Transport of sick neonates to a tertiary care hospital, south India: condition at arrival and outcome
Tropical Doctor 2015, Vol. 45(2) 96–99 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0049475514564270 tdo.sagepub.com
Deepak Rathod1, B Adhisivam2 and B Vishnu Bhat3
Abstract Objective: To describe the transport of sick neonates to a tertiary care hospital and evaluate their condition at arrival and outcome. Methods: This descriptive study included 303 extramural neonates who were transported to a tertiary care hospital in south India. Demographic parameters, transport details and clinical features at arrival were recorded. All neonates were followed up till discharge or death. Transport and clinical variables were correlated with outcome. Results: Sepsis and birth asphyxia were the major indications for transport. Only 11% were transported by 108 ambulances (free government service). One-fifth of all neonates died and among them 76% were hypothermic and 10% hypoglycemic on admission. Prematurity, pregnancy induced hypertension (PIH), prolonged rupture of membranes (PROM), respiratory distress, grunting, bleeding, abdominal distension and a positive blood culture correlated with a poor outcome. Conclusion: Stabilisation prior to transport is essential and the principles of neonatal transportation are independent of distance. Hypothermia and hypoglycaemia should be prevented in neonates during transport as they adversely affect the outcome.
Keywords Neonatal, transport, newborn, hypothermia, ambulance, mortality
Reducing under-ﬁve mortality rate by two-thirds is the World Health Organization (WHO) target as per Millennium Development Goal (MDG) 4 and timely treatment of complications for newborns is one of the key strategies for achieving the same.1,2 The phenomenal number of deliveries and poorly organised system of neonatal transport in developing countries are definite hurdles for the achievement of MDG 4. It is not uncommon to see hypothermic, hypoglycaemic, hypoxic or apnoeic neonates arriving at the paediatric emergency room owing to delayed and improper transport.3–5 In utero transfer is the safest transfer, but unfortunately preterm delivery, perinatal illness and congenital malformations cannot always be anticipated, resulting in a continuing need for transfer of these neonates after delivery. These babies are often critically ill and the outcome is partly dependent on the eﬀectiveness of the transport system. There is also paucity of data on neonatal transport in India. This study was done to describe the transport of sick neonates to a tertiary care hospital and evaluate their condition at arrival and outcome.
This descriptive study on neonatal transport was conducted in the Division of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry from February 2012 to January 2013. The study was approved by the Institute’s ethical committee and informed consent was obtained from parents. All extramural neonates (