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Trends in neonatal emergency transport in the last two decades

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Abstract

Although maternal antenatal transfer is the preferred option, some infants inevitably need urgent transport to a tertiary neonatal care facility after birth. This study aimed to investigate trends over time in patient characteristics and respiratory management in a large series of neonatal emergency transfers, in order to provide health caregivers an up-to-date profile of such patients and their therapeutic needs. Trends in patient characteristics and respiratory management were evaluated in 3337 transfers by the Eastern Veneto Neonatal Emergency Transport Service in 2000–2019. Joinpoint regression analysis was performed to evaluate trends and to estimate annual percentage changes (APCs). Proportions of preterm neonates increased (APC2000–2012 2.25%), then decreased (APC2012–2019 − 6.04%). Transfers at birth increased (APC2000–2013 2.69%), then decreased (APC2013–2019 − 5.76%). Proportion of neonates with cardiac and surgical diseases declined (APCs2000–2019 − 6.82% and − 3.32%), while proportion of neonates with neurologic diseases increased (APC2000–2019 8.62%). Use of nasal-continuous-positive-airway-pressure (APC2000–2019 9.72%) and high-flow-nasal-cannula (APC2007–2019 58.51%) at call, and nasal-continuous-positive-airway-pressure (APC2000–2019 13.87%) and nasal-intermittent-mandatory-ventilation (APC2000–2019 32.46%) during transfer increased. Mechanical ventilation during transfer decreased (APC2014–2019 − 10.77%). Use of oxygen concentrations at 21% increased at call and during transfer (APCs 2000–2019 2.24% and 2.44%), while oxygen concentrations above 40% decreased at call and during transfer (APCs 2000–2019 − 3.93% and − 5.12%).

Conclusion: Our findings revealed a shift toward a more “gentle” approach and the reduced use of oxygen in respiratory management. Equipment and team expertise should meet the requirements of such changing patients and their therapeutic needs.

What is Known:

• Although antenatal transfer is the preferred option, some infants inevitably need urgent transport to a tertiary neonatal care facility after birth.

• Trend studies investigating cohort information with appropriate statistical methods represent useful instruments to detect changes over time.

What is New:

• Our findings revealed marked changes in patient characteristics and respiratory management in a large series of neonatal emergency transfers during the last two decades.

• Equipment and team expertise should meet the requirements of such changing patients and their therapeutic needs.

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Data availability

Data is available upon reasonable request to the corresponding author.

Abbreviations

APC:

Annual percentage changes

BW:

Birth weight

GA:

Gestational age

HFNC:

High-flow nasal cannula

nCPAP:

Nasal continuous positive airway pressure

nIMV:

Nasal intermittent mandatory ventilation

NICU:

Neonatal intensive care unit

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Acknowledgments

We are very grateful to the nurses and physicians of the EV-NETS for their continuous dedication and care of patients.

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Author notes

  1. Francesco Cavallin equally contributed as co-first authors

Authors and Affiliations

  1. Department of Women’s and Children’s Health, University of Padova, Via Giustiniani, 3, 35128, Padova, Italy

    Daniele Trevisanuto, Cristina Loddo, Laura Brombin, Elisabetta Lolli, Nicoletta Doglioni & Eugenio Baraldi

  2. Solagna, Italy

    Francesco Cavallin

Authors
  1. Daniele Trevisanuto
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  2. Francesco Cavallin
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  3. Cristina Loddo
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  4. Laura Brombin
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  5. Elisabetta Lolli
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  6. Nicoletta Doglioni
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  7. Eugenio Baraldi
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Consortia

on behalf of the Servizio Trasporto Emergenza Neonatale STEN Group

  • Maria Elena Cavicchiolo
  • , Veronica Mardegan
  • , Mariella Magarotto
  • , Daniel Nardo
  • , Daniele Piva
  • , Elena Priante
  •  & Sabrina Salvadori

Contributions

Prof. Trevisanuto contributed to the study concept, study design, data interpretation, and writing of the manuscript. Mr Cavallin was responsible for the statistical design and analysis, data interpretation, and writing of the manuscript. Dr. Loddo contributed to study design, performed data collection, and critically reviewed the manuscript. Ms Brombin contributed to study design, performed data collection, and critically reviewed the manuscript. Ms Lolli contributed to study design, performed data collection, and critically reviewed the manuscript. Dr. Doglioni contributed to study design, coordinated and supervised data collection, and critically reviewed the manuscript. Prof. Baraldi contributed to the study concept, data interpretation, and critically reviewed the manuscript. STEN Group: Maria Elena Cavicchiolo, Veronica Mardegan, Mariella Magarotto, Daniel Nardo, Daniele Piva, Elena Priante, Sabrina Salvadori contributed to the study concept, data collection, and critically reviewed the manuscript contributed to data collection, data interpretation, and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Daniele Trevisanuto.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was approved by the Ethics Committee of the Azienda Ospedaliera di Padova (ref. Prot. n. 0021321/20.02.2020).

Consent to participate

Written informed consent for clinical records to be used for scientific purpose was prospectively given as a routine by parents or caregivers when the patients were transferred to the referral hospital.

Consent for publication

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Communicated by Daniele De Luca

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Trevisanuto, D., Cavallin, F., Loddo, C. et al. Trends in neonatal emergency transport in the last two decades. Eur J Pediatr 180, 635–641 (2021). https://doi.org/10.1007/s00431-020-03908-w

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  • DOI: https://doi.org/10.1007/s00431-020-03908-w

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