Neonatal Transport Service Research Articles

The role of a neonatal transport service in the initial care of extremely low birth weight infants

Bevezetés: Az extrém kis súlyú (1000 gramm alatti születési súlyú) koraszülöttek világrajövetele sok esetben nem számítható ki, így anyai/magzati veszélyállapotok esetén a méhen belüli szállítás a III. progresszivitási szintű neonatális intenzív centrumokba (NIC-III) nem valósítható meg. Ilyenkor az első életnapon neonatális transzportra kerül sor. Hazánkban kevés adat áll rendelkezésre e koraszülöttek demográfiai és kimeneteli mutatóiról, valamint a szállítást végző neonatális mentőszolgálatok ellátásban nyújtott szerepéről. Célkitűzés: A megszületést követő első életnapon szállított közép-magyarországi extrém kis súlyú koraszülöttek élesztési, kezdeti ellátási, szállítási és rövid távú kimeneteli adatainak elemzése. A születés helyszínén megkezdett definitív III. szintű neonatológiai ellátás eredményeinek bemutatása. Módszer: Retrospektív kohorszvizsgálatunkban a Peter Cerny Alapítványi Mentőszolgálat által 2017. 03. 20. és 2022. 08. 20. között született, 24 órán belül NIC-III-ba szállított, extrém kis súlyú koraszülöttek adatait elemeztük. Kizártuk azokat a betegeket, akiknek súlyos veleszületett fejlődési rendellenességeik voltak, akiket III. szintű NIC egységek között helyeztek át, illetve akiknek a szállítása 10 percnél rövidebb ideig tartott. Eredmények: Vizsgálatunkba 55 koraszülöttet vontunk be, gesztációs koruk medián 25 (tartomány: 21–31) hét, születési súlyuk medián 750 (tartomány: 300–990) gramm volt. 7 újszülött kórházon kívül született. A mentőszolgálat rohamegysége 18 esetben a születés pillanatában a helyszínen tartózkodott, a többi esetben az újszülött életkora a kiérkezéskor medián 52 perc volt. Az ellátócsapat kiérkezésekor az újszülöttek >50%-a hypothermiás volt. A transzport medián távolsága 59 kilométer volt. A betegek testhőmérséklete és vérgázértékei jelentősen javultak a szállítás során. A NIC-III-ról 30 csecsemő (55%) élt túl hazaadásig vagy alacsonyabb progresszivitású szintű osztályra való áthelyezéséig, azonban a 24. gesztációs hét előtt született betegek között nem volt túlélő. Az intézményen kívül született csecsemők közül 5 élt túl. Az összes túlélő között súlyos agyvérzés összesen 7 betegnél fordult elő. Megbeszélés és következtetés: Az első életnapon szállított extrém kis súlyú koraszülöttek halálozása nagy. A helyszínen megkezdett, majd a transzport alatt folytatott definitív mozgó NIC-III-ellátás jelentősen hozzájárulhat a kezdeti ellátás sikerességéhez és a szállítás biztonságos kivitelezéséhez. Orv Hetil. 2024; 165(42): 1643–1651.

Stabilization, respiratory care and survival of extremely low birth weight infants transferred on the first day of life.

To assess stabilization, respiratory care and survival of extremely low birth weight (ELBW, <1000 g at birth) infants requiring emergency transfer to tertiary NICUs on the first day of life. Retrospective cohort study of 55 ELBW infants transported by a dedicated neonatal transport service over a 65-month period. Ventilator data were downloaded computationally. 95% of infants were intubated and received surfactant prior to transfer. Median expired tidal volume was 5.0 mL/kg (interquartile range: 4.6-6.2 mL/kg). Infants ventilated with SIPPV had significantly higher mean airway pressure and minute ventilation, but similar FiO2 compared to babies on SIMV. Blood gases showed significant improvement during transport. 55% of infants survived to discharge from NICU. Most ELBW infants transferred on the first day of life require mechanical ventilation and can be ventilated with 5 mL/kg tidal volume.

