Advertisement

Neonatal Vital Sign Trajectories and Risk Factors During Transport Within a Regional Care Network

Published:September 14, 2022DOI:https://doi.org/10.1016/j.amj.2022.08.002

      Abstract

      Objective

      The aim of this study was to characterize vital sign abnormalities, trajectories, and related risk factors during neonatal transport.

      Methods

      We performed a retrospective analysis of neonates transported within a US regional care network in 2020 to 2021. Demographic and clinical data were collected from electronic records. Group-based trajectory modeling was applied to identify groups of neonates who followed distinct vital sign trajectories during transport. Patients with conditions likely to impact the assessed vital were excluded. Risk factors for trajectories were examined using modified Poisson regression models.

      Results

      Of the 620 neonates in the study, 92% had one abnormal systolic blood pressure (SBP) measure, approximately half had an abnormal heart rate (47%) or temperature (56%), and 28% had an abnormal oxygen saturation measure during transport. Over half (53%) were in a low and decreasing SBP trajectory, and 36% were in a high and increasing heart rate trajectory. Most infants ≤ 28 weeks postmenstrual age had 2 or more concerning vital sign trajectories during transport.

      Conclusion

      Abnormal vital signs were common during neonatal transport, and potentially negative trajectories in heart rate and SBP were more common than temperature or oxygen saturation. Transport teams should be trained and equipped to detect concerning trends and respond appropriately while en route.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Air Medical Journal
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Karlsen KA
        • Trautman M
        • Price-Douglas W
        • Smith S.
        National survey of neonatal transport teams in the United States.
        Pediatrics. 2011; 128: 685-691
        • Goldsmith JP.
        Guidelines for Air and Ground Transport of Neonatal and Pediatric Patients.
        Blackwell Publishing Inc, Malden, MA2009: 67-68
        • Macnab A
        • Yuenquan C
        • Gagnon F
        • Biraj B
        • Laszlo C.
        Vibration and noise in pediatric emergency transport vehicles: a potential cause of morbidity?.
        Aviat Space Environ Med. 1995; 66: 212-219
        • Alonzo CJ
        • Nagraj VP
        • Zschaebitz JV
        • Lake DE
        • Moorman JR
        • Spaeder MC.
        Heart rate ranges in premature neonates using high resolution physiologic data.
        J Perinatol. 2018; 38: 1242-1245
        • Pejovic B
        • Peco-Antic A
        • Marinkovic-Eric J.
        Blood pressure in non-critically ill preterm and full-term neonates.
        Pediatr Nephrol. 2007; 22: 249-257
        • Oguz F
        • Yildiz I
        • Varkal MA
        • et al.
        Axillary and tympanic temperature measurement in children and normal values for ages.
        Pediatr Emerg Care. 2018; 34: 169-173
        • Kronforst KD.
        Interhospital transport of the neonatal patient.
        Clin Pediatr Emerg Med. 2016; 17: 140-146
        • Zubarioglu U
        • Uslu S
        • Can E
        • Bülbül A
        • Nuhoglu A.
        Oxygen saturation levels during the first minutes of life in healthy term neonates.
        Tohoku J Exp Med. 2011; 224: 273-279
        • Pai VV
        • Kan P
        • Gould JB
        • Hackel A
        • Lee HC.
        Clinical deterioration during neonatal transport in California.
        J Perinatol. 2020; 40: 377-384
        • 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: 304-309
        • Messner H.
        Neonatal transport: a review of the current evidence.
        Early Hum Dev. 2011; 87 (S77-S77)
        • Abdelmawla M
        • Hansen G
        • Narvey M
        • et al.
        Evaluation of transport-related outcomes for neonatal transport teams with and without physicians.
        Paediatr Child Health. 2021; 26: e290-e296
        • Manja V
        • Saugstad OD
        • Lakshminrusimha S.
        Oxygen saturation targets in preterm infants and outcomes at 18-24 months: a systematic review.
        Pediatrics. 2017; 139e20161609
        • Nagin D.
        Group-Based Modeling of Development.
        Harvard University Press, Cambridge, MA2009
        • Jones BL
        • Nagin DS.
        A note on a Stata plugin for estimating group-based trajectory models.
        Sociol Methods Res. 2013; 42: 608-613
        • Frankfurt S
        • Frazier P
        • Syed M
        • Jung KR.
        Using group-based trajectory and growth mixture modeling to identify classes of change trajectories.
        Couns Psychol. 2016; 44: 622-660
        • Nagin DS.
        Group-based trajectory modeling: an overview.
        Ann Nutr Metab. 2014; 65: 205-210
        • Zou G.
        A Modified Poisson regression approach to prospective studies with binary data.
        Am J Epidemiol. 2004; 159: 702-706
        • Gould JB
        • Danielsen BH
        • Bollman L
        • Hackel A
        • Murphy B.
        Estimating the quality of neonatal transport in California.
        J Perinatol. 2013; 33: 964-970
        • Bunkenborg G
        • Poulsen I
        • Samuelson K
        • Ladelund S
        • Akeson J.
        Bedside vital parameters that indicate early deterioration.
        Int J Health Care Qual Assur. 2019; 32: 262-272
        • Giesinger RE
        • McNamara PJ.
        Hemodynamic instability in the critically ill neonate: an approach to cardiovascular support based on disease pathophysiology.
        Semin Perinatol. 2015; 40: 174-188
        • Kasdorf E
        • Perlman JM.
        Hyperthermia, inflammation, and perinatal brain injury.
        Pediatr Neurol. 2013; 49: 8-14
        • Abdul Wahab MG
        • Thomas S
        • Murthy P
        Anbu Chakkarapani A. Factors affecting stabilization times in neonatal transport.
        Air Med J. 2019; 38: 334-337
        • Dargaville PA
        • Gerber A
        • Johansson S
        • et al.
        Incidence and outcome of CPAP failure in preterm infants.
        Pediatrics. 2016; 138 (e20153985-e20153985)
        • Taylor C
        • Jan S
        • Curtis K
        • et al.
        The cost-effectiveness of physician staffed Helicopter Emergency Medical Service (HEMS) transport to a major trauma centre in NSW, Australia.
        Injury. 2012; 43: 1843-1849
        • Kumar N
        • Akangire G
        • Sullivan B
        • Fairchild K
        • Sampath V.
        Continuous vital sign analysis for predicting and preventing neonatal diseases in the twenty-first century: big data to the forefront.
        Pediatr Res. 2020; 87: 210-220
        • Eichenwald EC
        • Hansen AR
        • Martin C
        • Stark AR
        Cloherty and Stark's Manual of Neonatal Care.
        8th ed. Wolters Kluwer, Philadelphia, PA2017