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

Sang Hoon Shin; un Hee Lee; Jeong Hee Shin; Mi Jung Hwang; Young Ok Choi; Won Hee Seo; Byung Min Choi; Hai Joong Kim; Young Sook Hong

doi:10.14734/kjp.2013.24.4.265

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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

Original Article

Korean J Perinatol 2013;24(4):265-274.

Published online: 19 January 2013

DOI: https://doi.org/10.14734/kjp.2013.24.4.265

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

Sang Hoon Shin, M.D.¹, un Hee Lee, M.D.¹, Jeong Hee Shin, M.D.¹, Mi Jung Hwang, R.N.², Young Ok Choi, R.N.², Won Hee Seo, M.D., Ph.D.¹, Byung Min Choi, M.D., Ph.D.^1,, Hai Joong Kim, M.D., Ph.D.³, Young Sook Hong, M.D., Ph.D.¹

¹Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea

²Korea Department of Nursing, Korea University Ansan Hospital, Ansan, Korea

³Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea

주관책임자 : 최병민, 425-707, 경기도 안산시 단원구 적금로 123 고대안산병원 소아청소년과 전화 : 031)412-5096, 전송 : 031)405-8591 E-mail : cbmin@korea.ac.kr

Received 1 September 2013 Revised 4 October 2013 Accepted 8 October 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Transportation of patients, Regional medical programs, Preterm infant, Resuscitation, Perinatal care

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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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