Perspectives from military neonatal transport: past, present, and future.

This article traces the historical development of neonatal transport, from ancient Greek mythology to the modern era, with a particular focus on the contributions of U.S. military aviation. The narrative begins with early efforts in thermoregulation through stationary incubators and progresses to the pivotal role of aerial hospitals during World War II. Post-WWII, the establishment of neonatal transport services in New York and advancements in incubator technology set the stage for further innovation. The U.S. military's involvement in neonatal transport, initiated in the 1970s, witnessed significant milestones, including the adaptation of ECMO technology for air transport. The narrative unfolds through the lens of U.S. military neonatology in the Western Pacific, particularly at Clark Air Base. The article concludes with insights into the U.S. Indo-Pacific Command's neonatal transport mission, highlighting challenges faced during the SARS-CoV-2/COVID-19 pandemic and the development of specialized infection containment transport systems.

Assessing Clinical Profile and Short-term Outcomes of Neonates Retrieved by Neonatal Transport Service and Their Co-relation with Neonatal Severity Illness Scores: An Observational Study

Introduction: Newborn transport is a key component of neonatal perinatal care, and its delay is attributed highly to neonatal mortality. Aim: Our study aimed to assess the clinical profile and short-term outcomes (&lt;48 hours of admission) and to apply the severity illness scores to know the impact on outcomes of retrieved neonates. We used Transport Risk Index of Physiological Stability (TRIPS II) score to correlate with short-term morbidities and Score of Neonatal Physiology Perinatal Extension (SNAPPE II) to correlate with overall outcomes of retrieved neonates. Materials and Methods: It was an observational study done on 160 out-born neonatal retrievals over 13 months by a dedicated transport team at a level III NICU in Bengaluru, India. A validated TRIPS II score was recorded pre-transport, at Admission and at 12 and 24 hours of admission, and the SNAPPE II score was recorded at admission. An ROC curve was used to predict the utility of these scores. Results: Among 141 eligible neonates, the common indication for transport was respiratory distress syndrome 57 (40.4%). Extreme pre-terms (&lt;28 weeks; p = .001) and ELBW (&lt;1000 g; p = .001) are associated with an increased mortality rate. The area under the curve (AUC) for TRIPS II in predicting pulmonary bleed (AUC of ROC 0.866, 0.833, 0.823, 0.836), IVH (0.776, 0.79, 0.78, 0.77), worsening of respiratory settings (0.786, 0.814, 0.78, 0.79), and increase in ionotropic support (0.882, 0.904, 0.904, 0.902) at pre-transport, at admission, at 12 hours, and at 24 hours, respectively, was good. The AUC for SNAPPE II was 0.895, which is good in predicting mortality. Conclusion: A dedicated neonatal transport service can reduce the mortality rate significantly to 7.8%. TRIPS II and SNAPPE II scores were good in predicting the morbidities and mortality in retrieved neonates.

Neonatal Transport Network Services: Preparedness of healthcare systems in Southern Nigeria.

Nigeria remains a major contributor to neonatal deaths worldwide, yet little consideration has been given to intra/inter health facility transfer of sick neonates. The dearth of Neonatal Transport Network Services (NNTS) is probably an underappreciated driver of the abysmally high national neonatal mortality indices. This study aimed to evaluate neonatal transport services and the healthcare workers' preparedness among health facilities in Port Harcourt Metropolis, Rivers State, Nigeria. Twenty-eight selected health facilities (tertiary, private hospitals Primary Health Centers] were assessed on the availability, modality and practice of NNTS. Data was analyzed using SPSS Version 23. Routine transfer of high-risk pregnant mothers to higher levels of care occurred always in 14 (50%) and sometimes in 6 (21.4%) facilities; Private cars and taxis were the most common mode of transport in 24 (85.7%) facilities. Two facilities (7.2%) had ambulances equipped with transport incubators. Nurses and nurse attendants with no formal training in NNTS accompanied referred neonates in 2 (7.2%) facilities. Most referring facilities (78.6%) neither rarely or never contacted receiving centres before the arrival of neonates and most nor gave back referrals after offering neonatal care. None (100%) of the facilities had a trained emergency transport team. Health facilities in Southern Nigeria lack a standardized Neonatal Transport Network and are characterized by poor communication between health facilities and inadequately trained personnel for inter-facility transfer of sick neonates. Urgent action is required to address these gaps, including training of healthcare workers on neonatal transport and sharing findings with relevant stakeholders/policymakers to establish a functional neonatal transport network among health facilities.

