Trends in neonatal emergency transport in the last two decades

Although maternal antenatal transfer is the preferred option, some infants inevitably need urgent transport to a tertiary neonatal care facility after birth. This study aimed to investigate trends over time in patient characteristics and respiratory management in a large series of neonatal emergency transfers, in order to provide health caregivers an up-to-date profile of such patients and their therapeutic needs. Trends in patient characteristics and respiratory management were evaluated in 3337 transfers by the Eastern Veneto Neonatal Emergency Transport Service in 2000-2019. Joinpoint regression analysis was performed to evaluate trends and to estimate annual percentage changes (APCs). Proportions of preterm neonates increased (APC(2000-2012) 2.25%), then decreased (APC(2012-2019) - 6.04%). Transfers at birth increased (APC(2000-2013) 2.69%), then decreased (APC(2013-2019) - 5.76%). Proportion of neonates with cardiac and surgical diseases declined (APCs(2000-2019) - 6.82% and - 3.32%), while proportion of neonates with neurologic diseases increased (APC(2000-2019) 8.62%). Use of nasal-continuous-positive-airway-pressure (APC(2000-2019) 9.72%) and high-flow-nasal-cannula (APC(2007-2019) 58.51%) at call, and nasal-continuous-positive-airway-pressure (APC(2000-2019) 13.87%) and nasal-intermittent-mandatory-ventilation (APC(2000-2019) 32.46%) during transfer increased. Mechanical ventilation during transfer decreased (APC(2014-2019) - 10.77%). Use of oxygen concentrations at 21% increased at call and during transfer (APCs (2000-2019) 2.24% and 2.44%), while oxygen concentrations above 40% decreased at call and during transfer (APCs (2000-2019) - 3.93% and - 5.12%). Conclusion: Our findings revealed a shift toward a more gentle approach and the reduced use of oxygen in respiratory management. Equipment and team expertise should meet the requirements of such changing patients and their therapeutic needs. What is Known: center dot Although antenatal transfer is the preferred option, some infants inevitably need urgent transport to a tertiary neonatal care facility after birth. center dot Trend studies investigating cohort information with appropriate statistical methods represent useful instruments to detect changes over time. What is New: center dot Our findings revealed marked changes in patient characteristics and respiratory management in a large series of neonatal emergency transfers during the last two decades. center dot Equipment and team expertise should meet the requirements of such changing patients and their therapeutic needs.

Automated summary

This study revealed significant changes in patient characteristics and respiratory management in neonatal emergency transfers over the past two decades. There has been a shift towards a gentler approach in respiratory management and a reduction in the use of oxygen.