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. 2019 Apr 18;45(1):51.
doi: 10.1186/s13052-019-0640-z.

Nationwide survey of neonatal transportation practices in Italy

Maurizio Gente  1 , Roberto Aufieri  2 , Rocco Agostino  3 , Tiziana Fedeli  4 , Maria Grazia Calevo  5 , Paolo Massirio  6 , Carlo Bellini  7 ; Neonatal Transport Study Group of the Italian Society of Neonatology (SIN)
Collaborators, Affiliations

Nationwide survey of neonatal transportation practices in Italy

Maurizio Gente et al. Ital J Pediatr. .

Abstract

Background: Despite regionalization of perinatal care provides for the "in utero" transfer of high-risk pregnancies, there will always be a number of neonates who undergo acute inter-facility transport. The presence of a well-organized Neonatal Emergency Transport Service (NETS) can prevent and reduce risks of transportation, especially for very preterm infants, and is therefore mandatory for any program of regionalization of perinatal care. Italian National Health System is highly decentralized and Regions are autonomous to structure, plan and delivery their regional health services. Consequently, organization models and resources available vary widely and significant regional differences in access and quality of health services have been reported in the past years. A national survey was conducted in 2015 by the neonatal transport study group of the Italian Society of Neonatology with the aim to describe neonatal transfer practices and to assess the Neonatal Emergency Transport Services (NETS) status in the 20 Italian regions.

Methods: A questionnaire regarding neonatal transfer practices and NETS activity for the previous year (2014) was sent to the 44 NETS operating in the 20 Italian regions. Demographic data were obtained from the Italian National Statistical Institute (ISTAT).

Results: The overall survey response rate was 100%. In 2014, only 12 (60%) of the 20 Italian regions were fully covered by NETS, 3 (15%) regions were partially covered, while neonatal transport was not available in 5 (25%) regions. Overall, in 2014, the 44 NETS operating in Italy transported a total of 6387 infants, including 522 (8.17%) having a gestational age < 28 weeks.

Conclusions: The organization of NETS in Italy is devolved on a regional basis, resulting in a large heterogeneity of access and quality to services across the country. Where available, NETS are generally well-equipped and organized but limited volume of activities often cannot guarantee adequate levels of skills of personnel or an appropriate cost-efficiency ratio. The regions reported with lack of NETS have managed, or are trying, to fill the gap, but continuing efforts to reduce regional differences in the availability and quality of services are still needed.

Keywords: Health services accessibility; Infant, newborn; Intensive care, neonatal transport; Perinatal care; Regional medical programs.

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Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Geographical distribution and amount of activity of the 44 Italian NETS. Panel a. Geographical distribution of NETS in Italy, in 2014. Regional borders are shown. White regions were fully covered by NETS (Piemonte, Lombardia, Trentino-Alto Adige, Veneto, Friuli-Venezia Giulia, Liguria, Toscana, Marche, Lazio, Molise, Campania, and Basilicata); grey regions were partially covered (Emilia-Romagna, Puglia e Sicilia); NETS was not available in black regions (Valle d’Aosta, Umbria, Abruzzo, Calabria e Sardegna). Panel b. Number of transports per year of the 44 NETS, in 2014. All the three NETS organized on a dedicated model carried out more than 200 transports per year
Fig. 2
Fig. 2
Distribution of transports in Italy. Total number of transports within various Italian NETS in 2014; note that the four Turin NETS were grouped. Panel a: total number of transports. Panel b: total number back-transports
See this image and copyright information in PMC

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