Paediatric Intensive Care Transport Research Articles

Relation between the time of the transport team in reaching the bedside of children and the 30-day mortality rate after admission.

China's medical system has not yet issued quality control indicators related to the transfer of critically ill children, and when transport teams receive a transfer request for these children, due to various reasons, the time to arrive at the bedside varies. The aim of this study was to investigate the effect of the time taken by the pediatric intensive care transport team to reach the bedside of children after receiving a transport request on the prognosis of these children. Clinical data of 298 critically ill children admitted to Anhui Children's Hospital through long-distance transport from March 2020 to February 2022 were retrospectively analyzed. Pediatric patients were divided into three groups according to the time taken by the transport team to reach the bedside after receipt of a transport request: the ≤60, >60 to ≤180, and >180 min groups. The 30-day mortality of children after admission (0= no, 1= yes) was used as the dependent variable for multivariate logistic regression analysis, with the odds ratio (OR) and 95% confidence interval (CI) indicating the relation between the time taken by the transport team to reach the bedside and the 30-day mortality rate after admission. P<0.05 indicated a statistically significant difference. During the study period, there were 298 children for whom transports were requested, 50 (16.8%) of whom died within 30 days after admission. The limited evidence revealed that the time taken by the transport team to reach the bedside of children was not significantly related to the 30-day mortality rate after admission in Anhui Children's Hospital (P>0.05). The time taken by the transport team to reach the bedside of children is not associated with the 30-day mortality rate after admission into the pediatric intensive care unit (PICU).

Is Parental Presence in the Ambulance Associated With Parental Satisfaction During Emergency Pediatric Intensive Care Retrieval? A Cross-Sectional Questionnaire Study.

Quality standards for pediatric intensive care transport services in the U.K. state that at least one parent should be allowed to travel with their child during emergency transport to a PICU. We aimed to identify the reasons why parents do, or do not, accompany their child and whether there is an association between parental presence in the ambulance and their satisfaction with the transport. National cross-sectional parent questionnaire. Pediatric Critical Care Transport (PCCT) teams and PICUs in England and Wales. Parents of children transferred to one of 24 participating PICUs between January 2018 and January 2019. None. A parent feedback questionnaire was completed by parents whose child received an emergency interhospital transfer. As part of the questionnaire, a brief nine-item scale was developed to summarize parental transport experience (ranging from 1 to 5). The association between parental presence in the ambulance and parental experience was analyzed. A total of 4,558 children were transported during the study. Consent was obtained from 2,838 parents, and questionnaires received in 2,084 unique transports (response rate: 45.7%). In 1,563 transports (75%), at least one parent traveled in the ambulance. Parents did not travel in 478 transports (23%) and, in most instances (442 transports; 93%), offered reasons (emotional, practical, and health-related) for declining to travel or explanations why they were not permitted to travel (mainly due to space restrictions). Most parents rated their experience with the retrieval teams very highly, and within this context, we found evidence of greater variability in experience ratings if parents were not present in the ambulance and if this was not their choice. Most parents who completed questionnaires rated their experience with their PCCT team highly. Parental presence and choice to travel in the ambulance were associated with a more positive experience.

Modelling the association between weather and short-term demand for children’s intensive care transport services during winter in the South East of England

Data from a paediatric intensive care transport service based in the South East of England between 2006 and 2018 are studied using generalised additive models to investigate the effects of extreme weather on demand in winter. Noticeable increases in daily demand for the service are uncovered after periods of extreme weather, and can be partitioned into two characteristically different phenomena, most pronounced at 2 days and 7 days after a period of particularly low temperature combined with either high or low humidity. The effect is more visible when virus prevalence is accounted for, showing that demand can increase by as much as 30% 7 days after a period of low temperature and low humidity, and 20% 2 days after a period of low temperature and high humidity.

