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Impact of transport on arrival status and outcomes in newborns with heart disease: a low–middle-income country perspective

Published online by Cambridge University Press:  09 June 2020

Balaganesh Karmegaraj
Affiliation:
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India
Mahesh Kappanayil*
Affiliation:
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India
Abish Sudhakar
Affiliation:
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India
Raman Krishna Kumar
Affiliation:
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India
*
Author for correspondence: Mahesh Kappanayil, DNB, FNB, Clinical Professor, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Ponekkara PO, Kochi, Kerala682041, India. Tel: +91 484 2853570; Fax: +91 484 280 2020. E-mail: [email protected]

Abstract

Objectives:

We sought to systematically study determinants of “clinical status at arrival after transport” of neonates with CHD and its impact on clinical outcomes in a low- and middle-income country environment.

Methods and results:

Consecutive neonates with CHD (n = 138) transported (median distance 138 km; 5–425 km) to a paediatric cardiac programme in Southern India were studied prospectively. Among 138 neonatal transports, 134 were in ambulances. Four neonates were transported by family in private vehicles; 60% with duct-dependent circulation (n = 57) were transported without prostaglandin E1. Clinical status at arrival after transport was assessed using California modification of TRIPS Score (Ca-TRIPS), evidence of end-organ injury and metabolic insult.

Upon arrival, 42% had end-organ injury, 24% had metabolic insult and 36% had Ca-TRIPS Score >25. Prior to surgery or catheter intervention, prolonged ICU stay (>48 hours), prolonged ventilation (>48 hours), blood stream sepsis, and death occurred in 48, 15, 19, and 3.6%, respectively. Ca-TRIPS Score >25 was significantly associated with mortality (p = 0.005), sepsis (p = 0.035), and prolonged ventilation (p < 0.001); end-organ injury with prolonged ICU stay (p = 0.031) and ventilation (p = 0.045); metabolic insult with mortality (p = 0.012) and sepsis (p = 0.015).

Fifteen babies needed only medical management, 10 received comfort care (due to severe end-organ injury in 3), 107 underwent cardiac surgery (n = 83) or catheter intervention (n = 24), with a mortality of 6.5%. Clinical status at arrival after transport did not impact post-procedure outcomes.

Conclusion:

Neonates with CHD often arrive in suboptimal status after transport in low- and middle-income countries resulting in adverse clinical outcomes. Robust transport systems need to be integrated in plans to develop newborn heart surgery in low- and middle-income countries.

Type
Original Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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Footnotes

*

Equal contribution as first authors.

