Mortality Risk Factors in Neonates Requiring Interhospital Transport

Abstract

Objective. To identify predictors of newborn infants mortality before medical evacuation.Materials and methods. The observational, cohort, retrospective study included 564 newborns: 526 patients survived and 38 died after 604 visits of the resuscitation-consultation Center transport team (critical care transport — CCT team). Patient's anamnesis, objective data of a patient at the time of examination by CCT team, the volume of intensive care provided and treatment adjustments during preparation for the transfer, records of patient's monitored parameters and indicators of prognosis were analyzed.Results. Compared to survivors, non-survivors neonates exhibited significant increases in premature new-borns (gestation period <29 weeks in 55.26% vs 10.27% in survivors, P<0.001) and significantly increased need in a high-frequency ventilation (7.89% [1.66-21.38] vs 0.57% [0.12-1.66] in survivors, P=0.005), and in cate-cholamines support (use of adrenaline was 13.51% [4.54-28.77] in non-survivors vs 0.76% [0.21-1.94] in survivors, P<0.001). Both early and late neonatal infections predominated in non-survivors: ([26.32% [13.40-43.10] vs 8,75% [6,47-11,49, early infection, non-survivors vs. survivors, respectively, P=0.002) and (23.6% 8 [11.44-40.24] vs 10.46% [7.97-13.39], late infection, non-survivors vs. survivors, respectively, P=0.028). Significant differences in the fraction of inspired oxygen (30% [30-30] vs 45% [30-60], P<0.001), oxygenation saturation index (2.71 [2.54-3.03] vs 4.48 [2.55-7.67], P<0.001), and SpO2/FiO2 ratio (316.67 [313.33-320] vs 207.25 [151.67-313.33] P<0.001) were found between the groups of survived vs. non-survived neonates, respectively. Logistic regression model revealed following markers of neonatal mortality: birth weight, development of early and late neonatal infection, and the oxygenation saturation index.Conclusion. Low birth weight, development of early or late neonatal infection and an increase in the oxygenation saturation index are the risk factors of death in newborns requiring medical evacuation.

Keywords

• newborn transportation
• threat-metric scale
• neonatal intensive care
• risk of death
• oxygenation index