Journal List > Korean J Perinatol > v.24(4) > 1013690

Shin, Lee, Shin, Hwang, Choi, Seo, Choi, Kim, and Hong: Neonatal Transport and Regionalization of Neonatal Intensive Care: The Perspective of Transferred Preterm Infants in a Single Neonatal Intensive Care Unit of the South-western Area of Gyeonggi-do

Abstract

Purpose :

Not only regionalization of neonatal care for high risk newborn, but also safe neonatal transport system of newborn were not completely established in Korea. The aim of this study was to compare the clinical outcomes of preterm infants less than 35 week gestational age with regard to inborn and outborn status, to understand the problems of regionalization of neonatal care and neonatal transport system and to provide the basis to solve the potential problems.

Methods :

This retrospective study included 40 outborn and 40 inborn preterm infants less than 35 week gestational age admitted to the neonatal intensive care unit of Korea University Ansan Hospital during the period between January 2006 and June 2013.

Results :

Compared with those in the inborn group, the incidences of hypoglycemia and respiratory distress were significantly more frequent in the outborn group at admission. The uses of surfactant, ventilator, and inotrope were significantly more frequent in the outborn during hospitalization. Mortality occurred only in the outborn group. Most of infants were transferred by a nurse alone, not a team with doctor.

Conclusion :

Transferred preterm infants may not be sufficiently stabilized before transport, according to the result of more frequent hypoglycemia and respiratory distress in the outborn group. In order to reduce mortality and morbidity of transferred newborn from level I, the national policy about neonatal intensive care unit level guideline (manpower, equipment, and facility), regionalization of neonatal intensive care, and neonatal transport system are needed in Korea.

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Table 1.
Perinatal Characteristics of Outborn and Inborn Groups
  Outborn Group (n=40) Inborn Group (n=40) P-value
Gestational age (week) 32.6±2.4 32.6±2.2  
  33.3 [32.0-34.3] 33.3 [32.1-34.3] 0.397
Birth weight (g) 1,932±555 1,933±572  
  1,979 [1,470-2,350] 1,952 [1,463-2,475] 0.627
Male sex 23 (57.5%) 19 (47.5%) 0.541
1 minute Apgar score 6.8±1.9 7.1±2.1  
  8 [6-8] 7 [6-9] 0.453
Low Apgar score (<3) 1 (2.5%) 1 (2.5%) 1
Low Apgar score (<6) 5 (12.5%) 4 (10%) 1
5 minute Apgar score 8.3±1.5 8.4±1.8  
  9 [8-9] 9 [8-10] 0.419

Values are expressed as number (percent) or Mean±standard deviation and Median [inter-quartiles range]

Table 2.
Clinical Outcomes of Outborn and Inborn Groups at Admission
  Outborn Group (n=40) Inborn Group (n=40) P-value
Systolic blood pressure (mmHg) 54±12 51±11  
  54 [45-61] 49 [45-560] 0.192
Diastolic blood pressure (mmHg) 30±8 26±8  
  27 [23-37] 25 [21-32] 0.062
Heart rate (beat/minute) 140±24 145±16  
  148 [130-155] 148 [138-158] 0.577
Respiratory rate (breath/minute) 50±16 50±12  
  50 [40-62] 48 [41-60] 0.805
Tachypnea (>60 breath/minute) 10 (25%) 7 (17.5%) 0.607
Body temperature (℃) 36.4±0.6 36.0±0.6  
  36.5 [36.0-36.8] 36.2 [35.5-36.5] 0.070
Hypothermia (<36.0℃) 9 (22.5%) 14 (35%) 0.383
Glucose (mg/dL) 62[39-83] 71 [60-82] 0.065
Hypoglycemia (<50 mg/dL) 14 (35%) 6 (15%) 0.039
Blood gas analysis      
pH 7.215±0.140 7.276±0.074  
  7.227 [7.178-7.286] 7.270 [7.238-7.315] 0.036∗
pCO2 (mmHg) 57.0±18.2 48.8±9.8  
  57.3 [48.7-65.6] 47.8 [44.1-52.5] 0.032∗
HCO3 (mmol/L) 23.0±3.2 21.2±4.7  
  23.6 [22.2-24.7] 21.5 [20.1-24.0] 0.096
Base excess (mmol/L) (-5)±4 (-5)±3  
  (-4) [(-6)-(-2)] (-5) [(-6)-(-2)] 0.688
Acidosis (pH <7.2) 14 (35%) 6 (15%) 0.079
Hypercapnia (pCO2 >65 mmHg) 10 (25%) 2 (5%) 0.039
CRP 0.223±0.640 0.024±0.049  
  0.015 [0.010-0.030] 0.014 [0.010-0.020] 0.061
Positive CRP (>0.03 mg/dL) 9 (22.5%) 2 (5%) 0.039

Values are expressed as number (percent) or Mean±standard deviation and Median [inter-quartiles range]. ∗P<0.05 by Wilcoxon signed rank test

P<0.05 by McNemar test

Table 3.
Clinical Outcomes of Outborn and Inborn Groups during Hospitalization
  Outborn Group (n=40) Inborn Group (n=40) P-value
Hospital days 26±18 26±23  
  21 [14-38] 19 [11-39] 0.085
Hospital days except expired newborns group∗ 28±18 23±15  
  24 [14-41] 19 [11-36] 0.005
Duration of mechanical ventilation (day) 2.9±5.8 1.9±8.4  
  0 [0-4.75] 0 [0-0] 0.028
Use of ventilation 17 (42.5%) 8 (20%) 0.049
Use of inotrope 7 (17.5%) 0 (0%) 0.016
Duration of total parenteral nutrition (day) 4.2±7.1 5.0±10.6  
  0 [0-7.75] 0 [0-0] 0.837
Respiratory distress syndrome      
  Present of respiratory distress syndrome 25 (62.5%) 8 (20%) <0.001
  Treated with surfactant 21 (52.5%) 8 (20%) 0.002
Bronchopulmonary dysplasia 0 1 (2.5%) 1.000
Patent ductus arteriosus 3 (7.5%) 2 (5%) 1.000
Intraventricular hemorrhage (≥grade II) 3 (7.5%) 1 (2.5%) 0.625
Necrotizing enterocolitis 0 1 (2.5%) 1.000
Death 4 (10%) 0 0.125

∗Compared outborn group with inborn group except expired newborns (n=36) Values are expressed as number (percent) or Mean±standard deviation and Median [inter-quartiles range]

P<0.05 by Wilcoxon signed rank test

P<0.05 by McNemar test

Table 4.
Characteristics and Facilities while Outborn Preterm Infants were Transferred
  Total (n=40)
Tools of transferred baby  
  Portable incubator 38 (95%)
  Cradle 1 (2.5%)
  Baby wrap 1 (2.5%)
O2 supply during transferred period  
  Yes 37 (92.5%)
  No 3 (7.5%)
Method of O2 supply  
  Free flow O2 13 (32.5%)
  Hood 13 (32.5%)
  Nasal prong 2 (5%)
  Endotracheal tube 9 (22.5%)
  None 3 (7.5%)
Given surfactant before transport 0 (0%)
Intravenous infusion before transport 1 (2.5%)
Use of antibiotics before transport 0 (0%)
Time of arrival at the NICU (min) 95 [74-177]
CPR during transport 2 (5%)
Transport personnel  
  Nurse 29 (72.5%)
  Physician 3 (7.5%)
  Physician+Nurse 8 (20%)

Abbreviations: NICU, neonatal intensive care unit; CPR cardio-pulmonary resuscitation Values are expressed as number (percent) or Median [inter-quartiles range]

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