Interhospital transport of children with bronchiolitis by a statewide emergency transport service

Objective: To investigate the rate of interhospital emergency transport for bronchiolitis and intensive care admission following the introduction of high flow nasal cannula and standardised paediatric observation and response charts.Design: Retrospective cohort study.Setting: A statewide paediatric intensive care transport service and its two referral paediatric intensive care units (PICUs) in Victoria, Australia.Participants: Children less than 2 years old emergently transported with bronchiolitis during two time periods: 2008–2012 and 2015–2019.Main outcome measures: Incidence rates of bronchiolitis transport episodes, PICU admissions and respiratory support.Results: 802 children with bronchiolitis were transported during the study period, 233 in the first period (2008–2012) and 569 in the second period (2015–2019). The rate of interhospital transport for bronchiolitis increased from 32.9 to 71.8 per 100 000 children aged 0–2 years. The population-adjusted rate of PICU admission increased from 16.2 to 36.6 per 100 000 children aged 0–2 years. Metropolitan hospitals were the predominant referral source and this increased from 60.1% of transports to 78.6% (P < 0.001). In children admitted to a PICU, the administration of high flow nasal cannula during transport increased significantly from 1.7% to 75.9% (P < 0.001) and a concomitant reduction in continuous positive airway pressure and mechanical ventilation occurred (40–12.4% and 27–6.9% respectively; P < 0.001). The proportion of mechanical ventilation as well as PICU and hospital length of stay decreased over time.Conclusions: The population-adjusted rate of interhospital transport and admission to the PICU for bronchiolitis increased over time. This occurred despite a lower rate of non-invasive and invasive mechanical ventilation during transport and in the PICU.

P0316 / #1765: CAN A NURSE CONSULTANT SAFELY AND EFFECTIVELY MANAGE REGIONAL CRITICAL CARE REFERRALS?

Aims & Objectives: Nurses have trained as “Advanced practitioners (AP)” to deliver some traditional doctor roles in paediatric intensive care (PIC) & PIC transport. Key to staff retention and career longevity, is development andcareer progression. Currently critical care referrals aremedical consultant led. We explored the feasibility of developing Nurse Consultants to deliver consultant-led roles. Methods: AP with >6 years’ experience in PICU and PIC transport post qualification were included. A staged-development plan including AP leading regional referrals with step-wise reduction in immediate consultant supervision (with other safeguards) was produced prospectively with a plan to retrospectively analyse prospectively collected data over 7 months. Assessment plan included: 1. Direct ‘referral handling’ process in terms of quality of advice provided. 2. Indirect impacts such as incident reports, user feedback and peer-review at morbidity and mortality meetings. Results: Three AP’s eligible. 1. 109 calls were collected (53 high dependency level advice and 56 PICU level). Common diagnostic category underlying the referrals were respiratory(33%), followed by cardiovascular (14%), gastro (13%) and neurological (12%). 81% of calls were led by AP, 11% (n=12) needed additional urgent consultant input, 5 – for planned exemptions, 3 -severity of illness and 4 other. Non-urgent consultant advice was needed in 8% (n=7) of cases, 2 logistical and 5 clinical advice 2. No increase of incident reports or concerns raised at MM. Conclusions: The pilot shows feasibility of nurse consultant to safely and effectively deliver traditionally medical consultant led role. Further development process and detailed analysis of the data are on-going.

P0204 / #998: OUTCOME OF NEONATES REFERRED TO COMET WITH A PRELIMINARY DIAGNOSIS OF SEVERE BRONCHIOLITIS – AN UPDATE

Aims & Objectives: Bronchiolitis accounts for a significant number of intensive care transfers. Our initial study established that many neonates referred with the initial diagnosis of bronchiolitis had an alternate diagnosis. However, majority of the ones with final diagnosis of Bronchiolitis had a virus isolated from nasopharyngeal aspirate (NPA). CoMET (Children’s Medical Emergency Transport) is a Paediatric Intensive Care transport service in the UK. We wanted to re-evaluate the outcome of neonates requiring intensive care transfers with the referral diagnosis of bronchiolitis. Methods: We studied all neonatal referrals to CoMET with diagnosis of bronchiolitis from the end of our last study till December 2019. Transport data log and discharge documents were reviewed. Results: Our initial study showed that out of 19 neonates with referral diagnosis of Bronchiolitis 8 (42%) had a final diagnosis of Bronchiolitis; 7 out of these 8 babies (88%) had a positive NPA. Eleven babies (58%) had alternative diagnosis including three with congenital heart disease and 8 with non-viral infections. Follow up study showed six among thirty (20%) neonates referred with bronchiolitis had an alternative final diagnosis. Out of these six neonates, 5 (16%) had non-viral infections including potentially serious infections such as meningitis/encephalitis and one had Spinal Muscular Atrophy SMA Type 1. Of the 24 with a discharge diagnosis of bronchiolitis, 22 (92%) had a viral organism isolated from nasopharyngeal aspirate (NPA). Conclusions: Positive NPA, for a viral organism, suggests bronchiolitis. If negative, another diagnostic possibility should be strongly considered.

