Browning Carmo Kathryn, Lutz Tracey, Greenhalgh Mark, Berry Andrew, Kluckow Martin, Evans Nick
Neonatal and Paediatric Emergency Transport Service (NETS), Sydney, NSW, Australia.
Grace Centre for Newborn Intensive Care, CHW, Sydney, NSW, Australia.
Acta Paediatr. 2017 Aug;106(8):1296-1301. doi: 10.1111/apa.13881. Epub 2017 May 29.
Document the incidence of haemodynamic pathology in critically ill preterm newborns requiring transport.
A transport neonatologist performed cardiac and cerebral ultrasound before and after transportation of infants born ≤30 weeks gestation.
Forty-four newborns were studied in 2008-2015; of them, 21 were transported by road, 19, by helicopter and four, by fixed wing: median birthweight, 1130 g (680-1960 g) and median gestation, 27 weeks (23-30); 30 of 44 were male babies. Antenatal steroid course was complete in two babies. Ultrasound in the referring hospital was at a mean of two hours: 47 minutes (00:15-7:00) of age. Low systemic blood flow was common: 50% had right ventricular output <150mL/kg/min and 23%, a superior vena cava flow <50mL/kg/min. at stabilisation. Cranial US: 10 Grade I IVH, 2 Grade II IVH, 1 Grade IV IVH and 32 normal scans pretransport. After transport, three further Grade I IVH were reported. Mortality was higher in the babies with low systemic blood flow: 4 of 12 (33%) died vs 1 of 31 (6%) in the normal flow group (OR = 7.2, 95% CI: 1.1 to 47, p = 0.022).
Point-of-care ultrasound during the retrieval of preterm infants confirms a high incidence of haemodynamic pathology. The use of ultrasound during transport may provide an opportunity for earlier targeted circulatory support.
记录需要转运的危重新生儿血流动力学病变的发生率。
一名新生儿转运医生在对孕周≤30周的婴儿进行转运前后，对其进行心脏和脑部超声检查。
2008年至2015年期间对44例新生儿进行了研究；其中，21例通过公路转运，19例通过直升机转运，4例通过固定翼飞机转运；出生体重中位数为1130克（680 - 1960克），孕周中位数为27周（23 - 30周）；44例中有30例为男婴。两名婴儿完成了产前类固醇疗程。转诊医院的超声检查平均在婴儿出生后两小时进行：年龄为47分钟（00:15 - 7:00）。低体循环血流量很常见：50%的患儿右心室输出量<150mL/kg/min，23%的患儿上腔静脉血流量<50mL/kg/min。在稳定期进行颅脑超声检查：转运前10例为I级颅内出血，2例为II级颅内出血，1例为IV级颅内出血，32例扫描正常。转运后，又报告了3例I级颅内出血。低体循环血流量的婴儿死亡率更高：12例中有4例（33%）死亡，而正常血流量组31例中有1例（6%）死亡（比值比=7.2，95%可信区间：1.1至47，p = 0.022）。
在转运早产儿过程中进行床旁超声检查证实血流动力学病变的发生率很高。在转运过程中使用超声检查可能为早期进行有针对性的循环支持提供机会。
