Adverse events and clinical risk factors during intrahospital transport of critically ill neonates: a prospective pilot study at a tertiary center in Vietnam.

内容摘要

Intrahospital transport is often unavoidable in neonatal intensive care, but it may expose critically ill neonates to physiological instability and adverse events. Data from low- and middle-income settings remain limited, and differing hypothermia thresholds across studies may underestimate the true burden of transport-related harm. We conducted a prospective observational pilot study of intrahospital transport episodes from the neonatal intensive care unit (NICU) at a tertiary pediatric center in Ho Chi Minh City, Vietnam, between May and July 2024. Each transport episode was analyzed as a separate event. The primary outcome was unsafe transport, defined as at least one adverse event-including hypothermia <36.5&#xb0;C, respiratory deterioration, hemodynamic instability, or device-related events-occurring during transport or within 24&#x2005;h of NICU readmission. The secondary outcome excluded mild hypothermia and included only moderate hypothermia (32&#xb0;C-35.9&#xb0;C) and other clinically significant events. Of the 172 screened transport events, 138 involving 96 neonates were included. Under the primary definition, 71 transport events (51.4%) were unsafe, generating 100 adverse events; 89% occurred during the return leg or post-return period. Hypothermia was the most frequent event (74.0%): 40 mild (36.0&#xb0;C-36.4&#xb0;C) and 34 moderate (32&#xb0;C-35.9&#xb0;C). Under the secondary definition, 44 transport events (31.9%) were unsafe, with 60 adverse events. Transport was significantly associated with increased FiO2 (p&#x2009;=&#x2009;0.008) and reduced SpO2/FiO2 ratio (p&#x2009;=&#x2009;0.020). A surgical indication was the strongest independent predictor: moderate Bayesian model averaging evidence for the primary outcome [posterior inclusion probability (PIP) 0.616] and strong evidence for the secondary outcome (PIP 0.880; odds ratio 4.95, 95% credible interval 1.43-17.2). Moderate hypothermia was independently associated with support escalation (41.2% vs. 18.6%, p&#x2009;=&#x2009;0.018), whereas mild hypothermia was not. The vasoactive-inotropic score showed negligible predictive value, equivalent to vasoactive drug count. Intrahospital transport of critically ill neonates is frequently associated with adverse events, predominantly hypothermia occurring on the return leg. A surgical indication-particularly for esophageal atresia, gastroschisis, or urgent procedures - is the dominant independent risk factor. Improved thermal protection (including routine incubator use for surgical cases), standardized postreturn temperature assessment, and enhanced preparation for surgical transport are the highest-priority evidence-based interventions.