Abstract
BACKGROUND:
Morbidity related to ineffective resuscitation and stabilization of premature infants is increased when delivery occurs outside tertiary perinatal centers. The regional neonatal transport team received extensive training to expand their scope of practice to include delivery room resuscitation allowing them to attend high-risk deliveries in community hospitals when maternal transfer was not possible.
OBJECTIVE:
Compare the resuscitation and stabilization of premature infants when a specialized neonatal retrieval team (SNRT) is in attendance at delivery with immediate resuscitation and stabilization performed by the referral hospital team (RHT).
STUDY DESIGN:
We assessed the impact of a specially trained neonatal transport team by comparing the initial resuscitation process, airway and vascular access skills, illness severity and patient stabilization in both groups.
RESULTS:
Neonates resuscitated by the RHT were more likely to receive oxygen, mask CPAP, bag and mask ventilation and cardiac compressions for a significantly longer time period. Neonates resuscitated by the SNRT were intubated more promptly (8.5 minutes {1 to 22} vs 16 minutes {1 to 90}, p=0.035) following a fewer number of attempts. The endotracheal tube was correctly positioned on radiological assessment in 72% of cases in the SNRT group vs 38.1% in the RHT group (p<0.001). Many neonates had no vascular access (31%) and were profoundly hypothermic (38.5%) on arrival of the SNRT. Although there was no significant difference in maximum FiO2 or oxygenation index, babies with respiratory distress syndrome resuscitated by the RHT were less likely to receive surfactant therapy (76.6 vs 34.4%, p=0.001). There was no difference in transport-related mortality between the groups
CONCLUSIONS:
The presence of a highly skilled transport team at a high-risk preterm delivery improves the quality of neonatal resuscitation by increasing intubation success rates and achieving earlier vascular access. Neonates resuscitated by dedicated neonatal retrieval teams were less likely to become significantly hypothermic. Although the severity of RDS was similar neonates in the RHT were less likely to receive surfactant.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Lee SK, McMillan DD, Ohlsson A, et al. Variations in practice and outcomes in the Canadian NICU network: 1996–1997. Pediatrics 2000;106(5):1070–1079.
Hobel CJ, Hyvarinen MA, Okada DM, Oh W . Prenatal and intrapartum high-risk screening. I. Prediction of the high-risk neonate. Am J Obstet Gynecol 1973;117(1):1–9.
Jones PK, Halliday HL, Jones SL . Prediction of neonatal death or need for interhospital transfer by prenatal risk characteristics of mother. Med Care 1979;17(8):796–806.
Chance GW, O'Brien MJ, Swyer PR . Transportation of sick neonates, 1972: an unsatisfactory aspect of medical care. Can Med Assoc J 1973;109(9):847–851.
Chance GW, Matthew JD, Gash J, Williams G, Cunningham K . Neonatal transport: a controlled study of skilled assistance. Mortality and morbidity of neonates less than 1.5 kg birth weight. J Pediatr 1978;93(4):662–666.
Crowley P . Antenatal corticosteroids — current thinking. Br J Obstet Gynecol 2003;110(Suppl 20):77–78.
Niermeyer S, Kattwinkel J, Van Reempts P, et al. International Guidelines for Neonatal Resuscitation: an excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines. Pediatrics 2000;106(3):E29.
Morley CJ . Systematic review of prophylactic vs rescue surfactant. Arch Dis Child Fetal Neonatal Ed 1997;77(1):F70–F74.
Lange M, Jonat S, Nikischin W . Detection and correction of endotracheal-tube position in premature neonates. Pediatr Pulmonol 2002;34(6):455–461.
Blayney MP, Logan DR . First thoracic vertebral body as reference for endotracheal tube placement. Arch Dis Child Fetal Neonatal Ed 1994;71(1):F32–F35.
Rudolph AJ, Desmond MM, Pineda RG . Clinical diagnosis of respiratory difficulty in the newborn. Pediatr Clin North Am 1966;13(3):669–692.
Mortensson W, Noack G, Curstedt T, Herin P, Robertson B . Radiologic observations in severe neonatal respiratory distress syndrome treated with the isolated phospholipid fraction of natural surfactant. Acta Radiol 1987;28(4):389–394.
Cornblath M, Hawdon JM, Williams AF, et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics 2000;105(5):1141–1145.
Tibby SM, Murdoch IA, Durward A . Mortality in meningococcal disease: please report the figures accurately. Arch Dis Child 2002;87(6):559.
Bellingan G, Olivier T, Batson S, Webb A . Comparison of a specialist retrieval team with current United Kingdom practice for the transport of critically ill patients. Intensive Care Med 2000;26(6):740–744.
Berry A . Provision of intensive care for children. Effective transport systems are essential. BMJ 1998;317(7168):1320.
Cray SH, Heard CM . Transport for paediatric intensive care. Measuring the performance of a specialist transport service. Paediatr Anaesth 1995;5(5):287–292.
Hood JL, Cross A, Hulka B, Lawson EE . Effectiveness of the neonatal transport team. Crit Care Med 1983;11(6):419–423.
McLendon D, Check J, Carteaux P, et al. Implementation of potentially better practices for the prevention of brain hemorrhage and ischemic brain injury in very low birth weight infants. Pediatrics 2003;111(4, Part 2):e497–e503.
Moore JJ, Andrews L, Henderson C, Zuspan KJ, Hertz RH . Neonatal resuscitation in community hospitals. A regional-based, team-oriented training program coordinated by the tertiary center. Am J Obstet Gynecol 1989;161(4):849–855.
Van Marter LJ, Allred EN, Pagano M, et al. Do clinical markers of barotrauma and oxygen toxicity explain interhospital variation in rates of chronic lung disease? The Neonatology Committee for the Developmental Network. Pediatrics 2000;105(6):1194–1201.
Bjorklund LJ, Ingimarsson J, Curstedt T, et al. Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs. Pediatr Res 1997;42(3):348–355.
Attar MA, Donn SM . Mechanisms of ventilator-induced lung injury in premature infants. Semin Neonatol 2002;7(5):353–360.
Silverman WA, Fertig JW, Berger AP . The influence of the thermal environment upon the survival of newly born premature infants. Pediatrics 1958;22(5):876–886.
Soll RF, Morley CJ . Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Systemic Review 2001. Issue 2:CD000510.
Winrow AP . Are interhospital transport teams de-skilling the DGH paediatricians? Arch Dis Child 2003;88(2):177–178.
Acknowledgements
We thank Dr J Hellmann and Dr B Kavanagh for their careful review of the manuscript and helpful suggestions.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
McNamara, P., Mak, W. & Whyte, H. Dedicated Neonatal Retrieval Teams Improve Delivery Room Resuscitation of Outborn Premature Infants. J Perinatol 25, 309–314 (2005). https://doi.org/10.1038/sj.jp.7211263
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jp.7211263
This article is cited by
-
Maximum vasoactive-inotropic score and mortality in extremely premature, extremely low birth weight infants
Journal of Perinatology (2021)
-
Trends in neonatal emergency transport in the last two decades
European Journal of Pediatrics (2021)
-
Do transport factors increase the risk of severe brain injury in outborn infants <33 weeks gestational age?
Journal of Perinatology (2020)
-
Team Models in Interfacility Transport-Building and Maintaining Competencies
Current Treatment Options in Pediatrics (2017)
-
Optimizing Outcomes in Regionalized Perinatal Care: Integrating Maternal and Neonatal Emergency Referral, Triage, and Transport
Current Treatment Options in Pediatrics (2017)