Martínez VR, López GL, Rodríguez MD, Torre GM, Soto MJL, Márquez AM, Ávalos HLM, Ramos PE, García HHA, Gutiérrez PJA

Language: Spanish
References: 12
Page: 34-39
PDF size: 296.96 Kb.

ABSTRACT

Background. Transporting newborn infants to third-level units is often disorganized, thus entailing several risks that may further compromise the health of newborn patients.
Methods. A prospective study was designed in order to assess the impact of the S.T.A.B.L.E. program (Sugar and Safe Care, Temperature, Airway, Blood, Lab work, Emotional support) from 2005 to 2009 in regard to morbidity and mortality rates of newborn patients who had to be transferred from other regions within Jalisco state or within Guadalajara’s metropolitan area to the Neonatal Intensive Care Unit of the Civil Hospital in Guadalajara. The intervention process was based on applying the S.T.A.B.L.E. program to all newborns who needed to be transferred and was achieved with the intervention of the physicians regulating the Emergency Medical Assistance System (SAMU) of the state of Jalisco. A training course, as well as an educational brochure, was given to medical and paramedical staff from the medical assistance centers referring patients to our unit in order to provide them with information on the S.T.A.B.L.E. program and its implementation.
Results. A total of 3,277 newborn infants were included in the study, 384 before the intervention program and 2,893 once the S.T.A.B.L.E. program was implemented. Within the group transferred after the program´s implementation, we observed a greater incidence of patients with normal body temperature upon admission to the receiving unit [516 (87%) vs. 227 (59%); p ‹ 0.01] as well as with blood glucose figures within the normal range [690 (93%) vs. 173 (45%); p ‹ 0.001]. Mortality during the hospitalization period in the receiving unit was lower in the group treated after the program’s implementation [405 (14%) vs. 84 (22%); p ‹ 0.05]. After the intervention process, more patients were transported in incubators [2,806 (97%) vs. 200 (52%); p ‹ 0.001] and equally, pulse oximetry monitoring methods were applied in a greater number of patients [2,575 (89%) vs. 235 (61%); p ‹ 0.01]. With regard to the number of transfers of newborns that were regulated and authorized by the SAMU system, we also observed an increase in such numbers for the group treated after the intervention program [2,806 (97%) vs. 234 (61%); p ‹ 0.001]. There was no difference in the incidence of death during the newborns’ transport [30 (1%) vs. 10 (2.6%); p = NS].
Conclusions. Transfer of ill newborns to third-level medical care units in the state of Jalisco was safely undertaken with a significant improvement in morbidity rates. The S.T.A.B.L.E. program was highly effective and easy to implement. The decrease in mortality during the hospitalization period of patients treated after the intervention program merits further studies especially designed to establish possible associations.

REFERENCES

1. Norma Oficial Mexicana NOM 007. Atención del parto, puerperio y el recién nacido. Disponible en: http://www.salud.gob.mx/unidades/cdi/nom/007ssa23.html

2. Norma Oficial Mexicana 237-SSA1-2004. Regulación de los servicios de salud. Atención pre-hospitalaria de las urgencias médicas. Disponible en: http://www.ordenjuridico.gob.mx/Federal/PE/APF/APC/SSA/Modificaciones/2006/15062006(1).pdf

3. Resnick MB, Ariet M, Carter LR, Fletcher JW, Evans JH, Furlough RR, et al. Prospective pricing system for tertiary neonatal intensive care. Pediatrics 1986;78:820-828.

4. Kuch BA, Munoz R, Orr RA, Watson RS. Unplanned transport events and severity of illness: are we conveying the whole picture? Pediatrics 2007;119:648-649.

5. Yeager SB, Horbar JD, Greco KM, Duff JT, Thiagarajan RR, Laussen PC. Pretransport and posttransport characteristics and outcomes of neonates who were admitted to a cardiac intensive care unit. Pediatrics 2006;118:1070-1077.

6. Karlsen KA. The S.T.A.B.L.E. Program. Disponible en: http://www.stableprogram.org/index.php

7. Zupancic JA, Richardson DK. Characterization of the triage process in neonatal intensive care. Pediatrics 1998;102:1432-1436.

8. Bomont RK, Cheema IU. Use of nasal continuous positive airway pressure during neonatal transfers. Arch Dis Child Fetal Neonatal Ed 2006;91:F85-F89.

9. Cusack JM, Field DJ, Manktelow BN. Impact of service changes on neonatal transfer patterns over 10 years. Arch Dis Child Fetal Neonatal Ed 2007;92:F181-F184.

10. Browning CKA, Barr P, West M, Hopper NW, White JP, Badawi N. Transporting newborn infants with suspected duct dependent congenital heart disease on low-dose prostaglandin E1 without routine mechanical ventilation. Arch Dis Child Fetal Neonatal Ed 2007;92:F117-F119.

11. Spector JM, Villanueva HS, Brito ME, Sosa PG. Improving outcomes of transported newborns in Panama: impact of a nationwide neonatal provider education program. J Perinatol 2009;29:512-516.

12. O´Neill N, Howlett AA. Evaluation of the impact of the S.T.A.B.L.E. Program on the pretransport care of the neonate. Neonatal Netw 2007;26:153-159.