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Impact of transport on arrival status and outcomes in newborns with heart disease: a low–middle-income country perspective

Published online by Cambridge University Press:  09 June 2020

Balaganesh Karmegaraj Open the ORCID record for Balaganesh Karmegaraj [Opens in a new window] ,
Mahesh Kappanayil ,
Abish Sudhakar  and
Raman Krishna Kumar Open the ORCID record for Raman Krishna Kumar [Opens in a new window]
Balaganesh Karmegaraj
Affiliation:
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India
Mahesh Kappanayil*
Affiliation:
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India
Abish Sudhakar
Affiliation:
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India
Raman Krishna Kumar
Affiliation:
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Kochi, Kerala, India
*
Author for correspondence: Mahesh Kappanayil, DNB, FNB, Clinical Professor, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita University, Ponekkara PO, Kochi, Kerala682041, India. Tel: +91 484 2853570; Fax: +91 484 280 2020. E-mail: maheshpeds@yahoo.co.in
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Abstract

Objectives:

We sought to systematically study determinants of “clinical status at arrival after transport” of neonates with CHD and its impact on clinical outcomes in a low- and middle-income country environment.

Methods and results:

Consecutive neonates with CHD (n = 138) transported (median distance 138 km; 5–425 km) to a paediatric cardiac programme in Southern India were studied prospectively. Among 138 neonatal transports, 134 were in ambulances. Four neonates were transported by family in private vehicles; 60% with duct-dependent circulation (n = 57) were transported without prostaglandin E1. Clinical status at arrival after transport was assessed using California modification of TRIPS Score (Ca-TRIPS), evidence of end-organ injury and metabolic insult.

Upon arrival, 42% had end-organ injury, 24% had metabolic insult and 36% had Ca-TRIPS Score >25. Prior to surgery or catheter intervention, prolonged ICU stay (>48 hours), prolonged ventilation (>48 hours), blood stream sepsis, and death occurred in 48, 15, 19, and 3.6%, respectively. Ca-TRIPS Score >25 was significantly associated with mortality (p = 0.005), sepsis (p = 0.035), and prolonged ventilation (p < 0.001); end-organ injury with prolonged ICU stay (p = 0.031) and ventilation (p = 0.045); metabolic insult with mortality (p = 0.012) and sepsis (p = 0.015).

Fifteen babies needed only medical management, 10 received comfort care (due to severe end-organ injury in 3), 107 underwent cardiac surgery (n = 83) or catheter intervention (n = 24), with a mortality of 6.5%. Clinical status at arrival after transport did not impact post-procedure outcomes.

Conclusion:

Neonates with CHD often arrive in suboptimal status after transport in low- and middle-income countries resulting in adverse clinical outcomes. Robust transport systems need to be integrated in plans to develop newborn heart surgery in low- and middle-income countries.

Keywords

CHDlow-resource environmentnewborn transport
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 7 , July 2020 , pp. 1001 - 1008
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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Footnotes

*

Equal contribution as first authors.

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