Occurrence and prediction of clinical interventions during transfer of near-term and term infants with respiratory distress on CPAP. An observational study.

Abstract

Background: Neonatal respiratory distress (NRD) requiring continuous positive airway pressure (CPAP) is a common indication for inter-hospital transfer of late preterm and term neonates. The optimal composition of the inter-hospital team transfer - involving an advanced neonatal nurse and an ambulance driver or a complete team, which also includes a paediatrician - remains uncertain. Particularly when clinical interventions are required.

Objectives: To assess the occurrence of clinical interventions necessitating a complete transport team during the inter-hospital transfer of neonates with NRD on CPAP. A secondary objective was to evaluate whether data provided to the transfer regulation centre predicted such interventions.

Methods and setting: This retrospective observational study was conducted at the Paediatric Emergency Transport Service (PETS) of a level 3 maternity hospital between 2021 and 2023. A total of 110 infants ≥34 weeks' gestational age were included, all transported for NRD with CPAP (mean gestational age 37.6 ± 2.2 weeks, mean birth weight 3042±615 g). Clinical interventions recorded included intubation, surfactant administration, inhaled nitric oxide (iNO) administration, needle aspiration for pneumothorax, and prostaglandin E1 infusion. Complete team transport involved a paediatrician, an advanced neonatal nurse, and an ambulance driver.

Results: Clinical interventions occurred in 11 cases (10%). Factors associated with the need for intervention included higher FiO₂ (71.4 ± 18.5% vs 28.3 ± 8.0%, p < 0.01), presence of pneumothorax (p < 0.01), and transfer from higher-level maternity hospitals (p < 0.01). The ROC curve for FiO₂ predicting intervention had an area of 0.99 (95% CI 0.97-1.01, p = 0.001), with a cut-off of >40% yielding 91% sensitivity, 98% specificity, 83% positive predictive value, and 99% negative predictive value.

Conclusions: High oxygen dependency and the presence of pneumothorax are key indicators for mobilizing a complete transport team during the transfer of late preterm and term neonates with NRD on CPAP. Early identification of these factors could enhance team allocation and resource utilization.