[The role of a neonatal transport service in the initial care of extremely low birth weight infants].

Abstract

Introduction: Delivery of an extremely low birth weight infant is unpredictable and in utero transfer to a hospital with tertiary neonatal intensive care unit (NICU) is not always possible. Postnatal transfer is often required. Data about their demographics and outcomes in Hungary is scarce, and the role of transport teams in their initial care has not been reported. Objective: To analyze resuscitation, initial care, transport, and outcome of extremely low birth weight infants requiring transport on the first day of life in the Central Region of Hungary. To present the results of definitive tertiary neonatal intensive care initiated at the place of birth. Method: In a retrospective observational study, data were analyzed from extremely low birth weight infants transferred on the first day of life by the Neonatal Emergency and Transport Service of the Peter Cerny Foundation between 20/03/2017 and 20/08/2022. Infants with major congenital malformations, transport time of <10 min or transfers between level III NICUs were excluded. Results: 55 infants were included, with a median gestational age of 25 (range: 21–31) weeks and median birth weight of 750 (range: 300–990) grams. 7 infants were born outside hospitals. The transport team was present at birth in 18 cases, while median postnatal age was 52 minutes at their arrival for the others. >50% were hypothermic upon the team’s arrival. Median transfer distance was 59 kilometers. Infants’ body temperature and blood gases have improved significantly during transport. 30 (55%) neonates survived to discharge from level III NICUs. However, no infants born before 24 weeks survived. Of those born outside hospital, 5 survived. Among all survivors, 7 infants had severe intraventricular hemorrhage. Discussion and conclusions: Extremely low birth weight infants transferred on the first day of life face high mortality rates. A mobile NICU service initiating definitive tertiary neonatal intensive care at birth can significantly improve initial care and ensure safe transfer. Orv Hetil. 2024; 165(42): 1643–1651.