Immediate Outcomes of Neonatal Transport in a Tertiary Hospital in South-West of Nigeria

Abstract

Aim: Only a third of deliveries in Nigeria occur in health facilities and a number of sick neonates have to be referred for advanced care. We sought to assess the morbidity and mortality within 24 and 48 hours of arrival among neonates presenting at the University College Hospital, (UCH) Ibadan in relation to the prevailing neonatal transport care practices. Methods: The pretransport and intratransport care available to 401 neonates presenting in UCH were determined and their respiratory rate, heart rate, SpO2, serum bicarbonate, temperature and blood pressure were checked on arrival. TRIPS (Transport Risk Index of Physiologic Stability) scores were determined and same parameters were reassessed 24 and 48 hours after presentation. Results: Nineteen babies (4.7%) were brought in dead. The morbidities present on admission were hypothermia (35.1%), hypoxia (28.4%), hypoglycaemia (12.5%), apnoea (9%), acidosis (8.2%), unrecordable blood pressure (16.5%). The median TRIP score on arrival was 17 with 23% having very severe score (>30), severe 19.4%, moderate 24.6% and low 33%. Babies who received oxygen, IVF/breastmilk during transport were more in the low and moderate scores. By 48 hours of admission, 22% had died and those who did not receive IVF/breastmilk had the highest risk of dying (OR 4.67 CI 1.81,12.05). Conclusion: Neonates presenting at the UCH had significant morbidity and mortality in the first 48 hours of presentation, which was associated with poor pre and intratransport care. It is crucial to emphasize pretransport stabilization and suitable intratransport care in the training of peripheral healthcare workers in resource limited settings in order to improve newborn outcomes.