Medical evacuation of non-transportable newborns after re-evaluation

BACKGROUND: Early admission or birth in a high-level neonatal care facility is associated with lower morbidity in preterm infants. Assessment of transportability remains a problem of the pre-transport evaluation. The literature data lacks the possibility of subsequent evacuation of patients recognized as non-transportable at the first examination.

AIM: This study compares intensive care during the first and second examinations of patients recognized as non-transportable and evacuated after re-departure.

MATERIALS AND METHODS: The cohort study included data from patients recognized as non-transportable at the first examination and evacuated after the second examination (18 patients). Comparison of intensive care, assessments by scales, correction of intensive care by the transport team during the first and repeated examinations of the patient was performed. Descriptive statistics methods, Wilcoxon’s test, and McNemar’s test were applied.

RESULTS: Patients evacuated on the second attempt had a birth weight of less than 1500 grams. The median birth weight was 1125 [740–3240] grams. The patients were reliably more often on traditional mechanical ventilation and less on high-frequency ventilation at the second examination. The infusion of adrenaline and prostaglandins was more often performed. The average number of corrective actions per patient at the first examination was 1.33 (SD 0.77), at the second examination — 0.5 (SD 0.62), p = 0.003. During the first attempt at evacuation, patients significantly more often required the administration or correction of the catecholamine dose, tracheal reintubation, and blood transfusion.

CONCLUSION: The data obtained indicate the inadequacy of the therapy performed before the arrival of the transport team contributes to the decision on the patient’s non-transportability.