Assessment of The Neonatal Transport Service in Benha

Assessment of The Neonatal Transport Service in Benha

Structured Referral Call Handling Process Improves Neonatal Transport Dispatch Times.

In 2019 the Southern Alberta Neonatal Transport Service adopted a transport call handling process change to expedite transport team mobilization. This study compares the impact of this change on neonatal transport decision to dispatch and mobilization times. This retrospective cohort study was conducted using a historical cohort of neonates referred for transportation between January 2017 and December 2021. The "dispatch time" (DT) was the time from the start of consultation to the time a decision to dispatch the transport team was made, whereas "mobilization time" (MT) referred to the time from start of consultation to the time the team departed the home base. In 2019, a DT target of <3 minutes was implemented to meet a target MT of <15 and <30 minutes for emergent and urgent high-risk transport referral calls, respectively. In 2021 use of the "Situation" component of the SBAR (Situation, Background, Assessment, Recommendation) communication tool was introduced with the transport team asking five questions to determine need for mobilization. Data between 2017 and 2018 represented the preintervention period, 2019, the "washout" period for implementation, and 2020 to 2021, the postintervention period. Data were analyzed to determine trends in DT and MT. The DT was reduced from a median of 5 to 3 minutes following intervention (p < 0.001). DT target goal of 3 minutes was achieved in 67.08% of calls compared with 26.24% in the preintervention period, (p < 0.001). The team achieved MT target goals in 42.71% of urgent and emergent transfers compared with 18.05% prior to intervention (p < 0.001). Introduction of a time-sensitive referral call handling process improved dispatch and mobilization time of the neonatal transport team. · Time-sensitive triaging of neonatal transport referrals improves dispatch and mobilization time.. · A structured referral call handling process improves the efficiency of neonatal transport decision-making.. · Dedicated neonatal transport vehicles are likely to improve neonatal transport mobilization time..

Safety use of high frequency oscillatory ventilation in transport of newborn infants affected by severe respiratory failure: preliminary data in central Tuscany

BackgroundNeonatal Emergency Transport Services play a fundamental role in neonatal care. Stabilization before transport of newborns suffering from severe respiratory failure is often a challenging problem and some critically ill infants may benefit from High Frequency Oscillatory Ventilation (HFOV) as rescue treatment. In these cases, transition to conventional ventilation for transport may cause a deterioration in clinical conditions. HFOV during neonatal transport has been only exceptionally used, due to technical difficulties. Since May 2018, a new neonatal transport unit is available at the Neonatal Protected Transport Service of the Meyer University Hospital in Florence, equipped with a pulmonary ventilator capable of delivering HFOV. Therefore, we conducted an analysis on patients transferred in HFOV to Neonatal Intensive Care Unit (NICU), in order to evaluate the safety and feasibility of its use during neonatal transport.MethodsA retrospective analysis was performed reviewing medical records of the neonates transported by Meyer Children Hospital’s Neonatal Transport Service between May 2018 and December 2020, and newborns treated with HFOV during ground neonatal transport were identified. Safety was assessed by the comparison of vital signs, hemogas-analysis values and pulmonary ventilator parameters, at the time of departure and upon arrival in NICU. The dose of inotropes, the main respiratory complications (air leak, dislocation or obstruction of the endotracheal tube, loss of chest vibrations) and the number of deaths and transfer failures were recorded.ResultsOut of the approximate 400 newborns transported during the analysis period, 9 were transported in HFOV. We did not find any statistically significant difference in vital parameters, hemogas-analytical values and pulmonary ventilator settings recorded before and after neonatal transport of the nine patients’ parameters (p > 0,05). No patient required additional inotropes during transport. No transport-related deaths or significant complications occurred during transport.ConclusionsThe interest of our report is in the possibility of using HFOV during inter-hospital neonatal transfer. As far as our experience has shown, HFOV appears to be safe for the transportation of newborns with severe respiratory failure. Nevertheless, further larger, prospective and multicentre studies are needed to better evaluate the safety and efficacy of HFOV during neonatal transport.

