Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 150 No. 3334 (2020)

Neonatal transport in Switzerland: a retrospective single-centre analysis – quo vadis?

DOI
https://doi.org/10.4414/smw.2020.20308
Cite this as:
Swiss Med Wkly. 2020;150:w20308
Published
18.08.2020

Summary

AIM

To assess neonatal transport activities by the neonatal transport teams of the University Children’s Hospital Zurich in order to identify opportunities for improvement in the organisation of these transports.

METHODS

Retrospective analysis of prospectively collected data on neonatal transports by the neonatal transport teams of the University Children’s Hospital Zurich between January 2014 and December 2018. Data on transports affecting neonates with a corrected gestational age of up to 44 weeks and a weight less than 5 kg were extracted from registration forms, transport forms, transport reports and the neonates’ medical charts. Transport data were assessed separately for urgent, non-urgent and re-transfers.

RESULTS

During the study period, 1110 transport runs, including 883 (79.5%) urgent, 105 (9.5%) non-urgent and 122 (11.0%) re-transfers were performed. Ground transport accounted for 90.7% of the cases. The majority (77.7%) of the transported neonates were born at term and 59.1% were transported within the first 24 hours of life. The most common reason for transport was respiratory distress (39.9%), followed by cardiac diseases (14.6%). Medical procedures performed by the neonatal transport teams during transport mostly addressed peripheral intravenous line placement (41.8%) and feeding tube placement (41.8%). The median preparation time for urgent transfers was 35 min (range 8–225) for ground and 50 min (range 20–260) for air transport.

CONCLUSIONS

The high proportion of urgent transfers emphasises the need for an efficient neonatal transport system and dedicated neonatal transport teams staffed by members with training in neonatal transport and expertise in handling neonatal emergencies. To provide the best possible care to the vulnerable neonates, the heterogeneous nature of the cohort of transported neonates regarding the diagnoses transport demand was made for and the medical procedures performed during transport should be considered in simulation training of neonatal transport team staff. Additionally, processes to improve preparation time should be defined and implemented in order to reduce it to less than 30 min so as to guarantee efficient care. Further studies are needed to assess the quality and efficacy of neonatal transports in Switzerland. National guidelines on the standard of neonatal transport and quality metrics should be established in order to set benchmarks and to improve the quality of the transports.