References

Teasdale, D, Hamilton, C.Baby on the move: issues in neonatal transport. Paediatr Nurs 2008; 20: 2025.CrossRefGoogle ScholarPubMed
Saule, H, Riegel, K, Beltinger, C.Effectiveness of neonatal transport systems. J Perinat Med 1987; 15: 515521.CrossRefGoogle ScholarPubMed
Pieper, CH, Smith, J, Kirsten, GF, Malan, P.The transport of neonates to an intensive care unit. S Afr Med J 1994; 84 (11 Suppl): 801803.Google Scholar
Fenton, AC, Leslie, A, Skeoch, CH.Optimising neonatal transfer. Arch Dis Child Fetal Neonatal Ed 2004; 89:F215F219.CrossRefGoogle ScholarPubMed
Gunn, T, Outerbridge, EW.Effectiveness of neonatal transport. Can Med Assoc J 1978; 118: 646649.Google ScholarPubMed
Fresson, J, Guillemin, F, André, M, Abdouch, A, Fontaine, B, Vert, P.Influence of the transfer mode on short-term outcome in neonates with high perinatal risk. Arch Pediatr 1997; 4: 219226.CrossRefGoogle ScholarPubMed
Lupton, BA, Pendray, MR.Regionalized neonatal emergency transport. Semin Neonatol 2004; 9: 125133.CrossRefGoogle ScholarPubMed
Gould, JB, Danielsen, BH, Bollman, L, Hackel, A, Murphy, B.Estimating the quality of neonatal transport in California. J Perinatol 2013; 33: 964970.CrossRefGoogle ScholarPubMed
Broughton, SJ, Berry, A, Jacobe, S, et al.The mortality index for neonatal transportation score: a new mortality prediction model for retrieved neonates. Pediatrics 2004; 114: e424e428.CrossRefGoogle ScholarPubMed
Lee, SK, Zupancic, JA, Sale, J, Pendray, M, Whyte, R, Brabyn, D.Cost-effectiveness and choice of infant transport systems. Med Care 2002; 40: 705716.CrossRefGoogle ScholarPubMed
Schreiner, K, Reynolds, JW, Benda, G. A scoring system for evaluating the condition of transported neonates. Air Med J 1993; 1: 8992.CrossRefGoogle Scholar
Lee, SK, Zupancic, JA, Pendray, M, et al. Transport risk index of physiologic stability: a practical system for assessing infant transport care. J Pediatr 2001; 139: 220226.CrossRefGoogle Scholar
Reid, S, Bajuk, B, Lui, K, Sullivan, EA; NSW and ACT Neonatal Intensive Care Units Audit Group, PSN. Comparing CRIB-II and SNAPPE-II as mortality predictors for very preterm infants. J Paediatr Child Health 2015; 51: 524528.CrossRefGoogle ScholarPubMed
Heermann, LK, Thompson, CB.Prototype expert system to assist with the stabilization of neonates prior to transport. Proc AMIA Annu Fall Symp 1997: 213217.Google ScholarPubMed
Greene, WT.Organization of neonatal transport services in support of a regional referral center. Clin Perinatol 1980; 7: 187195.CrossRefGoogle ScholarPubMed
Chiu, HS, Vogt, JF, Chan, LS, Rother, CE.Regionalization of infant transports: the southern California experience and its implications. I: referral pattern. J Perinatol 1993; 13: 288296.Google ScholarPubMed
Gupta, N., Leven, L., Stewart, M.et al.Transport of infants with congenital heart disease: benefits of antenatal diagnosis. Eur J Pediatr 2014; 173: 655.CrossRefGoogle ScholarPubMed
Shenoy, RU, DiLorenzo, M.The safety of postnatal transport of newborns prenatally diagnosed with duct-dependent congenital heart disease. J Matern Fetal Neonatal Med 2016; 29: 19111914.CrossRefGoogle ScholarPubMed
Hoffman, JI.The global burden of congenital heart disease. Cardiovasc J Afr 2013; 24: 141145.CrossRefGoogle ScholarPubMed
Duke, T.Transport of seriously ill children: a neglected global issue. Intens Care Med 2003; 29: 14141416.CrossRefGoogle ScholarPubMed
Ramnarayan, P, Intikhab, Z, Spenceley, N, Iliopoulos, I, Duff, A, Millar, J.Inter-hospital transport of the child with critical cardiac disease. Cardiol Young 2017; 27: S40S46.CrossRefGoogle ScholarPubMed
Narang, M, Kaushik, JS, Sharma, AK, Faridi, MM.Mortality in newborns referred to tertiary hospital: an introspection. J Family Med Prim Care 2015; 4: 435438.Google Scholar
Aggarwal, KC, Gupta, R, Sharma, S, Sehgal, R, Roy, MP. Mortality in newborns referred to tertiary hospital: an introspection. J Family Med Prim Care 2015; 4: 435438.Google Scholar
Goldsmit, G, Rabasa, C, Rodríguez, S, et al.Risk factors associated to clinical deterioration during the transport of sick newborn infants. Arch Argent Pediatr 2012; 110: 304309.Google ScholarPubMed
Reddy, NS, Kappanayil, M, Balachandran, R, et al.Preoperative determinants of outcomes of infant heart surgery in a limited-resource setting. Semin Thorac Cardiovasc Surg 2015; 27: 331338.CrossRefGoogle Scholar
Woods, P, Browning Carmo, K, Wall, M, Berry, A. Transporting newborns with transposition of the great arteries. J Paediatr Child Health 2013; 49: E68E73.CrossRefGoogle ScholarPubMed
Shivananda, S, Kirsh, J, Whyte, HE, Muthalally, K, McNamara, PJ. Impact of oxygen saturation targets and oxygen therapy during the transport of neonates with clinically suspected congenital heart disease. Neonatology 2010; 97: 154162.CrossRefGoogle ScholarPubMed
Bakshi, KD, Vaidyanathan, B, Sundaram, KR, et al.Determinants of early outcome after neonatal cardiac surgery in a developing country. J Thorac Cardiovasc Surg 2007; 134: 765771.CrossRefGoogle ScholarPubMed
England, K, Thorne, C, Pembrey, L, Tovo, PA, Newell, ML. Age- and sex-related reference ranges of alanine aminotransferase levels in children: European paediatric HCV network. J Pediatr Gastroenterol Nutr 2009; 49: 7177.CrossRefGoogle ScholarPubMed
Boer, DP, de Rijke, YB, Hop, WC, Cransberg, K, Dorresteijn, EM.Reference values for serum creatinine in children younger than 1 year of age. Pediatr Nephrol 2010; 25: 21072113.CrossRefGoogle ScholarPubMed
World Health Organization. Hypoglycemia of the Newborn: Review of the Literature. World Health Organization, Geneva, 1997. Retrieved August 1, 2018, from http://www.who.int/child_adolescent_health/documents/chd_97_1/en/index.htmlGoogle Scholar
Ganetzky, RD, Cuddapah, SR. Neonatal lactic acidosis: a diagnostic and therapeutic approach. NeoReviews 2017; 18: e217e227.CrossRefGoogle Scholar
Vaidyanathan, B, Kumar, S, Sudhakar, A, Kumar, RK.Conotruncal anomalies in the fetus: referral patterns and pregnancy outcomes in a dedicated fetal cardiology unit in South India. Ann Pediatr Cardiol 2013; 6: 1520.CrossRefGoogle Scholar
Attaining Millennium development goals in India. Infant and child mortality. Retrieved August 17, 2012, from http://www.mospi.gov.in/sites/default/files/publication_reports/MDG_Final_Country_report_of_India_27nov17.pdfGoogle Scholar
Kumar, RK.Screening for congenital heart disease in India: Rationale, practical challenges, and pragmatic strategies. Ann Pediatr Cardiol 2016; 9: 111114CrossRefGoogle ScholarPubMed
Zimmerman, M, Smith, A, Sable, CA, et al.Relative impact of congenital heart disease on mortality in infancy around the globe: the global burden of disease study. Circulation 2017; 136: A14666.Google Scholar