Organization of Neonatal Transport Service with Regional Perspective - Review Article

Organization of Neonatal Transport Service with Regional Perspective - Review Article

A national retrospective review of neonatal critical care transfers in dedicated critical care transport services in the private sector

South Africa (SA) has a shortage of dedicated neonatal critical care services, which are mostly concentrated in urban areas, thus illustrating the need for neonatal critical care transport (CCT) services. Neonates who are transported by teams without the requisite experience and knowledge in neonatal care are at risk of severe adverse events during transport. This has led to the development of dedicated CCT teams by some emergency medical services. There is a paucity of national literature describing the neonatal population who undergo CCT in dedicated services.To describe a sample of neonates who underwent CCT transfer by dedicated CCT services in the private sector in SA.This observational cohort study with a retrospective descriptive design sampled all neonatal transfers completed during 1 year (1 January 2017 - 31 December 2017) from the dedicated CCT of the two largest national emergency medical services in SA. Data were extracted from patient report forms by trained data extractors, and subjected to descriptive analysis.A total of 444 neonates were transferred between the two services. A total of 760 diagnoses were recorded, yielding an average of ~2 diagnoses per patient. The most prevalent diagnosis was respiratory distress syndrome (n=139, 31%), followed by congenital heart defects (n=123, 28%) and prematurity (n=81, 18%). Patients had an average of ~4 attachments, with the most prevalent being patient monitoring (n=677, 152%). Just under half (n=182, 41%) of patients required ventilatory support. A total of 422 medications were required during transport, yielding a rate of ~1 medication or infusion per neonate transported. The most common infusion was maintenance (n=199, 45%), while almost 1 in 10 neonates required inotropic support (n=33, 7%).This study provides insight into the demographics, most prevalent diagnoses, and interfacility transfer monitoring needs of neonates being transported in SA by two private dedicated CCT services. The results of this study should be used to inform future specialised neonatal CCT courses and qualifications, as well as the scopes of practice of providers transporting neonates.

Neonatal Air Medical Transportation Practices in Italy: A Nationwide Survey

The present article shows the current neonatal air transport organization and activity in Italy. The results were obtained on the basis of a recent 2019 survey (year of activity 2018) performed by the Neonatal Transport Study Group of the Italian Society of Neonatology. The total number of newborn transports during the year 2018 was 6,464. The air-suitable transports were 512 of 5,852 (8.74%), and among them, 101 of 512 (19.72%) were performed by helicopter and 34 by airplane. Besides the availability of air transport, the interfacility distance, weather and traffic conditions, and rural mountainous roads were the main factors in determining the vehicle choice. Neonatal air transport in Italy is not homogeneously distributed and needs organizational corrections. The high density of neonatal emergency transport services on the national territory indicates the need to overcome the limits imposed by regional administrative borders, thus expanding the geographic area of competence.

