Neonatal transports—risks and opportunities

Aim: To assess the need for and quality of neonatal transports. Material and methods: Prospective observational study of consecutive transports from a level II neonatal unit. Results: 500 transports were undertaken 1982-2010 in 445 patients, representing 0.7% of liveborn infants (n = 61 450). Indications were congenital malformations in 223 (45%), prematurity/respiratory distress syndrome (RDS) in 87 (17%), and other conditions in 190 (38%). For patients ventilated during transport (n = 121) mean pCO2 was improved at arrival, and for spontaneously breathing patients mean pH, pCO2, and base excess (p < 0.05). After establishing a local respirator programme from 1989, transports for prematurity/RDS declined from 3.4 per 1000 live born infants in 1982-88 to 0.8 per 1 000 in 1989-2010 (p < 0.0001), and night-time transports (departure between 22.00 pm - 06.00 am) declined from 24/119 (20%) to 38/381 (10%) (p = 0.003). Technical mishaps or severe clinical deterioration occurred in 16 (3%) of the transports. Conclusions: Neonatal transport carries risks, but also an opportunity for further stabilization and improvement. A local respirator programme reduced the need for transfer of premature infants with RDS as well as for transports during night-time.

Congenital heart defects through 30 years

Aim: To assess basic trends in epidemiology of congenital heart defects (CHDs). Method: Population based prospective observational study. Material: CHDs in infants born alive in a Norwegian county 1982-2011. Results: In 828/71 217 infants (12 per 1000) a CHD was diagnosed. The prevalence increased from 8 to 12 per 1000 after introduction of early echocardiography in newborns with suspected CHD from 1986 (p = 0.0001). Ventricular septal defect (VSD) was the dominating CHD (474;57%). In 222 (27%) the CHDs were missed and diagnosed after discharge from hospital after birth. Twelve critical CHDs (causing death or requiring invasive procedures before 28 days of life) were missed. Prenatal diagnosis of critical CHDs increased from 4/67 (6%) born 1997-2006 to 4/11 (36%) born 2007-2011 (p = 0.01). In 177 (21%) a syndrome or extracardial defect occurred. The occurrence of CHDs associated with chromosomal disorders (60/73 (82%) trisomies) more than doubled from the cohort born in the first 10-year period 1982-1991 (0.6 per 1000) to the last 2002-2011 (1.4 per 1000) (p < 0.0001) in parallel with increasing births in women ≥ 35 years old in the population. 237 (29%) underwent therapeutic procedures (203 (86%) surgery, of whom 16 after initial catheter intervention, and 34 (14%) catheter intervention alone). 39/237 (16%) died, 101 (43%) were repaired and 97 (41%) had some minor residual defect. The death rate declined significantly from 65/532 (12%) born 1982-2001 to 11/296 (4%) born 2002-2011 (p = 0.0001). 37/76 (49%) deaths occurred within 28 days after birth. Conclusions: The rate of detection of CHDs increased substantially after introduction of echocardiography in newborns with suspected CHD, especially VSDs. Some critical CHDs were overlooked. The prenatal detection rate of such defects increased. The prevalence of CHDs with associated chromosomal disorders increased in parallel with increasing maternal age in the population. Most deaths occurred during the neonatal period. Increasing survival increases the load on long-term follow-up programmes.