Predicting the need for pre-transport adjustments in neonatal intensive care depending on the level of initial medical organization

Abstract

Introduction. The need for intensive care adjustments to be made by the transport team at the originating medical organization remains an important element of pre-transport preparation, being an indirect indicator that the level of care does not match the needs of the patient.   The aim of the study is to identify factors associated with the need for therapy adjustments depending on the level of initial medical organization.   Materials and methods. The one-stage, cross-sectional study included the data of visits of the neonatal transport team of the resuscitation and consultative centre of the Regional Children’s Clinical Hospital (Ekaterinburg) in the period 01. 07. 2014–31. 12. 2018 (n = 2029). The sample was divided into groups: the first group – patients from level 1 organizations (22.8 %, n = 462), the second group – patients from level 2 organizations without paediatric intensive care units (34.9 %, n = 709), the third group – patients from level 2 organizations with paediatric intensive care units (32.5 %, n = 659), the fourth group – patients from level 3 institutions (9.8 %, n = 199).   Results. The need for therapy adjustment at baseline was dependent on the level of the institution, with a maximum in level 1 organizations and a minimum in level 3 organizations. The odds ratio of need for therapy correction for level 1 organizations compared to level 2 organizations with paediatric intensive care units was 1.4, 95 % CI [1.2–1.7], p = 0.002, and compared to level 3 organizations was 1.6, 95 % CI [1.2–2.3], p = 0.003. Multivariate analysis identified the following factors associated with the need to adjust therapy at the original facility: for level 1 facilities, respiratory support, dopamine administration; for level 2 facilities without paediatric intensive care units, respiratory support, dopamine and epinephrine infusion, sedation; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; and for level 3 facilities with paediatric intensive care units, respiratory support, dopamine infusion.   Discussion. The need for respiratory support and administration of catecholamines are indicators of the severity of the patient’s condition. Patients in low-acuity healthcare organizations require an increased level of care, regardless of the birth weight and gestational age of the newborn.   Conclusion. Logistic regression analysis revealed factors associated with the need for therapy correction in patients in the initial medical organizations depending on their level. The following factors played a statistically significant role: respiratory support, sedation, intravenous infusion of catecholamines, patient weight.