Occurrence and prediction of clinical interventions during transfer of near-term and term infants with respiratory distress on CPAP. An observational study
A. Morel, J. Baleine, C. Milesi, M. Badr, A. Gaudaire, A. Deveze, S. Paulhac, C. Andrieu, M. Palpacuer, G. Cambonie, A. Gavotto
Background : Neonatal respiratory distress (NRD) requiring continuous positive airway pressure (CPAP) is a common indication for inter-hospital transfer of late preterm and term neonates. The optimal composition of the inter-hospital team transfer – involving an advanced neonatal nurse and an ambulance driver or a complete team, which also includes a paediatrician – remains uncertain. Particularly when clinical interventions are required.
Objectives : To assess the occurrence of clinical interventions necessitating a complete transport team during the inter-hospital transfer of neonates with NRD on CPAP. A secondary objective was to evaluate whether data provided to the transfer regulation centre predicted such interventions.
Methods and Setting : This retrospective observational study was conducted at the Paediatric Emergency Transport Service (PETS) of a level 3 maternity hospital between 2021 and 2023. A total of 110 infants >=34 weeks gestational age were included, all transported for NRD with CPAP (mean gestational age 37.6 +/- 2.2 weeks, mean birth weight 3042+/-615 g). Clinical interventions recorded included intubation, surfactant administration, inhaled nitric oxide (iNO) administration, needle aspiration for pneumothorax, and prostaglandin E1 infusion. Complete team transport involved a paediatrician, an advanced neonatal nurse, and an ambulance driver.
Results : Clinical interventions occurred in 11 cases (10%). Factors associated with the need for intervention included higher FiO2 (71.4 +/- 18.5% vs 28.3 +/- 8.0%, p < 0.01), presence of pneumothorax (p < 0.01), and transfer from higher-level maternity hospitals (p < 0.01). The ROC curve for FiO2 predicting intervention had an area of 0.99 (95% CI 0.97-1.01, p = 0.001), with a cut-off of >40% yielding 91% sensitivity, 98% specificity, 83% positive predictive value, and 99% negative predictive value.
Conclusions : High oxygen dependency and the presence of pneumothorax are key indicators for mobilizing a complete transport team during the transfer of late preterm and term neonates with NRD on CPAP. Early identification of these factors could enhance team allocation and resource utilization.