Department of Women's and Children's Health, University of Padova, Via Giustiniani, 3, 35128, Padova, Italy.
, Solagna, Italy.
Eur J Pediatr. 2021 Feb;180(2):635-641. doi: 10.1007/s00431-020-03908-w. Epub 2021 Jan 7.
Although maternal antenatal transfer is the preferred option, some infants inevitably need urgent transport to a tertiary neonatal care facility after birth. This study aimed to investigate trends over time in patient characteristics and respiratory management in a large series of neonatal emergency transfers, in order to provide health caregivers an up-to-date profile of such patients and their therapeutic needs. Trends in patient characteristics and respiratory management were evaluated in 3337 transfers by the Eastern Veneto Neonatal Emergency Transport Service in 2000-2019. Joinpoint regression analysis was performed to evaluate trends and to estimate annual percentage changes (APCs). Proportions of preterm neonates increased (APC 2.25%), then decreased (APC - 6.04%). Transfers at birth increased (APC 2.69%), then decreased (APC - 5.76%). Proportion of neonates with cardiac and surgical diseases declined (APCs - 6.82% and - 3.32%), while proportion of neonates with neurologic diseases increased (APC 8.62%). Use of nasal-continuous-positive-airway-pressure (APC 9.72%) and high-flow-nasal-cannula (APC 58.51%) at call, and nasal-continuous-positive-airway-pressure (APC 13.87%) and nasal-intermittent-mandatory-ventilation (APC 32.46%) during transfer increased. Mechanical ventilation during transfer decreased (APC - 10.77%). Use of oxygen concentrations at 21% increased at call and during transfer (APCs 2.24% and 2.44%), while oxygen concentrations above 40% decreased at call and during transfer (APCs - 3.93% and - 5.12%).Conclusion: Our findings revealed a shift toward a more "gentle" approach and the reduced use of oxygen in respiratory management. Equipment and team expertise should meet the requirements of such changing patients and their therapeutic needs. What is Known: • Although antenatal transfer is the preferred option, some infants inevitably need urgent transport to a tertiary neonatal care facility after birth. • Trend studies investigating cohort information with appropriate statistical methods represent useful instruments to detect changes over time. What is New: • Our findings revealed marked changes in patient characteristics and respiratory management in a large series of neonatal emergency transfers during the last two decades. • Equipment and team expertise should meet the requirements of such changing patients and their therapeutic needs.
尽管产妇产前转院是首选，但仍有一些婴儿在出生后不可避免地需要紧急转运到三级新生儿护理机构。本研究旨在调查一项大型新生儿急救转运系列中患者特征和呼吸管理方面的随时间变化趋势，以便为医疗保健人员提供有关此类患者及其治疗需求的最新概况。2000 年至 2019 年，通过东威尼托新生儿急救转运服务对 3337 例转运进行了患者特征和呼吸管理趋势评估。采用 Joinpoint 回归分析评估趋势并估计年百分比变化（APC）。早产儿的比例增加（APC2.25%），然后减少（APC-6.04%）。出生时的转运增加（APC2.69%），然后减少（APC-5.76%）。患有心脏和外科疾病的新生儿比例下降（APC-6.82%和-3.32%），而患有神经系统疾病的新生儿比例增加（APC8.62%）。在呼叫时使用鼻持续气道正压通气（APC9.72%）和高流量鼻导管（APC58.51%），以及在转运期间使用鼻持续气道正压通气（APC13.87%）和鼻间歇强制通气（APC32.46%）增加。转运期间机械通气减少（APC-10.77%）。在呼叫和转运期间，使用 21%氧气浓度增加（APC2.24%和 2.44%），而在呼叫和转运期间使用 40%以上氧气浓度减少（APC-3.93%和-5.12%）。结论：我们的研究结果表明，在呼吸管理方面，一种更为“温和”的方法和减少氧气使用的趋势正在出现。设备和团队专业知识应满足此类变化的患者及其治疗需求。已知：• 尽管产前转院是首选，但仍有一些婴儿在出生后不可避免地需要紧急转运到三级新生儿护理机构。• 用适当的统计方法调查队列信息的趋势研究是检测随时间变化的有用工具。新发现：• 在过去二十年中，我们的研究结果表明，在一项大型新生儿急救转运系列中，患者特征和呼吸管理发生了显著变化。• 设备和团队专业知识应满足此类变化的患者及其治疗需求。
