Predicting the need for intensive care correction during pre-transport stabilization of newborns, requiring medical evacuation

Abstract

Introduction. Pre-transport preparation reduces the risks of deterioration when transporting a newborn. Correction of intensive care in the original medical organization may be an indicator of the need for the transport team to travel to the patient. Purpose of the study is to identify predictors of the need for correction of neonatal therapy during pre-transplant preparation. Materials and Methods. Data from all transport team departures of the neonatal intensive care and consultation center between July 1, 2014, and December 31, 2018 (n = 2029) were included in an observational, cohort, retrospective study. Two groups were identified: the first group (n = 502) – patients who underwent correction of intensive care, the second group (n = 1527) – newborns who did not require correction of the ongoing therapy before evacuation. Results. Statistically significant differences in the volume of intensive care administered at baseline medical organization, parameters of respiratory support were observed between patient groups. The oxygenation saturation index demonstrated good predictive properties regarding the need for correction of intensive care with an AUC ROC of 0.696 [0.662–0.730]. Logistic regression revealed the following reliable predictors of the need for therapy correction: Apgar score at 1 and 5 minutes, giving the patient respiratory support, SpO₂/FiO₂ ratio value, catecholamine infusion, and giving therapy in a Level 1 organization. Discussion. The identified predictors indirectly indicate the need for correction of intensive care, which is an argument in favor of an evacuation trip and can be a tool for determining the order of such trips. Conclusion. Predictors of the need to adjust the neonate's therapy include the need for respiratory support (EVI or pCPR), SpO₂/FiO₂ ratio, need for adrenaline or dopamine infusion, Apgar scores at 1 and 5 minutes, and therapy in a Level 1 medical organization.