Only 3 (0.7%) were transported in incubators and none in KMC position. Only 42.0% had referral letters and 7.0% were accompanied by medical personnel. Materials available during transport included Ambubags (3.7%), oxygen (3.5%) and some drugs (3.5%). Events during transport were apnoea, 4.7%, vomiting 1.0%, reduced activity 16.2% and seizures 13.7%. 19 (4.7%) neonates were dead on arrival. Pre-transport care included resuscitation (18.2%), intravenous fluid/feeding (24.4%) and supplemental oxygen (14.0%). Conclusion: Neonatal transport practices in Ibadan, Nigeria are abysmal with associated high mortality.

Newborn Transport Practices: Influence on Newborn Survival in Benin City, Nigeria

American Journal of Pediatrics, 2020

Objective: To assess the transfer process, modes of transportation, distances covered to access care, condition on arrival, and outcomes of newborns admitted to hospital in Benin City, Nigeria. Methods: This was a cross sectional survey of all consecutively presenting neonates to the children's emergency unit over a 12-month period. Their demographic information, antepartum and perinatal antecedents, clinical information, main complaint, and co-morbidities were noted on a structured questionnaire. Other information gathered included transfer process, mode of transport, distance covered to reach facility, interventions during transport, condition on arrival, and outcome. Data were analyzed using descriptive statistics, frequencies, and chi-square comparisons; significance was set at P<0.05. Results: Responsible persons for 115 babies-73 males and 42 females-completed the questionnaire. Of the newborns, 62 (53.9%) were of normal birth weight and 43 (37.3%) of low birth weight; of these 37 (32.2%) were preterm. Most cases arrived from peripheral hospitals without referral notes or prior contact with the receiving hospitals. There was no organized pre-or intra-transfer stabilization or medical interventions. Patients came mainly with relatives (89%) or healthcare workers (10%). They arrived in private cars (81%), and were not kept in warm clothes. Distance covered was 10-20 km for more than 50% and over 100 km for less than 8%. Perinatal asphyxia was the commonest reason for transfer (14%). Lower gestational age and cyanosis on presentation significantly affected survival, as only 13 of 25 (52%) with cyanosis and 23 of 37 (62.2%) preterm babies survived. Overall mortality was 30/ 115 (26.1%), and preterm mortality was significantly higher at 14/37 (37.8%). Conclusions: The neonatal transfer process is poorly developed. Prior contact with receiving hospitals is infrequent. Staffing, monitoring, and stabilizing interventions during transfer of sick newborns are inadequate. Transfer mode might have affected survival of preterm infants in particular.

Effect of Current Neonatal Transport Services on Short Term Outcome of Outborn Neonates

Journal of Evolution of Medical and Dental Sciences, 2019

BACKGROUND Neonatal transport is the most important component of regionalized perinatal health care system, but still there are no legal regulations on regionalized perinatal care and transport of sick new-borns in our country. Although hospital-based deliveries have increased, level I & II centers still have extremely limited resources. The need for the systematic transport from these far situated, level I & II centers with inadequate staffing and equipment, indicates the need for better regionalization with special care newborn units at district level. The present study was done to assess the effect of available Neonatal Transport System on morbidity and mortality of out born neonates; including modes, organized transport, special needs and care during transport. MATERIALS AND METHODS In this prospective observational study, we included all neonates (from birth to 28 days of life) born outside SAIMS hospital and referred to SAIMS, Neonatal Intensive Care Unit (NICU) for tertiary care centre for a period of one year. Cases who were found to be dead at the time of arrival to the institute were excluded from the study. RESULTS We observed that immediate and long-term outcome varies with the place of delivery, mode of transport, travelling distance and initial stabilization of the baby. We also found that biochemical and temperature disturbances are more common in babies transported on their own and a specialized neonatal transport service could improve the survival of these new-borns. CONCLUSION All Neonatal health care facilities should have some basic referral guidelines so that events like hypothermia, hypoglycaemia and hypoxia can be prevented.

Neonatal transports—risks and opportunities

Open Journal of Pediatrics, 2011

Aim: To assess the need for and quality of neonatal transports. Material and methods: Prospective observational study of consecutive transports from a level II neonatal unit. Results: 500 transports were undertaken 1982-2010 in 445 patients, representing 0.7% of liveborn infants (n = 61,450). Indications were congenital malformations in 223 (45%), prematurity/respiratory distress syndrome (RDS) in 87 (17%), and other conditions in 190 (38%). For patients ventilated during transport (n = 121) mean pCO 2 was improved at arrival, and for spontaneously breathing patients mean pH, pCO 2 , and base excess (p < 0.05). After establishing a local respirator programme from 1989, transports for prematurity/RDS declined from 3.4 per 1000 live born infants in 1982-1988 to 0.8 per 1000 in 1989-2010 (p < 0.0001), and night-time transports (departure between 22.00 pm -06.00 am) declined from 24/119 (20%) to 38/381 (10%) (p = 0.003). Technical mishaps or severe clinical deterioration occurred in 16 (3%) of the transports. Conclusions: Neonatal transport carries risks, but also an opportunity for further stabilization and improvement. A local respirator programme reduced the need for transfer of premature infants with RDS as well as for transports during night-time.

