Abstract
Background
Infants born outside perinatal centers may have compromised outcomes due to the transfer speed and efficiency to an appropriate tertiary center. This study aimed to evaluate the impact of regional coordinated changes in perinatal supports and retrieval services on the outcome of transported neonates in Bei**g, China.
Methods
Information about transported newborns between phase 1 (July 1, 2004 to June 30, 2006) and phase 2 (July 1, 2007 to June 30, 2009) was collected. The strategic changes during phase 2 included standardized neonatal transport procedures, skilled attendants, a perinatal consulting service, and preferential admission of transported neonates to the intensive care unit of the tertiary care center. Data from phase 2 (after-strategic changes) were compared with those of phase 1 (the period of pre-strategic changes) after a 12-month washout period, especially regarding the reduction in mortality and selected morbidity.
Results
There was a large increase in the number of transported infants in phase 2 compared with phase 1 (2797 vs. 567 patients). The average monthly rate of increase of transported infants was 383.3% (from 24 infants per month to 116 infants per month). The mortality rate of transported neonates reduced significantly from phase 1 to phase 2 (5.11% vs. 2.82%; P=0.005), particularly for preterm infants (8.47% vs. 4.34%; P=0.006). In addition, transported neonates during phase 2 had significantly decreased morbidities.
Conclusions
Regional coordinated strategies optimizing the perinatal services and transport of outborn sick and preterm infants to tertiary care centers improved survival outcomes considerably. These findings have vital implications for health outcomes and resource planning.
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References
Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where? Why? Lancet 2005;365:891–900.
Murray CJ, Laakso T, Shibuya K, Hill K, Lopez AD. Can we achieve Millennium Development Goal 4? New analysis of country trends and forecasts of under-5 mortality to 2015. Lancet 2007;370:1040–1054.
Spector JM, Castro OR. Coordinated neonatal transport: advancing newborn care in resource-limited settings. Trop Doct 2008;38:68.
Arad I, Braunstein R, Bar-Oz B. Neonatal outcome of inborn and outborn extremely low birth weight infants: relevance of perinatal factors. Isr Med Assoc J 2008;10:457–461.
Chien LY, Whyte R, Aziz K, Thiessen P, Matthew D, Lee SK. Improved outcome of preterm infants when delivered in tertiary care centers. Obstet Gynecol 2001;98:247–252.
Lui K, Abdel-Latif ME, Allgood CL, Bajuk B, Oei J, Berry A, et al. Improved outcomes of extremely premature outborn infants: effects of strategic changes in perinatal and retrieval services. Pediatrics 2006;118:2076–2083.
Samuelson JL, Buehler JW, Norris D, Sadek R. Maternal characteristics associated with place of delivery and neonatal mortality rates among very-low-birthweight infants, Georgia. Paediatr Perinat Epidemiol 2002;16:305–313.
Feng ZC, Wang B, Huang WM, Bi JY, Lan HK, Ji Y, et al. Report and evaluation on work of the neonatal transport network in the Pearl River (Zhujiang) Data. Chin J Contemp Pediatr 1999;1:214–217.
Lu Q. Analysis of improper neonatal transfer. **ao Er Ji Jiu Yi Xue 2001;8:98.
Behrman RE, Kleigman RM, Jenson HB, Nelson Textbook of Pediatrics. WB Saunders: Philadephia. 2004: 249–602.
Gomella TL, Cunningham MD, Eyal FG. Neonatology: Management, Procedures, On-call Problems, diseases, and Drugs. 6th Edition. New York: McGraw-Hill Professional, 2009.
Chung MY, Fang PC, Chung CH, Chen CC, Hwang KP, Chen FS. Comparison of neonatal outcome for inborn and outborn very low-birthweight preterm infants. Pediatr Int 2009;51:233–236.
China Population and Development Research Center. Population natural dynamics in provinces of China 2007. China Statistical Summary 2008. http://wwwcpdrcorgcn/tjsj/tjsj_cydetailasp?id=9754 (accessed November 6, 2011).
Lee SK, McMillan DD, Ohlsson A, Pendray M, Synnes A, Whyte R, et al. Variations in practice and outcomes in the Canadian NICU network: 1996–1997. Pediatrics 2000;106:1070–1079.
Towers CV, Bonebrake R, Padilla G, Rumney P. The effect of transport on the rate of severe intraventricular hemorrhage in very low birth weight infants. Obstet Gynecol 2000;95:291–295.
Lupton BA, Pendray MR. Regionalized neonatal emergency transport. Semin Neonatol 2004;9:125–133.
McNamara PJ, Mak W, Whyte HE. Dedicated neonatal retrieval teams improve delivery room resuscitation of outborn premature infants. J Perinatol 2005;25:309–314.
James AG. Resuscitation, stabilization, and transport in perinatology. Curr Opin Pediatr 1993;5:150–155.
Rashid A, Bhuta T, Berry A. A regionalised transport service, the way ahead? Arch Dis Child 1999;80:488–492.
Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA. Communitybased interventions for improving perinatal and neonatal health outcomes in develo** countries: a review of the evidence. Pediatrics 2005;115:519–617.
Spector JM, Villanueva HS, Brito ME, Sosa PG. Improving outcomes of transported newborns in Panama: impact of a nationwide neonatal provider education program. J Perinatol 2009;29:512–516.
Horbar JD, Badger GJ, Carpenter JH, Fanaroff AA, Kilpatrick S, LaCorte M, et al. Trends in mortality and morbidity for very low birth weight infants, 1991–1999. Pediatrics 2002;110:143–151.
Noone D, Bowden A, Twomey A. The National Neonatal Transport Programme (NNTP) 2004–2009. Ir Med J 2011;104:232–234.
Zhang XF, Li Y, **ao GH, Dai WX, Wang TC, Liu H, et al. Application of regionalized critical neonatal emergency transport system. Zhongguo Dang Dai Er Ke Za Zhi 2012;14:101–104.
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Kong, XY., Liu, XX., Hong, XY. et al. Improved outcomes of transported neonates in Bei**g: the impact of strategic changes in perinatal and regional neonatal transport network services. World J Pediatr 10, 251–255 (2014). https://doi.org/10.1007/s12519-014-0501-1
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DOI: https://doi.org/10.1007/s12519-014-0501-1