Dissertation on prehospital treatment and transport in newborn

Dissertation on neonatal transport

1. Dissertation

2. AIM- To STUDY THE INFLUENCE OF PREHOSPITAL TREATMENT IN THE SURVIVAL OF NEWBORNS TRANSPORTED TO A TERTIARY CARE CENTRE Objective – PRIMARY: To assess the influence of pre hospital treatment and transportation in the outcome of neonates by using TOPS score SECONDARY: The study aims to predict the outcome and also to evaluate the mortality, morbidity and length of stay of transported neonates

3. STUDY DESIGN: Prospective observational study STUDY POPULATION: Term Neonates referred from peripheral centre and admitted in level III NICU Inclusion criteria:  All term neonates ≤ 7 day of life transported to our NICU from periphery hospitals for a comorbidity

4. Exclusion criteria: All infants with missing data. Infants with lethal congenital anomalies. Refusal to give informed written consent. New born who left against medical advice (LAMA).

5. STUDY JUSTIFICATION        The out born babies generally have a poor outcome when compared to inborn babies. I had considered to conduct a study on outborn babies, to identify at risk babies by using a scoring system Since the mortality of the neonates also depends on physiological status of the neonate before reaching the referral centre, trained neonatal staff will do a pre transport TOPS . The pre transport TOPS will be compared with the post transport TOPS which will be done after reaching the referral centre by the NICU residents , if there is a positive difference, it indeed helps us to know the role played by the neonatal transport team in stabilising the physiological status of the newborn.

6. STUDY PLACE: Neonatal Intensive Care Unit, Institute of Social pediatrics, Stanley medical college, Chennai STUDY PERIOD: 18 months( January 2023 to June 2024) STUDY DESIGN: Prospective observational study

7. ANNEXURE - A PROFORMA PRE TRANSPORT Name: Age: Referred from: Mode of transport: Reason for referral: Prior hospitalization: Yes/ No Treatment received: Transport Started at: Reached in NICU at: Duration of transport: Distance travelled: < 50 km/ 50 – 100 km/ > 100 km Transport team composition: Patient Stabilization before transport: IV assess Inotrope support - dopamine / dobutamine / adrenaline Respiratory support – oxygen hood / CPAP/ Intubated

8. ON ADMISSION (POST TRANSPORT) Admission Weight: IP NO: Sex: Boy/ Girl Mode of delivery: Labour natural LSCS (elective/ emergency) IndicationForceps delivery/ vacuum extraction Date of birth/ Time of birth: Place of delivery: PHC/ CHC/ ESI/ GH/ Private/ Medical College Birth Weight: ELBW/ VLBW/ LBW Resuscitation: Initial steps/ PPV/ Chest compressions/ Intubation/ Drugs 1 Min 5 Min Apgar: Maternal age: Consanguinity: first/ second / nil Obstetrical code: G P L A EDD: Gestational age: Extreme prematurity/ Very preterm/ 32- 34 wks / Late preterm/ Early term/ Term/ post term /AGA/ SGA/ IUGR/ LGA Blood grouping & typing: HIV/ HBSAG/ VDRL: Maternal complications: GDM/ Type I DM/ PIH/ Epilepsy/ Eclampsia/ Heart diseases/ Exanthem/ Drug intake/ Hypothyroidism/ Hyperthyroidism Obstetrical USG: Antenatal steroids

9. Month FEB MARCH MAY No. of babies 40 46 50 MCH 23 21 29 FCH 17 25 21 GA Term 33 42 41 PreTerm 7 4 9 Weight >2.5 Kg 38 44 49 <1.5 Kg 2 2 1 <1 Kg 1 Nil Nil No of referrals No of referrals term less than 7days 24 16 28 18 35 20 Indication for referral Birth asphyxia 2 Nil 3 Respiratory distress 9 14 11 Others 5 4 6

10. FEB MARCH MAY Duration of transport <30mins/>30mins 11 / 5 15 / 3 17 / 3 Distance travelled <10km 14 17 18 >10km 2 1 2 Prior stabilisation IV access 4 6 6 Inotropes Nil Nil Nil Respiratory support 02 hood 5 8 10 CPAP Nil Nil Nil Intubation Nil Nil Nil

11. Post transport TRIPS SCORE FEB MARCH MAY 0- 8 15 16 19 9-16 1 2 1 17- 34 Nil Nil Nil

12. Duration of hospital stay- Less than 7days- 30 More than 7days -14 Death - nil