Predictive score for clinical complications during intra-hospital transports of infants treated in a neonatal unit.

OBJECTIVE: To develop and validate a predictive score for clinical complications during intra-hospital transport of infants treated in neonatal units. METHODS: This was a cross-sectional study nested in a prospective cohort of infants transported within a public university hospital from January 2001 to December 2008. Transports during even (n=301) and odd (n = 394) years were compared to develop and validate a predictive score. The points attributed to each score variable were derived from multiple logistic regression analysis. The predictive performance and the score calibration were analyzed by a receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test, respectively. RESULTS: Infants with a mean gestational age of 35 ± 4 weeks and a birth weight of 2457 ± 841 g were studied. In the derivation cohort, clinical complications occurred in 74 (24.6%) transports. Logistic regression analysis identified five variables associated with these complications and assigned corresponding point values: gestation at birth [<28 weeks (6 pts); 28-34 weeks (3 pts); >34 weeks (2 pts)]; pre-transport temperature [<36.3°Cor >37°C(3pts); 36.3-37.0°C (2 pts)]; underlying pathological condition [CNS malformation (4 pts); other (2 pts)]; transport destination [surgery (5 pts); magnetic resonance or computed tomography imaging (3 pts); other (2 pts)]; and pre-transport respiratory support [mechanical ventilation (8 pts); supplemental oxygen (7 pts); no oxygen (2 pts)]. For the derivation and validation cohorts, the areas under the ROC curve were 0.770 and 0.712, respectively. Expected and observed frequencies of complications were similar between the two cohorts. CONCLUSION: The predictive score developed and validated in this study presented adequate discriminative power and calibration. This score can help identify infants at risk of clinical complications during intra-hospital transports.

Fatores associados à hipotermia durante o transporte intra-hospitalar em pacientes internados em unidade de terapia intensiva neonatal / Factors associated with hypothermia during intra-hospital transport in patients assisted in a neonatal intensive care unit

OBJETIVO: Determinar a frequência e os fatores associados à ocorrência de hipotermia em transportes intra-hospitalares de pacientes internados em uma unidade neonatal de cuidados intensivos. MÉTODOS: Estudo transversal aninhado em uma coorte prospectiva de crianças submetidas a transportes intra-hospitalares realizados por uma equipe treinada de janeiro de 1997 a dezembro de 2008 na unidade de cuidados intensivos de um hospital público universitário. Foram excluídos os transportes de pacientes com mais de um ano e/ou com peso na data do transporte superior a 10kg. Os fatores associados à hipotermia durante o transporte foram estudados por regressão logística. RESULTADOS: Dos 1.197 transportes realizados no período do estudo, 1.191 (99,5 por cento) atenderam aos critérios de inclusão. As doenças de base das 640 crianças estudadas (idade gestacional: 35,0±3,8 semanas; peso ao nascer: 2341±888g) foram: malformações únicas ou múltiplas (71,0 por cento), infecções (7,7 por cento), hemorragia peri/intraventricular (5,5 por cento), desconforto respiratório (4,0 por cento) e outros (11,8 por cento). Os pacientes foram transportados para realização de cirurgias (22,6 por cento), ressonância magnética (10,6 por cento), tomografia (20,9 por cento), exames contrastados (18,2 por cento) e outros procedimentos (27,7 por cento). A hipotermia ocorreu em 182 (15,3 por cento) transportes e se associou ao (OR; IC95 por cento): peso ao transporte <1000g (3,7; 1,4-9,9); peso ao transporte 1000-2500g (1,5; 1,0-2,2); temperatura axilar pré-transporte <36,5ºC (2,0; 1,4-2,9); presença de malformações do sistema nervoso (2,8; 1,8-4,4); uso de oxigênio inalatório (1,6; 1,0-2,5); ventilação mecânica antes do transporte (2,5; 1,5-4,0); cirurgias (1,7; 1,0-2,7) e anos de 2001, 2003 e 2006 (protetores). CONCLUSÕES: Os transportes intra-hospitalares apresentaram risco elevado de hipotermia, mostrando que devem ser realizados por equipe habilitada e com equipamentos adequados.

