Venter M, Theron E, Williams W, Khan W, Stassen W
Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2021 Oct 5;111(10):981-984. doi: 10.7196/SAMJ.2021.v111i10.15736.
South Africa (SA) has a shortage of dedicated neonatal critical care services, which are mostly concentrated in urban areas, thus illustrating the need for neonatal critical care transport (CCT) services. Neonates who are transported by teams without the requisite experience and knowledge in neonatal care are at risk of severe adverse events during transport. This has led to the development of dedicated CCT teams by some emergency medical services. There is a paucity of national literature describing the neonatal population who undergo CCT in dedicated services.
To describe a sample of neonates who underwent CCT transfer by dedicated CCT services in the private sector in SA.
This observational cohort study with a retrospective descriptive design sampled all neonatal transfers completed during 1 year (1 January 2017 - 31 December 2017) from the dedicated CCT of the two largest national emergency medical services in SA. Data were extracted from patient report forms by trained data extractors, and subjected to descriptive analysis.
A total of 444 neonates were transferred between the two services. A total of 760 diagnoses were recorded, yielding an average of ~2 diagnoses per patient. The most prevalent diagnosis was respiratory distress syndrome (n=139, 31%), followed by congenital heart defects (n=123, 28%) and prematurity (n=81, 18%). Patients had an average of ~4 attachments, with the most prevalent being patient monitoring (n=677, 152%). Just under half (n=182, 41%) of patients required ventilatory support. A total of 422 medications were required during transport, yielding a rate of ~1 medication or infusion per neonate transported. The most common infusion was maintenance (n=199, 45%), while almost 1 in 10 neonates required inotropic support (n=33, 7%).
This study provides insight into the demographics, most prevalent diagnoses, and interfacility transfer monitoring needs of neonates being transported in SA by two private dedicated CCT services. The results of this study should be used to inform future specialised neonatal CCT courses and qualifications, as well as the scopes of practice of providers transporting neonates.
南非缺乏专门的新生儿重症监护服务，这些服务大多集中在城市地区，这表明需要新生儿重症监护转运（CCT）服务。由缺乏新生儿护理所需经验和知识的团队转运的新生儿在转运过程中面临严重不良事件的风险。这促使一些紧急医疗服务机构组建了专门的CCT团队。目前国内缺乏描述在专门服务中接受CCT的新生儿群体的文献。
描述在南非私营部门由专门的CCT服务进行CCT转运的新生儿样本。
这项采用回顾性描述设计的观察性队列研究对南非两家最大的国家紧急医疗服务机构的专门CCT在1年（2017年1月1日至2017年12月31日）期间完成的所有新生儿转运进行了抽样。数据由经过培训的数据提取人员从患者报告表中提取，并进行描述性分析。
两家服务机构之间共转运了444名新生儿。共记录了760个诊断结果，平均每名患者约有2个诊断。最常见的诊断是呼吸窘迫综合征（n = 139，31%），其次是先天性心脏病（n = 123，28%）和早产（n = 81，18%）。患者平均有4种左右的附属设备，最常见 的是患者监测（n = 677，152%）。不到一半（n = 182，41%）的患者需要通气支持。转运期间共需要422种药物，即每转运一名新生儿约有1种药物或输液。最常见的输液是维持性输液（n = 199，45%），而近十分之一的新生儿需要强心支持（n = 33，7%）。
本研究深入了解了南非两家私营专门CCT服务机构转运的新生儿的人口统计学特征、最常见的诊断以及机构间转运监测需求。本研究结果应用于为未来专门的新生儿CCT课程和资质认证以及转运新生儿的服务提供者的执业范围提供参考。