Pediatric Critical Care Transport: Survey of Current State in Latin America. Latin American Society of Pediatric Intensive Care Transport Committee.

An electronic, anonymous, multicenter survey housed by Monkey Survey was sent to physicians in LA and included questions about hospital and pediatric critical transport, resources available and level of car. Nineteen Latin-American countries were asked to complete the survey. A total of 212 surveys were analyzed, achieving a representativity of 19 LA countries, being most participants (59.4%, n = 126) from South America (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Uruguay and Venezuela). Most surveys were conducted by physicians of tertiary level centers (60.8%, n = 129), most of the institutions were classified by the participants as public health care centers (81.6%, n = 173). Most of the surveyed physicians (63.7%, n = 135) reported that there is a coordination center for critical care transport (CCT). In most cases, physicians report that a unified transport system for pediatric critical patients does not exist in their countries (67.45%, n = 143). Only 59 (30.7%) surveys reported the use of an exclusively pediatric critical care transport system. Most of these transport systems are described as a mixture of public and private efforts (51.56%, n = 99), but there is also a considerable involvement of government-funded critical transport systems (43.75%, n = 84). Specific training for personnel devoted to transportation of critically ill patients is reported in 55.6% (90), and the medical equipment necessary to carry out the transport is available in 67.7%. The majority (83.95%, n = 136) mentioned that access to advanced life support courses is possible. Training in triage and disaster is available in 44.1%. Physicians and registered nurse were identified as the transport providers in 41.5%, and only one third were made by pediatricians-pediatric nurse. The main reasons for transfers were respiratory illness, neonatal pathologies, trauma, infectious diseases, and neurological conditions. Overall, pediatric transport was reported as insufficient (70.19%, n = 148) by the surveyed physicians in LA and nonexisting by some of them (6.83%, n = 15). There were no regulations or laws in the majority of the surveyed countries (63.13%), and in the places where physicians reported regulatory laws, there were no dissemination (84.9%) by the local authorities. In LA, there is a great variability in personnel training, equipment for pediatric-neonatal transport, transport team composition, and characterization of critical care transport systems. Continued efforts to improve conditions in our countries by generating documents that standardize practices and generating scientific information on the epidemiology of pediatric transfers, especially of critically ill patients, may help reduce patient morbidity and mortality.

Clinical Characteristics and Outcomes for Neonates, Infants, and Children Referred to a Regional Pediatric Intensive Care Transport Service for Extracorporeal Membrane Oxygenation.

To describe the clinical characteristics and outcomes of referrals for extracorporeal membrane oxygenation to a regional pediatric intensive care transport service, and identify clinical features at initial referral that predict the eventual need for extracorporeal membrane oxygenation. Retrospective analysis of prospectively collected data. Specialist pediatric intensive care transport service based at a large U.K. extracorporeal membrane oxygenation center. All referrals made for potential extracorporeal membrane oxygenation transport between January 2014 and July 2017. None. Demographic and clinical data at the time of referral, referral outcome, and 90-day mortality status were extracted. Univariate and multivariate analyses were used to identify clinical features at initial referral in neonates that predicted the need for extracorporeal membrane oxygenation. Of 253 extracorporeal membrane oxygenation referrals, 203 were included: 64 of 203 received extracorporeal membrane oxygenation (31.5%), 18 were accepted for extracorporeal membrane oxygenation but died before extracorporeal membrane oxygenation could be provided (8.8%), and 121 did not receive extracorporeal membrane oxygenation (59.6%). The transport team mobilized in 136 of 203 referrals (66.9%); conventional transport to an extracorporeal membrane oxygenation center was successful in 127 of 136 (93.4%), while nine of 136 were too unstable to transport. The 90-day mortality for the cohort was 17.7% (36/203). In logistic regression analysis, the odds ratio of requiring extracorporeal membrane oxygenation for diaphragmatic hernia was 12.0 (95% CI, 2.8-52.1) compared to meconium aspiration syndrome. Oxygenation index and Vasoactive-Inotropic Score were independent predictors of the need for extracorporeal membrane oxygenation in neonates. In this large cohort of neonatal and pediatric extracorporeal membrane oxygenation referrals to a pediatric intensive care transport service, a considerable portion of extracorporeal membrane oxygenation referrals (59.6%) continued on conventional management; however, 8.8% of the referrals died before extracorporeal membrane oxygenation could be provided. Earlier referral for extracorporeal membrane oxygenation; targeted referral triage using primary diagnosis, oxygenation index, and Vasoactive-Inotropic Score; and access to mobile extracorporeal membrane oxygenation services and faster mobilization of transport teams are important factors that could improve outcomes.

