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Transport Characteristics of Referred Newborns and Their Outcomes: Indian Perspective

Poonam Dalal Jasbir Singh Geeta Gathwala
Pediatrics, Pt. B.D. Sharma PGIMS Rohtak

Background: Safe and specialized neonatal transport is a significant determinant for favourable outcome among sick neonates, yet it is often inaccessible and unorganized in developing countries like India. The National Family Health Survey (NFHS-4) shows encouraging improvements in infant and under-five mortality rates in India over last few years, however, the single digit neonatal mortality rate still remains a distant dream. OBJECTIVES: To determine the transport characteristics and define predictors of mortality among newborn babies referred to a tertiary care centre of North India.

Methods: This descriptive study was conducted from 15th Jan 2016 to 30th April 2016 and included babies who were referred to a tertiary care centre of North India. Baseline characteristics of referred newborns, transport practices observed, clinical presentation and condition of babies at arrival were recorded. The data was evaluated to define predictors of mortality among the transported newborns.

Results: A total of 301 newborns were enrolled during the study period. The most common indication for transport was prematurity (40%) followed by need for mechanical ventilation (38%) and birth asphyxia (28%). Most neonates were transported by government ambulance services (84%) followed by private ambulances (12.5%) and private vehicles (3.5%). Paramedic personnel accompanied the babies in 85% of cases. About 60% babies got referred within 12 hours of life, 73% in 24 hours and 85% presented within first week. Ninety babies out of 301 died. Out of these 45% expired within 12 hour of presentation. Hypothermia at time of admission (P<0.0001), shock at presentation (P<0.0001) and extreme low birth-weight (P<0.0001) were found to be the most significant predictors of mortality among the transported newborns.

Conclusion: The presently observed neonatal transport practices in India are suboptimal. Pre-transport stabilization, dedicated teams for neonatal transport and prevention of hypothermia before and during transport seem to be promising interventions to improve neonatal outcomes.

Poonam  Dalal
Poonam Dalal
Pt. B D Sharma, Post Graduate Institute of Medical Sciences, Rohtak








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