PC.25 Inhaled nitric oxide therapy during transport of neonates – experience of CenTre transport service

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Abstract

Background

Continuing inhaled nitric oxide (iNO)during transport sustains acute improvements in oxygenation and diminishes the oxygenation lability characteristic of persistent pulmonary hypertension (PPHN).

Aim

To evaluate the characteristics,safety and outcomes of babies that needed iNO treatment during transport initiated by the CenTre transport service.

Methods

Retrospective review of case notes and excel database of CenTre transport from April 2010–July 2013.

Results

CenTre team transported 25 neonates on iNO of which 24 were initiated by the transport team. 3/25 died before transfer in the local hospitals.19/22 neonates were transported to tertiary neonatal unit and 3 to ECMO centre of which 2 neonates received ECMO and both survived. Median (range) gestational age and birth weight were 40 weeks (28–42) and 3205 grams (918–5400). In 21/25(85%) neonates, the indications for starting iNO were PPHN secondary to meconium aspiration (8),respiratory failure (6), hypoxic ischaemic encephalopathy (4) sepsis (2) and congenital diaphragmatic hernia (1). 2 had cardiac and 2 upper airway anomalies with difficult oxygenation. The median (range) time from referral to arrival at the referring unit is 2.3 hrs (1–6),stabilisation time 3.45 hrs (2–10) and transport time to receiving unit is 50 min (30–120). Mean Oxygenation index prior to initiation of iNO and on arrival at the receiving unit were 44 and 33 (p -0.008). All transports were uneventful. The median duration of iNO therapy was 48 h (Q1;Q3- 24;78)and hospital stay was 10 days (Q1;Q3 7;19).

Conclusions

The indication for iNO treatment in majority of babies was PPHN. There was significant improvement in the OI following iNO treatment. Transport teams should be aware of significantly long duration involved in transfers of babies with PPHN needing iNO.

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