Assessing Clinical Profile and Short-term Outcomes of Neonates Retrieved by Neonatal Transport Service and Their Co-relation with Neonatal Severity Illness Scores: An Observational Study

Abstract

Introduction: Newborn transport is a key component of neonatal perinatal care, and its delay is attributed highly to neonatal mortality. Aim: Our study aimed to assess the clinical profile and short-term outcomes (<48 hours of admission) and to apply the severity illness scores to know the impact on outcomes of retrieved neonates. We used Transport Risk Index of Physiological Stability (TRIPS II) score to correlate with short-term morbidities and Score of Neonatal Physiology Perinatal Extension (SNAPPE II) to correlate with overall outcomes of retrieved neonates. Materials and Methods: It was an observational study done on 160 out-born neonatal retrievals over 13 months by a dedicated transport team at a level III NICU in Bengaluru, India. A validated TRIPS II score was recorded pre-transport, at Admission and at 12 and 24 hours of admission, and the SNAPPE II score was recorded at admission. An ROC curve was used to predict the utility of these scores. Results: Among 141 eligible neonates, the common indication for transport was respiratory distress syndrome 57 (40.4%). Extreme pre-terms (<28 weeks; p = .001) and ELBW (<1000 g; p = .001) are associated with an increased mortality rate. The area under the curve (AUC) for TRIPS II in predicting pulmonary bleed (AUC of ROC 0.866, 0.833, 0.823, 0.836), IVH (0.776, 0.79, 0.78, 0.77), worsening of respiratory settings (0.786, 0.814, 0.78, 0.79), and increase in ionotropic support (0.882, 0.904, 0.904, 0.902) at pre-transport, at admission, at 12 hours, and at 24 hours, respectively, was good. The AUC for SNAPPE II was 0.895, which is good in predicting mortality. Conclusion: A dedicated neonatal transport service can reduce the mortality rate significantly to 7.8%. TRIPS II and SNAPPE II scores were good in predicting the morbidities and mortality in retrieved neonates.