Lene Nymo Trulsen, Lisa Gullhav Hansen, Nils Thomas Songstad, Astri Lang, Claus Klingenberg
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引用次数: 0
Abstract
Background and aims: Regionalized centralization of moderate and high-risk pregnancies is essential, but a well-organized postnatal transport service is equally important. This study evaluates the overall activity and clinical outcomes of the neonatal air transport team (NATT) at the University Hospital of North Norway (UNN) in Tromsø, covering a large catchment area in the Arctic region of Norway.
Methods: Medical data from all neonatal air transports between the years 1994-2023 were recorded prospectively. Body temperature, blood glucose and blood gas within 3-6 h after arrival at UNN were assessed from medical files retrospectively. To assess temporal changes, we compared data between 1994 and 2008 (Period 1) and 2009-2023 (Period 2).
Results: A total of 882 acute transports were included. Of these, 655 (74.3%) were referrals to the tertiary neonatal unit at UNN and 227 (25.7%) transfers to national surgical centers. Most transports (61.5%) were by fixed wing aircrafts. The proportion of infants transported due to congenital heart defects (CHD), prematurity and asphyxia was lower in Period 2. When comparing Period 1 and 2, upon arrival we found similar rates of hypothermia (9.8% vs. 6.7%, p = 0.17) and hypercapnia (17.3% vs. 15.3%, p = 0.55), but decreasing rates of hypocapnia (6.7% vs. 2.5%, p = 0.014) and hypoglycemia (10.8% vs. 2.3%, p = 0.001). There were low rates of outborn very low birth weight (VLBW) infants (<1,500 g) in both periods; 4.3% and 3.1%. However, severe IVH was observed in 6/29 (20.7%) outborn VLBW-infants vs. only 21/356 (5.9%) inborn VLBW-infants in the last 15-year period.
Conclusion: Decreasing rates of transport due to prematurity and CHDs is probably secondary to improved perinatal care. Rates of hypoglycemia and hypocapnia improved in the second 15-year period, but further focus on improvements in both temperature and CO2 control is warranted. Acute transport of VLBW-infants is associated with a markedly increased risk of severe IVH. In-utero transfer of women with threatened preterm birth to a tertiary perinatal center is therefore paramount.
背景和目的:中等和高危妊娠的区域化集中是必不可少的,但组织良好的产后运输服务同样重要。本研究评估了特罗姆瑟北挪威大学医院(UNN)新生儿航空运输小组(NATT)的总体活动和临床结果,该小组覆盖了挪威北极地区的一大片集水区。方法:前瞻性记录1994-2023年间所有新生儿空运的医疗资料。回顾性评估到达UNN后3 ~ 6 h内的体温、血糖和血气。为了评估时间变化,我们比较了1994 - 2008年(第1期)和2009-2023年(第2期)的数据。结果:共纳入急性转运病例882例。其中,655例(74.3%)转诊到UNN的三级新生儿病房,227例(25.7%)转诊到国家外科中心。大多数运输(61.5%)是固定翼飞机。第2期因先天性心脏缺陷(CHD)、早产和窒息转运的婴儿比例较低。当比较第1期和第2期时,到达时我们发现低体温(9.8% vs. 6.7%, p = 0.17)和高碳酸血症(17.3% vs. 15.3%, p = 0.55)的发生率相似,但低碳酸血症(6.7% vs. 2.5%, p = 0.014)和低血糖(10.8% vs. 2.3%, p = 0.001)的发生率下降。结论:早产儿和冠心病转运率的降低可能是围产期护理改善的结果。在第二个15年期间,低血糖和低碳酸血症的发生率有所改善,但进一步关注温度和二氧化碳控制的改善是必要的。vlbw婴儿的急性转运与严重IVH的风险显著增加相关。因此,将有早产危险的妇女宫内转移到第三围产中心是至关重要的。
期刊介绍:
Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.