The use of severity assessment scales in evaluating the transportability of newborns: a cohort retrospective study

Introduction. Standardized assessment of the patient status and the decision on the possibility of transfer is an essential part of the neonatal transport service. However, there are no generally accepted tools for assessing severity and making decisions regarding newborn transfer. Objectives. To compare the capabilities of scales in relation to the decision about the non-transportability of newborns. Materials and Methods. The cohort study included data from 604 trips of the transport team of the neonatal resuscitation and consultation center. The assessment was carried out on the KSHONN, NTISS and TRIPS scales, the distribution of transportable and non-transportable patients was studied depending on the assessment for each scale. The calculation of the risk ratio of nontransportation was performed depending on the assessment on the scales. AUC ROC was calculated for all scales in relation to the decision of transport team about the patientʼs non-transportability. Results. The scores on the scales significantly differ between the subgroups of transportable and non-transportable newborns, p &lt; 0.0001. Significant differences in subgroup distribution were observed depending on the scores between transportable and nontransportable patients. When evaluated by KSHONN 6–8 points, the risk ratio of non-transportability was 61.36 [3.77–999.47]. For NTISS of 20–29 points, the risk ratio of non-transportability was 51.37 [3.18–829.11]. When evaluated by TRIPS 17–23 points, the risk ratio of non-transportability was 18.81 [1.09 — 327.26]. Conclusions. Scales have a high predictor value in relation to the decision of the transport team about the non-transportability of patients. Comparison of the subgroups by the proportion of non-transportable patients indicates that a score of more than 5 according to the KSHONN, more than 19 points on the NTISS scale and more than 16 points on the TRIPS scale are associated with a significant increase in the risk of non-transportability.

The Neonatal Transport Service in Singapore: A 5-Year Review

The Neonatal Transport Service in Singapore: A 5-Year Review

Training Hungarian neonatal transport nurses in screening for retinopathy of prematurity with telemedicine

Purpose Remote screening for retinopathy of prematurity by wide-field digital imaging and network telemedicine is increasingly used to prevent blindness without the unnecessary transport of infants. Our purpose was to train and license dedicated neonatal transport nurses to do this in Hungary. Materials and methods We developed a complex, four-step curriculum in mobile retinotelemetry. Using a robust selection process, we invited eight transport nurses (NtNP/RtN) to receive training during the 2008–2017 project. The curriculum started with the basics of ophthalmology. Using an artificial eye, it continued with the theory and practice of ophthalmologic exams. Then, supervised by an ophthalmologist, each nurse performed 50 video recordings of anaesthetized and non-anaesthetized infants. Results After demonstrating their competence, five of the eight candidate nurses received a license for retinotelemetry. During their subsequent practice, they had to undergo case reviews half-yearly by a specialist and renew their license every 2–3 years. During the 2008–2016 period, we analysed 7,177 remote screenings from a training perspective. During January 1–August 31 in 2017 period, we analysed extra data from 795 remote screenings of 332 infants from specific prevention perspectives. Conclusions With the cooperation of preexisting neonatal transport service and the ophthalmological reading centre of a university hospital, a mobile telemedicine screening network was successfully developed in Hungary. Our results demonstrate how retinotelemetry can support different levels of prevention medicine. The network should work effectively and efficiently with continuous professional development.

Neonatal transport services, a cross-sectional study

Objective: To understand the process and challenges facing neonatal transport in Canada and to delineate their composition and working.Subjects and methodology: An online questionnaire was sent to all neonatal transport team directors/coordinators in Canada. The questionnaire covered different aspects of transport and was pilot tested prior to finalization. The responses were anonymous to the investigators.Results: All sixteen neonatal transport teams in Canada surveyed. Fifteen teams responded. Dedicated team as a model was adopted by 12 teams (80%). A combined Neonatal/pediatrics team, where the team could be assembled by either neonatal or pediatrics intensive care staff, adopted by two (13%). Team members were cross-trained in about quarter of the teams (four teams out of 15) with respiratory therapists and registered nurses performing each other’s roles. Neonatal Resuscitation Program was mandatory for all teams that responded (15 teams) to become certified as a neonatal transport team member. Nine teams use a central dispatch phone call system.Conclusion: As the first to comprehensively describe the status of neonatal transport in Canada, our study shows that neonatal transport teams have similarities as well as differences. Regionalization and differences in referral practices, geography, provincial laws, and manpower are the main reasons why teams may have their individual variations in policies, protocols, and logistics. Our data can be utilized by health professionals and policy makers to improve neonatal transport logistics within their health care systems resulting in better outcomes of transported neonates.