References

  1. Messner H. Neonatal transport: a review of the current evidence. Early Hum Dev. 2011;87(Suppl 1):S77. doi:.https://doi.org/10.1016/j.earlhumdev.2011.01.018
  2. Hohlagschwandtner M, Husslein P, Klebermass K, Weninger M, Nardi A, Langer M. Perinatal mortality and morbidity. Comparison between maternal transport, neonatal transport and inpatient antenatal treatment. Arch Gynecol Obstet. 2001;265(3):113–8. doi:.https://doi.org/10.1007/s004040100197
  3. Fenton AC, Leslie A. Who should staff neonatal transport teams? Early Hum Dev. 2009;85(8):487–90. doi:.https://doi.org/10.1016/j.earlhumdev.2009.05.006
  4. Fenton AC, Leslie A. The state of neonatal transport services in the UK. Arch Dis Child Fetal Neonatal Ed. 2012;97(6):F477–81. doi:.https://doi.org/10.1136/archdischild-2011-300573
  5. Soliman Y, Paul R, Pearson K, Alshaikh B, Thomas S, Yusuf K. Neonatal transport services, a cross-sectional study. J Matern Fetal Neonatal Med. 2019;1–6. doi:.https://doi.org/10.1080/14767058.2019.1618823
  6. Gente M, Aufieri R, Agostino R, Fedeli T, Calevo MG, Massirio P, et al.; Neonatal Transport Study Group of the Italian Society of Neonatology (SIN). Nationwide survey of neonatal transportation practices in Italy. Ital J Pediatr. 2019;45(1):51. doi:.https://doi.org/10.1186/s13052-019-0640-z
  7. Swiss Society of Neonatology. Standards for Levels of Neonatal Care in Switzerland. https://www.neonet.ch/application/files/7715/6880/5956/Level_Standards_2019-03-14.pdf. Published 14 March 2019.
  8. McEvoy CG, Descloux E, Schuler Barazzoni M, Stadelmann Diaw C, Tolsa J-F, Roth-Kleiner M. Evaluation of Neonatal Transport in Western Switzerland: A Model of Perinatal Regionalization. Clin Med Insights Pediatr. 2017;11:1179556517709021. doi:.https://doi.org/10.1177/1179556517709021
  9. Roth-Kleiner M, Berger TM, Arlettaz Mieth R. Neue Herausforderungen für die regionale Zusammenarbeit. Swiss Med Forum. 2019;19(2526):408–10. doi:.https://doi.org/10.4414/smf.2019.08267
  10. Swiss Federal Statistical Office. Lebendgeburten nach Kanton und Staatsangehörigkeitskategorie der Mutter, 1970-2018. Neuchâtel: Federal Statistical Office. 2019.
  11. Swiss Society of Neonatology. Accredited neonatology units. https://www.neonet.ch/unit-accreditation/accredited-neonatology-units. (Accessed 2019 December 18)
  12. Kanton Zürich Regierungsrat. Zürcher Spitalliste 2012 Akutsomatik (Version 2018.1; ab 1. Januar 2018). Zürich. 2018.
  13. Lee KS. Neonatal transport metrics and quality improvement in a regional transport service. Transl Pediatr. 2019;8(3):233–45. doi:.https://doi.org/10.21037/tp.2019.07.04
  14. Akula VP, Hedli LC, Van Meurs K, Gould JB, Peiyi K, Lee HC. Neonatal transport in California: findings from a qualitative investigation. J Perinatol. 2020;40(3):394–403. doi:.https://doi.org/10.1038/s41372-019-0409-7
  15. Kempley ST, Sinha AK ; Thames Regional Perinatal Group. Census of neonatal transfers in London and the South East of England. Arch Dis Child Fetal Neonatal Ed. 2004;89(6):F521–6. doi:.https://doi.org/10.1136/adc.2003.029017
  16. Sampaio TZAL, Wilson M, Aubertin C, Redpath S. Diagnosis Discordance and Neonatal Transport: A Single-Center Retrospective Chart Review. Am J Perinatol. 2019;36(5):522–5. doi:.https://doi.org/10.1055/s-0038-1669906
  17. Whyte HE, Jefferies AL ; Canadian Paediatric Society, Fetus and Newborn Committee. The interfacility transport of critically ill newborns. Paediatr Child Health. 2015;20(5):265–9. doi:.https://doi.org/10.1093/pch/20.5.265
  18. Shivananda S, Kirsh J, Whyte HE, Muthalally K, McNamara PJ. Accuracy of clinical diagnosis and decision to commence intravenous prostaglandin E1 in neonates presenting with hypoxemia in a transport setting. J Crit Care. 2010;25(1):174.e1–9. doi:.https://doi.org/10.1016/j.jcrc.2009.04.005
  19. Sumpton JE, Kronick JB. Medication use during neonatal and pediatric critical care transport. Can J Hosp Pharm. 1991;44(3):153–6, 166.
  20. McNamara PJ, Mak W, Whyte HE. Dedicated neonatal retrieval teams improve delivery room resuscitation of outborn premature infants. J Perinatol. 2005;25(5):309–14. doi:.https://doi.org/10.1038/sj.jp.7211263
  21. Gould JB, Danielsen BH, Bollman L, Hackel A, Murphy B. Estimating the quality of neonatal transport in California. J Perinatol. 2013;33(12):964–70. doi:.https://doi.org/10.1038/jp.2013.57
  22. Lee SK, Zupancic JA, Pendray M, Thiessen P, Schmidt B, Whyte R, et al.; Canadian Neonatal Network. Transport risk index of physiologic stability: a practical system for assessing infant transport care. J Pediatr. 2001;139(2):220–6. doi:.https://doi.org/10.1067/mpd.2001.115576
  23. Mori R, Fujimura M, Shiraishi J, Evans B, Corkett M, Negishi H, et al. Duration of inter-facility neonatal transport and neonatal mortality: systematic review and cohort study. Pediatr Int. 2007;49(4):452–8. doi:.https://doi.org/10.1111/j.1442-200X.2007.02393.x
  24. Taskforce on interhospital transport, American Academy of Pediatrics. Guidelines for air and ground transport on neonatal and pediatric patients, 2nd ed. Elk Grove Village: American Academy of Pediatrics; 1999.
  25. Devon C, Jackson A. NTG Annual Transport Data.2019. http://ukntg.net/wp-content/uploads/2020/01/2019-NTG-data-report.pdf. Published January 2020.
  26. Kempley ST, Baki Y, Hayter G, Ratnavel N, Cavazzoni E, Reyes T ; Thames Regional Perinatal Group; Neonatal Transfer Service for London, Kent, Surrey and Sussex. Effect of a centralised transfer service on characteristics of inter-hospital neonatal transfers. Arch Dis Child Fetal Neonatal Ed. 2007;92(3):F185–8. doi:.https://doi.org/10.1136/adc.2006.106047
  27. Bellini C, Pasquarella M, Ramenghi LA, Ambrosino D, Sciomachen AF. Evaluation of neonatal transport in a European country shows that regional provision is not cost-effective or sustainable and needs to be re-organised. Acta Paediatr. 2018;107(1):57–62. doi:.https://doi.org/10.1111/apa.14084
  28. Chen P, Macnab AJ, Sun C. Effect of transport team interventions on stabilization time in neonatal and pediatric interfacility transports. Air Med J. 2005;24(6):244–7. doi:.https://doi.org/10.1016/j.amj.2005.08.003

Most read articles by the same author(s)