Improved outcomes of transported neonates in Beijing:the impact of strategic changes in perinatal and regional neonatal transport network services

Background:Infants born outside perinatal centers may have compromised outcomes due to the transfer speed and effi ciency to an appropriate tertiary center.This study aimed to evaluate the impact of regional coordinated changes in perinatal supports and retrieval services on the outcome of transported neonates in Beijing,China.Methods:Information about transported newborns between phase 1(July 1,2004 to June 30,2006)and phase 2(July 1,2007 to June 30,2009)was collected.The strategic changes during phase 2 included standardized neonatal transport procedures,skilled attendants,a perinatal consulting service,and preferential admission of transported neonates to the intensive care unit of the tertiary care center.Data from phase 2(after-strategic changes)were compared with those of phase 1(the period of pre-strategic changes)after a 12-month washout period,especially regarding the reduction in mortality and selected morbidity.Results:There was a large increase in the number of transported infants in phase 2 compared with phase 1(2797 vs.567 patients).The average monthly rate of increase of transported infants was 383.3%(from 24 infants per month to 116 infants per month).The mortality rate of transported neonates reduced significantly from phase 1 to phase 2(5.11%vs.2.82%;P=0.005),particularly for preterm infants(8.47%vs.4.34%;P=0.006).In addition,transported neonates during phase 2 had signifi cantly decreased morbidities.Conclusions:Regional coordinated strategies optimizing the perinatal services and transport of outborn sick and preterm infants to tertiary care centers improved survival outcomes considerably.These findings have vital implications for health outcomes and resource planning.

Perioperative extracorporeal membrane oxygenation in pediatric congenital heart disease:Chinese expert consensus

Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces more severe challenges due to the complex anatomical structure of the heart,special pathophysiology,perioperative complications and various concomitant malformations.The survival rate of ECMO for CHD was significantly lower than other classifica-tions of diseases according to the Extracorporeal Life Support Organization database.This expert consensus aims to improve the survival rate and reduce the morbidity of this patient population by standardizing the clinical strategy.Methods The editing group of this consensus gathered 11 well-known experts in pediatric cardiac surgery and ECMO field in China to develop clinical recommendations formulated on the basis of existing evidences and expert opinions.Results The primary concern of ECMO management in the perioperative period of CHD are patient selection,cannulation strategy,pump flow/ventilator parameters/vasoactive drug dosage setting,anticoagulation management,residual lesion screening,fluid and wound management and weaning or transition strategy.Prevention and treatment of complications of bleeding,thromboembolism and brain injury are emphatically discussed here.Special conditions of ECMO management related to the cardiovascular anatomy,haemodynamics and the surgical procedures of common complex CHD should be considered.Conclusions The consensus could provide a reference for patient selection,management and risk identification of periop-erative ECMO in children with CHD.