Impact of Education on Hypothermia Delivery during Neonatal Transport

Background: Moderate therapeutic hypothermia (TH) initiated within 6 h of life reduces adverse neurodevelopmental outcomes in infants after perinatal hypoxic ischaemic insult. For infants born in non-tertiary centres, TH may be initiated manually en route to a neonatal intensive care unit (NICU). However, both over- and undercooling is reported with this strategy, precluding some infants from the benefits of TH. Objectives: To evaluate the impact of a region-wide educational programme on the safety and efficacy of manual cooling administered by the Wellington Neonatal Transport Service (NeTS). Methods: Clinical records of infants with hypoxic ischaemic encephalopathy (HIE) retrieved by the Wellington NeTS for TH between January 2012 and June 2017 were reviewed retrospectively. Temperature outcomes of infants retrieved before and after the education programme were compared. Results: A total of 101 infants were cooled manually by Wellington NeTS for TH during the study period. Education and training significantly reduced the rate of overcooling to ≤32.0°C (4/43 [9%] vs. 0/58, p = 0.02). However, there was no difference in the proportion of infants who achieved target rectal temperature within 6 h of life (29/43 [65%] vs. 35/58 [60%], p = 0.57). Conclusions: Introduction of a region-wide educational programme may have improved the safety of manual cooling during neonatal transport but it had a negligible impact on its efficacy. The use of servo-controlled cooling during transport should therefore be considered to improve access to the optimal neuroprotective benefits of TH for outborn infants with HIE.

Abstract P-064: NOT JUST A TEAM LEADER - CREATING THE IDEAL TRANSPORT TEAM

Aims & Objectives: To improve the training of team leaders on a regional retrieval team to better support their nursing colleagues. Methods KIDS/NTS is a regionalized, paediatric and neonatal intensive care retrieval and transport service based in the UK Midlands, transporting around 1,800 infants/children annually. KIDS (paediatric team) train 10–15 doctors and 8–10 nurses annually to transport critically ill infants/children. The team is usually comprised of a team leader (Consultant/Advanced Nurse Practitioner (ANP)/Registrar/Clinical Fellow), a nurse and an ambulance technician. Anecdotal feedback from KIDS nurses suggested differences in team leadership depending on the discipline of the team leader affected their stress levels. To understand this, all KIDS/NTS nurses (n=25) were surveyed (Figure 1).Results Response rate was 48%. The discipline of the team leader was identified in 66.7% of responses as affecting stress levels with 58.3% preferring ANP’s as team leader. Familiarity with the nurse’s role was identified as a reason for this preference in 91.7% of respondents, as was transport experience for 75% of respondents. 66.7% felt that spending more time with retrieval nurses and 58.3% a more structured supernumerary period would be beneficial to training. Lack of familiarity with the ‘transport process’ was also cited as a stressor. Conclusions A key factor to stress levels experienced by nurses on the team was shown to be familiarity of the nurse’s roles. The survey findings have been used to redesign training to narrow the gap between disciplines. All new team leaders are now trained by core ANP’s and time is allocated to work alongside retrieval nurses.

Feasibility and Safety of Controlled Active Hypothermia Treatment During Transport in Neonates With Hypoxic-Ischemic Encephalopathy.

