Predictors of the need for re-evacuation of newborns from secondary level hospitals

Abstract

BACKGROUND: The medical evacuation of premature newborns to institutions providing a higher level of medical care results in the reduction of death risk. The use of pediatric intensive care units in level 2 organizations for the hospitalization of newborns can be a potential solution to the lack of neonatal beds in level 3 institutions.

AIM: This study aimed to determine the predictors of the re-evacuation of newborns from level 2 medical organizations to level 3 institutions.

MATERIALS AND METHODS: This observational, cohort, retrospective study included data of 284 cases of the evacuation of newborns from level 1 and 2 medical organizations without a pediatric intensive care unit to level 2 medical organizations with a pediatric intensive care unit. The sample was divided into two groups: the first group included patients who received the necessary therapy in level 2 medical organizations and did not require further evacuation to level 3 (n = 261), and the second group included patients who required further transfer to level 3 (n = 23). Anamnesis data, nosological structure, respiratory support parameters, intensive therapy, and volume of pretransoport activities in the groups were analyzed. Methods of statistical analysis included median, interquartile range, proportion and its 95% CI, Fisher exact test, Mann–Whitney test, receiver operating characteristic analysis, and odds ratio.

RESULTS: The predictor of the requirement for re-evacuation was birthweight (area under the curve [AUC] 0.658 [0.522–0.795]). When only patients on a ventilator were included in the analysis, the saturation oxygenation index (AUC 0.730 [0.579–0.863]) and the SpO₂/FiO₂ ratio (AUC 0.720 [0.571–0.869]) have the maximum predictive value.

CONCLUSIONS: Birthweight of <1390 g (AUC 0.658 [0.522–0.795], sensitivity 0.348 [0.153–0.542], and specificity 0.950 [0.924–0.977]) is a predictor of the requirement for further evacuation of newborns from level 2 pediatric and neonatal intensive care units to a level 3 organization. For patients on a ventilator, such predictors included saturation oxygenation index > 4.25 (AUC 0.730 [0.579–0.863], sensitivity 0.471 [0.233–0.708] and specificity 0.928 [0.888–0.967]) and SpO₂/FiO₂ ratio < 265.71 (AUC 0.720 [0.571–0.869], sensitivity 0.588 [0.354–0.822], and specificity 0.837 [0.781–0.893]). However, the high negative and low positive predictive values for these parameters do not allow their solitary use when deciding about routing a newborn.

Keywords

newborn / gestational age / neonatal intensive care unit / birth weight / oxygen saturation / mechanical ventilators

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