74 - Regional review of morbidity, intraventricular hemorrhage (IVH) and mortality in transported compared to non-transported preterm infants below 33 weeks gestation

Poster Number: 74
Publication Number: 74.429

kim chi T. Bui, Kaiser Permanente- Los Angeles Medical Center, Los Angeles, CA, United States; Tameka T. Watson, Children's National Health System, Washington, DC, United States; qiaoling chen, Kaiser Permanente Southern California, Pasadena, CA, United States; Darios Getahun, Kaiser Permanente Southern California, Pasadena, CA, United States; anny Xiang, Kaiser Permanente Southern California, Pasadena, CA, United States; Marielle Nguyen, Southern California Permanente Medicine, Anaheim, CA, United States; Fu-Sheng Chou, Kaiser Permanente Riverside Medical Center, Rancho Cucamonga, CA, United States; Afshan R. Abbasi, Kaiser Permanente, Downey, CA, United States; Sharon Burdick, Kaiser Permanente Los Angeles Medical Center, North Hollywood, CA, United States

Background: Preterm infants below 33 ^0/7 weeks gestation may be born in hospitals with level 1 or 2 NICUs and must be transported to a tertiary level NICU after birth. Neonatal transport plays a vital role in a regionalized care delivery system but may be associated with increased mortality risk and severe IVH.

Objective: To provide a better understanding of regional transport practices and evaluate whether current neonatal transport poses risks for IVH and mortality in preterm neonates.

Design/Methods: Retrospective review of records of live births from 2014 where there was one transport team, compared to 2018 to 2020, when two transport teams were available. Inclusion criteria: infants admitted to NICU at 22 to 32 ^6/7 weeks GA or birthweight < 1500 grams. Excluded intrapartum fetal deaths and deaths in the labor and delivery room. Outcome measures: IVH of all grades, severe IVH grades 3 and 4, and infant mortality.
Data sources: California Perinatal Quality Care Collaborative (CPQCC) database for comorbidities, risk factors for IVH and detailed manual medical records review about the age at IVH and neonatal transports. Descriptive statistics are summarized as percentages, mean(standard deviation), or median (interquartile range). Categorical data were compared using Chi-Square test.

Results: The study cohort included 633 transported and 1746 non-transported neonates with similar characteristics, except that the transported group had a lower mean GA (28.8 weeks [SD2.9] vs.29.1 weeks [SD2.9], p=0.05), a higher percentage of intubated and ventilated infants (60.1% vs. 52.1%, p< 0.01), lower antenatal steroids (88.7% vs.92.3%, p=0.02), higher rate of necrotizing enterocolitis (6.7%vs.3.5%, p< 0.01), and neonatal infection (15.7% vs.10%, p< 0.01). Each year 25-30% of preterm infants were transported. Reasons for transport: a higher level of care, subspecialty consultation, bed availability, transport closer to home, or insurance reasons. The mortality and IVH rates were inversely related to GA, with infants below 28 weeks GA at the highest risk of IVH in the first 3 days of life. IVH rate was higher in the transported group (9.2% vs.5.3%, p< 0.001) during the whole hospital stay, however, the majority of transport (58%) occurred after 7 days of age, with IVH being diagnosed before transport. Mortality rate was lower in the transported group (3.5% vs.6.9%, p=0.002)

Conclusion(s): As the diagnosis of IVH depends on the timing of the head utrasound studies, no conclusion was able to be made regarding IVH and transport, an area requiring further investigation. Mortality was lower in the transported group.