To evaluate the feasibility and safety of controlled active hypothermia versus standard intensive care during neonatal transport in patients with hypoxic-ischemic encephalopathy. Cohort study with a historic control group. All infants were transported by Neonatal Emergency & Transport Services to a Level-III neonatal ICU. Two hundred fourteen term newborns with moderate-to-severe hypoxic-ischemic encephalopathy. An actively cooled group of 136 newborns were compared with a control group of 78 newborns. Controlled active hypothermia during neonatal transport. Key measured variables were timing of hypothermia initiation, temperature profiles, and vital signs during neonatal transport. Hypothermia was initiated a median 2.58 hours earlier in the actively cooled group compared with the control group (median 1.42 [interquartile range, 0.83-2.07] vs 4.0 [interquartile range, 2.08-5.79] hours after birth, respectively; p < 0.0001), and target temperature was also achieved a median 1.83 hours earlier (median 2.42 [1.58-3.63] vs 4.25 [2.42-6.08] hours after birth, respectively; p < 0.0001). Blood gas values and vital signs were comparable between the two groups with the exception of heart rate, which was significantly lower in the actively cooled group. The number of infants in the target temperature range (33-34°C) on arrival was 79/136 (58.1%) and the rate of overcooling was 16/136 (11.8%) in the actively cooled group. In the overcooled infants, Apgar scores, pH, base deficit, and eventual death rate (7/16; 43.8%) indicated more severe asphyxia suggesting poor temperature control in this subgroup of patients. Adverse events leading to pulmonary or circulatory failure were not observed in either groups during the transport period. Therapeutic hypothermia during transport is feasible and safe, allowing for significantly earlier initiation and achievement of target temperature, possibly providing further benefit for neonates with hypoxic-ischemic encephalopathy.

Evaluation of neonatal transport in a European country shows that regional provision is not cost-effective or sustainable and needs to be re-organised.

There are three dedicated and 41 on-call neonatal emergency transport services (NETS) in Italy, and activity levels vary dramatically. We examined the cost-effectiveness of a hub-and-spoke NETS by looking at the costs and activity levels in the Liguria region and established the financial needs for improving NETS across Italy. The cost of running NETS in the Liguria region from 2012 to 2015 was evaluated and analysed, and three different models determined the transports needed each year to provide the best organisational model. The average number of NETS transports in the Liguria region during the study period was 234, and the models indicated that 200-350 transports per year were the optimal amount of activity that was needed to achieve good financial performance and for the personnel to acquire a suitable skill set. Only five of the 41 on-call Italian NETS and the three dedicated services carried out more than 200 transports a year. Of the rest, 26 carried out up to 100 and 10 carried out 101-200. Italian NETS, which are managed on the basis of regional decisional autonomy, are expensive and no longer sustainable in this era of limited financial resources. A complete overhaul is urgently needed.

Hyperglycemia in transported neonates: A tertiary care experience

Introduction: Hyperglycemia is common in low birth weight and sick neonates which affect them adversely due to hyperosmolarity. As these neonates need often referral to higher setup, maintenance of euglycemia during transport should be emphasized. Objective: To know the prevalence of hyperglycemia on admission among outborn neonates and analyze the association of different transport variables and other clinical parameters with it. Methods: An observational, analytical, and cross-sectional study was designed and conducted on outborn neonates, enrolled by simple consecutive sampling from November 2014 to October 2016. All data were analyzed using SPSS version 24 and Microsoft Excel version 16 software. Results: Out of 394 outborn neonates, 33.75% were hyperglycemic. 76.4% newborns were transported by ambulance, 94.9% were stabilized before referral, 61.2% had accompanying paramedics, 86.5% neonates given intravenous fluid (IVF) during transport, 61.4% transported by moderately equipped, and 38.6% by poorly equipped vehicle. Admission hyperglycemia was significantly associated with variables such as gestational age, birth asphyxia, type of transport vehicle, duration of transport, IVF during transport, hypoxic ischemic encephalopathy, and neonatal jaundice with p&lt;0.05. Logistic regression model taking variable which shows a strong association, we can predict 70.3% time correctly the hyperglycemia on admission. Conclusion: Prevalence of hyperglycemia found to be quite common in referred neonates. Although there is quite improvement in neonatal transport due to the implementation of various government transport schemes for patients, specialized neonatal transport service with accompanied skill personnel and care during transport is a long way to go.