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.

Neonatal outcomes of very preterm infants from a neonatal intensive care center

Background:Information about clinical outcomes of very preterm(VPT)infants in tertiary neonatal intensive care unit(NICU)setting is scant in China.This study aimed to investigate the mortality and morbidity of VPT infants admitted to BaYi Children’s Hospital,which serves as a NICU referral center for the city of Beijing,China.Methods:Retrospectively collected perinatal/neonatal data on all admissions of infants born at<32 weeks of gestational age and subsequently admitted to the VPT-NICU from clinical records between October 2010 and September 2011.Results:Totally 729 infants were identified.90%of VPT infants were outborn.The overall survival of the infants to discharge was 92%,which increased with increasing gestational age(range from 69%at<28 weeks to 99%at 31 weeks).The incidence of bronchopulmonary dysplasia was 4%,retinopathy of prematurity requiring treatment 2%,intraventricular hemorrhage III-IV 6%,and periventricular leukomalacia 2%.10%of the VPT infants had a major morbidity at discharge.Conclusions:The outcomes of the VTP infants at this referral NICU were comparable to those in tertiary centers in developed countries.The most common complications were lower than those in other cohorts.Accordingly,high-volume NICU may minimize the adverse effects of VPT infants’transport.