Transport Factors Affecting the Outcome of Referred Neonates Admitted in A Tertiary Care Hospital

Bangladesh Journal of Child Health, 2018

Background: Adequate neonatal transport is a key component of care of the sick newborns who require referral to tertiary care center. Poor transportation is one of the iatrogenic factors associated with greater neonatal mortality. Neonatal transport is the greatest challenge faced today in our country. The purpose of this study was to find out characteristics of transport of referred neonates and to idention the factors that contribute to mortality. Methodology: This cross sectional study was conducted in Dhaka Shishu (Children) Hospital from June 2013 to November 2013. Both term and preterm neonates who were referred within first seven days of life were included and those with gross congenital abnormalities and left against medical advice were excluded from the study. After enrollment, data were collected using a structured questionnaire including birth details, interventions before transportation, reasons for referral, and details of transportation. Outcome & duration of hospital ...

High risk newborn intra-hospital transport in Neonatal Intensive Care Unit ( NICU )

2013

Aims: Newborns, who are hospitalized, may need transfer due to different reasons that may happen in inter or intra-hospital form, but what should be noted in transferring a newborn is stabilization of the infant’s situation transportationbefore transport and maintaining stability during transportationtransport. So this study had been designed and performed with the aim of “determining intra-hospital neonatal transportation situation”. Methods: In this cross-sectional study, which had been done in selected hospitals of Tehran University of Medical Sciences in 2013, totally 52 intrahospital neonatal transport transportation had been assessed by using equipment standard checklist of the least transportation, transport team, the questionnaire of the newborn condition and the checklist of performing newborn’s stabilization program. Data were analyzed by using SPSS 19 software and descriptive statistic. Results: Most of the transportations had been done by one single person and by special...

The National Neonatal Transport Programme (NNTP) 2004-2009

Irish medical journal, 2011

A retrospective analysis of all National Neonatal Transport Programme (NNTP) transport data from 2004-2009 was performed. 1621 transports were conducted during this period with a yearly average of 271. The majority (96%) were ground transports. 1118 (69%) were forward transfers. Of the 446 (27.5%) retrotransfers, 411 (91%.) were to tertiary centres. When transported, 592 infants (36.5%) were <48 hours old and 770 (47.5%) were <1 week old. 902 transports (55%) involved infants <32 wks birth-gestation and 720 (44%) involved infants weighing <1500gms. Transport for management of patent ductus arteriosus accounted for 357 (22%). The average mobilisation time was 34 minutes. 54% of transports were completed after scheduled service hours. The NNTP currently transports similar numbers of critically ill infants during its 8hr service compared with neonatal transport services that operate 24hr services. Performing PDA ligations in a tertiary neonatal unit would significantly redu...

Studying High risk newborn intra-hospital transport in Neonatal Intensive Care Unit (NICU)

Newborns, who are hospitalized, may need transfer due to different reasons that may happen in inter or intra-hospital form, but what should be noted in transferring a newborn is stabilization of the infant's situation transportationbefore transport and maintaining stability during transportationtransport. So this study had been designed and performed with the aim of "determining intra-hospital neonatal transportation situation". Methods: In this cross-sectional study, which had been done in selected hospitals of Tehran University of Medical Sciences in 2013, totally 52 intrahospital neonatal transport transportation had been assessed by using equipment standard checklist of the least transportation, transport team, the questionnaire of the newborn condition and the checklist of performing newborn's stabilization program. Data were analyzed by using SPSS 19 software and descriptive statistic. Results: Most of the transportations had been done by one single person and by specialist nurses, Most nurses had mean age of 20-29 years old (46.6%) and they were female (72.6%).They had the experience of working ionic (71%). Most of them had not passed the neonatal resuscitation courses, or it was more than six months since their last passed course (61.2%). the majority of the transportations had been done without monitoring blood oxygen (56.6%). There wasn't enough necessary equipment and drugs with the newborn during transportation in most of the transportations (71.8%). Conclusion: neonatal Intra-hospital transportationtransportation is far from the international standard. Considering these conditions, it is expected that authorities of nursing continue education to hold training and skill courses of newborn's Transportation and highlight the part of emotional support in educational programs. Also paying attention to use special incubators and having necessary equipment and drugs needed for transportationtransportation are essential.