Attitudes towards fever amongst UK paediatric intensive care staff

Staff on paediatric intensive care units in the United Kingdom and Ireland tends to treat temperatures within the febrile range. There was a willingness to conduct a randomized controlled trial of treatment of fever. What is known: • The effect of fever on the outcome in paediatric critical illness is unknown. • Paediatricians have traditionally been reluctant to allow fever in sick children. What is new: • Paediatric intensive care staff report a tendency towards treating fever, with a median reported treatment threshold of 38°C. • There is widespread support amongst PICU staff in the UK for a randomized controlled trial of temperature in critically ill children. • Within a trial setting, PICU staff attitudes to fever are more permissive than in clinical practice.

Shock Index Values and Trends in Pediatric Sepsis: Predictors or Therapeutic Targets? A Retrospective Observational Study.

Shock index (SI) (heart rate [HR]/systolic blood pressure [SBP]) has been used to predict outcome in both adult and pediatric sepsis within the intensive care unit (ICU). We aimed to evaluate the utility of SI before pediatric ICU (PICU) admission. We conducted a retrospective observational study of children referred to a pediatric intensive care transport service (PICTS) between 2005 and 2011. The predictive value of SI, HR, and blood pressure at three prespecified time points (at referral to PICTS, at PICTS arrival at the referring hospital, and at PICU admission) and changes in SI between the time points were evaluated. Death within the first 48 h of ICU admission (early death) was the primary outcome variable. Over the 7-year period, 633 children with sepsis were referred to the PICTS. Thirty-nine children died before transport to a PICU, whereas 474 were transported alive. Adjusting for age, time points, and time duration in a multilevel regression analysis, SI was significantly higher in those who died early. There was a significant improvement in SI with the transport team in survivors but not in nonsurvivors. However, the predictive value of a change in SI for mortality was no better than either a change in HR or blood pressure. The absolute or change in SI does not predict early death any more than HR and SBP individually in children with sepsis.

Timing of death in children referred for intensive care with severe sepsis: implications for interventional studies.

Early deaths in pediatric sepsis may limit the impact of therapies that can only be provided on PICUs. By introducing selection and survivorship biases, these very early deaths may also undermine the results of trials that employ standard consent procedures. We hypothesized that: 1) the majority of deaths in children with severe sepsis occur very early, within 24 hours of referral to PICU; and 2) a significant proportion of deaths occur before PICU admission. We studied consecutive referrals of newborns through to 16 years of age, between 2005 and 2011 to the Children's Acute Transport Service, the North Thames regional pediatric intensive care transport service, with a working diagnosis of "sepsis," "severe sepsis," "meningococcal sepsis," or "septic shock." The primary outcome measure was the proportion of deaths within 24 hours of referral. Survival distributions of previously healthy children were compared with those with significant comorbidities. Thirteen thousand four hundred and nine referrals were made to Children's Acute Transport Service, of whom 703 (5%) met inclusion criteria. Data on survival to 1 year were available in 627 of 703 patients (89%). One hundred thirty children (130/627; 21%; 95% CI, 18-24%) died in the first year. A higher proportion of children with comorbidity cases (46/85, 54%, 44-64) died compared with previously healthy cases (84/542; 16%; 13-19; p < 0.0005, Fisher exact test). Seventy-one deaths occurred within 24 hours of PICU referral (71/130, 55%, 46-63). The timing of death differed with comorbidity. Similar proportions of children survived to 24 hours (previously healthy children 90% vs children with comorbidity 83%, p = 0.06). However, deaths after 24 hours were infrequent among previously healthy cases (28/84 deaths, 33%, 24-44%) compared with children with comorbidity cases (31/46 deaths, 66%, 53-79%) (p < 0.001, Fisher exact test). This majority of deaths among children referred for pediatric intensive care with for severe sepsis occur within 24 hours. This has important implications for future clinical trials and quality improvement initiatives aimed at improving sepsis outcomes.

