Authors (including presenting author) :
Chee YY (1), Tan YW (1), Choi A (1), Dudi A(1), Ng B(1), Yim SW(1), Wong MSR(1)
Affiliation :
(1) Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital
Introduction :
Commencement of clinical service of the Neonatal Intensive Care Unit (NICU) at the HKCH was started in July 2019. HKCH NICU mainly takes care of neonates transferred from other hospitals with neonatal surgical problems. A standardized protocol was developed comprising workflow on case referral, systematic clinical handover via telephone conferencing, and pre-transportation preparation (with specific neonatal transport equipment bag, medications for use during transport together with body-weight specific resuscitation chart to minimize medication error). Interhospital transport of critically ill infants are performed by a designated and specialized Critical Care Transport (CCT) team, comprising of medical and nursing staff equipped with neonatal transport training. Critical care transport will be performed by at least one doctor who is a paediatric specialist and one nurse with prior training on neonatal transport.
Objectives :
1) Review clinical outcomes during interhospital transport.
2) To identify area(s) for service improvement in neonatal transport
Methodology :
This is a retrospective observational study of infants transported between NICU of regional hospitals and the NICU of HKCH by the CCT team over a three-year period between 1st July 2019 to 31st July 2022. Electronic records and medical notes were reviewed and statistical analysis was performed.
Result & Outcome :
Total of 283 transfers (male 58%, female, 42%) were included. The mean gestational age at birth was 33.3 ± 5.1 weeks and birth weight of 2060 ± 984 g. The median age at transport was 7 days of life. 65% (183/283) required invasive or non-invasive ventilatory support, 14% (39/283) required ionotropic support. 84 (critical/serious) complications were documented in 71 patients (25.1%) and a total of 39 interventions were required from 36 patients (12.7%). The most common complications were mild acidosis (31%, 26/85), hypothermia (8%, 23/282) and mild alkalosis (7%, 6/85). Further analysis of hypothermia complications showed improvement when comparing 2019-2020 vs 2021-2022 (69.6% vs 26.1%, p<0.01), following the introduction of the Trans-Warmer® infant transport mattress as thermoregulation for very-low-birth-weight infants.
Conclusion: Complications of transport of critically ill infants are significantly reduced with the establishment of a designated and specialized critical care transport team, with fewer unplanned events during transport when compared to international and local data. This study identifies the areas that require service improvement in the future.
