Risk factors associated to clinical deterioration during the transfer of sick newborns

Satisfactory neonatal transport is a key component of newborn (NB) care. Objective. To determine characteristics and risk of clinical deterioration during neonatal transport. Material and methods. Observational and prospective study. There were included consecutively NB transferred to Hospital Garrahan's NICU. Risk score TRIPS (Transport Risk Index of Physiology Stability) was measured prior transportation and at the admission in the NICU. Clinical deterioration (CD) was considered when TRIPS value at admission was higher than the prior transportation value. We registered: diagnosis, distance, admission condition, immediate cardiorespiratory support (ICRS) requirement, and death before 7th day, and at discharge. Associations with CD we evaluated by bivariate and multivariate analysis. Results. A total of 160 transferred NB were enrolled (GA: 35 +/- 3 w, BW: 2482 +/- 904 g), median 2 days, mostly due to cardiorespiratory (50%) or surgical (34%) illness. CD was observed; in 57% of the cases (91) furthermore, 46% presented hypothermia. Forty nine NB required ICRS, 28 died (12 before 7th day). Studied variables were not associated with risk of CD. Mortality was higher in the deterioration group (24%) (OR 3,34; IC 95% 1,2-8,7), also when were considered NB risk (OR A 3; IC 95% 1,2-8,3). Clinical deterioration during transportation was associated with SCRI (OR 2,4; IC 95% 1,2-5). Conclusions. Transferred NB often loose stability or has CD, independently of their characteristics, and this is related to higher mortality. It is necessary to optimize care strategies during every neonatal transfer.