Variations in transport outcomes of outborn infants among Canadian neonatal intensive care units

Abstract

Background: Outborn infants born at community hospitals and transported to tertiary neonatal intensive care units (NICUs) for treatment account for 20% of all tertiary NICU admissions in Canada. Little is known about variations in their outcomes. The Transport Risk Index of Physiologic Stability (TRIPS) is a validated score of neonatal physiological status that can identify differences between transport teams' outcomes.

Objective: To examine regional variations in outcomes among outborn infants transported to Canadian tertiary NICUs using TRIPS.

Design and methods: Transport teams prospectively collected data for all outborn infants admitted to 25 Canadian NICUs during 2006 to 2007. Singleton outborn infants ≥ 32 weeks' gestation admitted to NICUs for at least 24 hours who died or who were transferred to another NICU within 24 hours were examined for overall incidence of mortality, major morbidity, and change in TRIPS score.

Results: Complete transport data were available for 2313 (72.9%) of 3193 eligible infants. There were significant variations in interhospital and interprovincial outcomes. Factors significantly affecting change in TRIPS score were gender, pretransport TRIPS score, composition of transport team and distance traveled.

Conclusion: Significant variation exists in transport outcomes in Canada. Further investigation is required to optimize infant transport systems, processes, and clinical care.