OBJECTIVE: To determine frequency and factors associated with hypothermia during intra-hospital transports of patients assisted in a neonatal intensive care unit (NICU). METHODS: Cross-sectional study nested in a prospective cohort of infants submitted to intra-hospital transports performed by a trained team from January 1997 to December 2008 at a NICU of a public university hospital. Transports of patients aged more than one year and/or with weight higher than 10kg were excluded. Factors associated with hypothermia during intra-hospital transports were studied by logistic regression analysis. RESULTS: Among the 1,197 transports performed during the studied period, 1,191 (99.5 percent) met the inclusion criteria. The 640 transported infants had mean gestational age of 35.0±3.8 weeks and birth weight of 2341±888g. They presented the following underline diseases: single or multiple malformations (71.0 percent), infections (7.7 percent), peri/intraventricular hemorrhage (5.5 percent), respiratory distress (4.0 percent) and others (11.1 percent). Patients were transported for surgical procedures (22.6 percent), magnetic resonance (10.6 percent), tomography imaging (20.9 percent), contrasted exams (18.2 percent), and others (27.7 percent). Hypothermia occurred in 182 (15.3 percent) transports and was associated with (OR; 95 percentCI): weight at transport <1000g (3.7; 1.4-9.9), weight at transport 1000-2500g (1.5; 1.0-2.2), pre-transport axillary temperature <36.5ºC (2.0; 1.4-2.9), central nervous system malformation (2.8; 1.8-4.4); use of supplemental oxygen (1.6; 1.0-2.5); mechanical ventilation prior to transport (2.5; 1.5-4.0); transport for surgeries (1.7; 1.0-2.7) and the years 2001, 2003 and 2006 (protection factors). CONCLUSIONS: Intra-hospital transports presented increased risk for hypothermia, showing that this kind of transport should be done by skilled teams with adequate equipment.

OBJETIVO: Determinar la frecuencia y los factores asociados a la ocurrencia de hipotermia en transportes intrahospitalarios de pacientes internados en una unidad neonatal de cuidados intensivos. MÉTODO: Estudio transversal anidado en una cohorte prospectiva de niños sometidos a transportes intrahospitalarios realizados por un equipo entrenado de ene/1997 a dic/2008 en la unidad de cuidados intensivos de un hospital público universitario. Se excluyeron los transportes de pacientes con más de un año de edad y con peso en la fecha del transporte superior a 10kg. Los factores asociados a la hipotermia durante el transporte fueron estudiados por regresión logística. RESULTADOS: De los 1197 transportes realizados en el periodo de estudio, 1191 (99,5 por ciento) atendieron a los criterios de inclusión. Las enfermedades de base de los 640 niños estudiados (edad gestacional: 35,0±3,8sem; peso al nacer: 2341±888g) fueron: malformaciones únicas o múltiples (71 por ciento), infecciones (7,7 por ciento), hemorragia peri/intraventricular (5,5 por ciento), angustia respiratoria (4,0 por ciento) y otros (11,8 por ciento). Los pacientes fueron transportados para realización de cirugías (22,6 por ciento), resonancia magnética (10,6 por ciento), tomografía (20,9 por ciento), exámenes contrastados (18,2 por ciento) y otros procedimientos (27,7 por ciento). La hipotermia ocurrió en 182 (15,3 por ciento) transportes y se asoció al (OR; IC95 por ciento): peso al transporte <1000g (3,7; 1,4-9,9); peso al transporte 1000-2500g (1,5; 1,0-2,2); temperatura axilar pre-transporte <36,5º C (2,0; 1,4-2,9); presencia de malformaciones del sistema nervioso (2,8; 1,8-4,4); uso de oxígeno inhalatorio (1,6; 1,0-2,5); ventilación mecánica antes del transporte (2,5; 1,5-4,0); cirugías (1,7; 1,0-2,7) y años de 2001, 2003 y 2006 (protectores). CONCLUSIONES: Los transportes intrahospitalarios presentan elevado riesgo de hipotermia, mostrando que deben ser realizados por personas habilitadas...

Predictive score for clinical complications during intra-hospital transports of infants treated in a neonatal unit

OBJECTIVE: To develop and validate a predictive score for clinical complications during intra-hospital transport of infants treated in neonatal units. METHODS: This was a cross-sectional study nested in a prospective cohort of infants transported within a public university hospital from January 2001 to December 2008. Transports during even (n=301) and odd (n = 394) years were compared to develop and validate a predictive score. The points attributed to each score variable were derived from multiple logistic regression analysis. The predictive performance and the score calibration were analyzed by a receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test, respectively. RESULTS: Infants with a mean gestational age of 35 + 4 weeks and a birth weight of 2457 + 841 g were studied. In the derivation cohort, clinical complications occurred in 74 (24.6 percent) transports. Logistic regression analysis identified five variables associated with these complications and assigned corresponding point values: gestation at birth [<28 weeks (6 pts); 28-34 weeks (3 pts); >34 weeks (2 pts)]; pre-transport temperature [<36.3°Cor >37°C(3pts); 36.3-37.0°C (2 pts)]; underlying pathological condition [CNS malformation (4 pts); other (2 pts)]; transport destination [surgery (5 pts); magnetic resonance or computed tomography imaging (3 pts); other (2 pts)]; and pre-transport respiratory support [mechanical ventilation (8 pts); supplemental oxygen (7 pts); no oxygen (2 pts)]. For the derivation and validation cohorts, the areas under the ROC curve were 0.770 and 0.712, respectively. Expected and observed frequencies of complications were similar between the two cohorts. CONCLUSION: The predictive score developed and validated in this study presented adequate discriminative power and calibration. This score can help identify infants at risk of clinical complications during intra-hospital transports.