973 Regional Paediatric Intensive Care (PIC) Transport Services: Benefits of 2 Becoming 1!

BackgroundApproximately 1.7 million children North West and North Wales (UK) and 600–700 are transferred annually from 31 hospitals into 2 regional PICUs.Prior to 2010 specialist PIC transport teams were unit...

1905 “Keeping the Family Together” Versus “The Worst Journey of our Lives”: Parents Travelling with Regional Paediatric Intensive Care Transport Team

BackgroundFrom approximately 1.7 million children North West and North Wales (UK), 600–700 transferred annually from 31 hospitals into 2 regional PICs. PICS standards 2010 state “wherever possible and appropriate, parents...

Effect of patient- and team-related factors on stabilization time during pediatric intensive care transport

To examine the effects of patient- and transport-related factors on the time spent at the referring hospital by an intensive care retrieval team to stabilize critically ill children and to study the relationship between stabilization time and patient outcome. : Analysis of prospectively collected data during pediatric intensive care transport. A dedicated regional pediatric intensive care retrieval service performing interhospital transports in England. Critically ill children transported to intensive care units over a 2-yr period between April 1, 2006 and March 31, 2008. None. Factors related to the patient (age group, diagnostic category, and severity of illness) and transport (time of referral, team response time, and number of major and minor interventions performed) were analyzed for their effect on stabilization time in univariate and multivariate analyses. The relationship between stabilization time and patient outcome in the first 24 hrs post intensive care unit admission was also studied. Patient acuity was high in the transported population (84% invasively ventilated; 28% on vasoactive agents). Predicted mortality risk (Pediatric Index of Mortality 2 score), diagnostic category, team response time, and number of major interventions performed had an independent effect on stabilization time, whereas the length of stabilization itself did not influence early mortality on the intensive care unit. Each minor intervention prolonged the stabilization time by an average of 10 mins. Stabilization time during intensive care transport is influenced by a number of patient- and transport-related factors, and cannot be used in isolation as an indicator of team efficiency. Time spent undertaking intensive care interventions early in the course of patient illness at the referring hospital does not worsen patient outcome, suggesting that the "scoop and run" model can be safely abandoned in interhospital transport.

Point-of-care blood analyzer during the interhospital transport of critically ill children

To investigate the influence of point-of-care laboratory results (arterial blood gases, ionized calcium, potassium, sodium, glucose, hematocrit and hemoglobin) on therapeutic interventions during interhospital pediatric intensive care transport. Prospective observational study. Specialist pediatric intensive care retrieval team of a university hospital. Critically ill pediatric patients who were referred from a community hospital to a pediatric intensive care of a tertiary center. The retrieval team sampled arterial blood during the time of stabilization in the referring hospital and during transport. All results were recorded and for each result the physician of the specialist retrieval team wrote down the influence on the treatment (none, partly, only). The physician specified the kind of intervention. Point-of-care blood analyses influenced the therapeutic management in 76.5% of all blood samples and in 86.2% of the referred patients. Of all interventions, 42.9% were based only on the laboratory results. The majority of interventions were adjustments of the mechanical ventilation. Point-of-care blood analyses reduced the delay in treatment of potentially life-threatening abnormalities of laboratory results (severe hypokalemia and low hematocrit). During interhospital pediatric intensive care transport, point-of-care blood analyses frequently led to therapeutic interventions. Some abnormal blood results were potentially life threatening and could not have been discovered without point-of-care measurement. We therefore recommend the use of a point-of-care blood analyzer during interhospital intensive care transports, not only for blood gases but also for electrolytes, glucose and hematocrit.

Pediatric interhospital intensive care transport in The Netherlands: Current situation and future perspectives

Kritisch zieke kinderen hebben een betere kans op overleving en genezing indien zij worden behandeld op speciaal daarvoor ingerichte intensieve-zorgafdelingen voor kinderen (picu's). In Nederland is deze zorg gecentraliseerd binnen de acht universitaire ziekenhuizen, hoewel nog een aanzienlijk aantal kinderen die voor overplaatsing in aanmerking komen, niet naar deze centra worden overgeplaatst. Deze centralisatie leidt tot een toename van het aantal interklinische transporten en kan alleen succesvol zijn als de risico's van het transport naar de gespecialiseerde centra worden geminimaliseerd.

Interhospital paediatric intensive care transport: a novel transport unit based on a standard ambulance trolley.

A recent development in providing intensive care for children is that it is more and more centralized in tertiary centres. The centralization of intensive care facilities for children in tertiary centres demands a safe and well-organized transport system. The transfer of critically ill children from a referring general hospital to a tertiary paediatric intensive care centre should be performed by a specially trained and fully equipped transport team. During the transfer of these children continuous intensive care facilities should be provided. The minimal requirements of equipment and materials for transport that allow such care have been determined. The equipment consists of a monitor allowing continuous measurement of vital signs, a defibrillator, tools for airway and ventilatory management, an oxygen source, suction unit, fluid and electrolyte management, medication, resuscitation chart and a communication system. A mobile paediatric intensive care unit was constructed in order to store this equipment, including easily accessible ventilator and materials optimized for close patient observation and ventilator control.

Problems in interhospital pediatric intensive care transport in The Netherlands: results from a survey of general pediatricians.

Interhospital pediatric intensive care transport accompanied by non-trained specialists usually occurs with inadequate equipment and has been associated with high incidence of complications. These facts have serious consequences for patients but also can be very disconcerting for specialists. This survey was undertaken to gain insight into the problems encountered in organizing pediatric intensive care transport in The Netherlands to measure the specialist's satisfaction or dissatisfaction with the current state of affairs in the organization of such transports, and additional workload and feelings of insecurity experienced during self-organized transports. Survey, retrospective. A postal questionnaire sent to all pediatricians of community hospitals in The Netherlands. Results of direct questioning are given as discrete frequencies. After factor and reliability analysis 5-point Likert scale items are summed up in scale constructions. Relationships between scales are examined in regression analysis. Pediatricians appear to be satisfied with current specialist retrieval teams if these teams are available in their region, and highly dissatisfied if not available. Many nontrained specialists consider these transports burdening tasks with a high workload, and they feel insecure during these transports, especially if they report lack of knowledge of the transport equipment. The need for pediatric specialist retrieval teams in The Netherlands is seen not only in the insufficient level of care delivered by accompanying nontrained specialists and the reported high incidence of complications as shown in the literature but also in the dissatisfaction and high stress of these specialists.

Pediatric septic shock.

1. Stephen M. Schexnayder, MD* 1. 2. *Associate Professor of Pediatrics & Internal Medicine, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, AR. After completing this article, readers should be able to: 1. Explain how the host’s immune response may cause toxic effects during sepsis. 2. Delineate the cornerstone of resuscitation in patients who have septic shock. 3. List the factors to be considered when prescribing empiric antimicrobial therapy for septic shock. 4. Explain when referral and transport arrangements should be made for patients in septic shock. Despite major advances in vaccines in the past two decades, septic shock continues to be an important pediatric problem. It is a frequent reason for admission to a pediatric intensive care unit, and this complex problem requires prompt recognition and intervention to improve the likelihood of a good outcome. Because the clinical picture of sepsis is not unique to infectious conditions, a number of definitions have been advocated. Investigators in the field have separated the clinical spectrum of sepsis into the categories of bacteremia, systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, and multiple organ dysfunction syndrome. Clinical observations over the past two decades have led to the description of the systemic inflammatory response syndrome (SIRS) and have identified the major role that endothelium plays in the pathogenesis of this disorder. Infection is one of the major causes of SIRS, but a number of other entities, including trauma, acute respiratory distress syndrome, neoplasms, burns, and pancreatitis, also have been recognized as triggers for this complex series of pathophysiologic events. Although initially written with adult vital sign parameters, the principles behind the definitions shown in Table 1⇓ are valid, and modifications have been proposed for applying them to children. View this table: Table 1. Definitions of the Systemic Inflammatory Response Syndrome Sepsis is a recognized important cause of death, with the highest mortality rate occurring among infants. The most recent data report 5.9 deaths per 100,000 population in infants, with the fatality rate decreasing …

Paediatric intensive care transport.

Paediatric intensive care transport.