NEONATAL SOCIETY ABSTRACTS
In-utero transfer, too difficult? A prospective survey of “missed” in-utero transfers
Presented at the Neonatal Society 2009 Autumn Meeting (programme).
Gale CR1, Hay A2, Chauhan H2, Khan R3, Ratnavel N1 (introduced by Dr S Kempley )
1 Neonatal Transport Team, 2nd floor, David Hughes Building, The Royal London Hospital, Whitechapel Road, London, E1 1BB, UK
2 Emergency Bed Service, London Ambulance Service NHS Trust, 220 Waterloo Road, London, SE1 8SD, UK
3 Department of Obstetrics and Gynaecology, The Royal London Hospital, Whitechapel Road, London, E1 1BB, UK
Background: In cases of preterm labour in-utero transfer is associated with better neonatal outcomes than postnatal transfer(1-2), and is consequently recommended whenever possible. Since the establishment of a neonatal transport team (NTS) in London to simplify postnatal transfers, in-utero transfers have declined, with a simultaneous rise in postnatal transfers(3). Anecdotal reports suggest arranging in-utero transfer is difficult and time consuming, and as a result potential opportunities are missed.
Aims: To determine the incidence of “missed” in-utero transfers in London. To determine reasons for “missed” in-utero transfers.
Design: Potential cases were defined as follows: post-natal transfers following passage of >12 hours between maternal admission and delivery, infant <29 weeks gestation, infant transferred for reasons of prematurity to higher level unit within 24 hours of birth. Following appropriate Caldicott Guardian and information governance approval a prospective questionnaire-based study assessed clinical, organisational and administrative reasons in-utero transfer did not occur. “Missed” transfers were defined as cases where there was no clinical contra-indication to in-utero transfer. In collaboration with the Emergency Bed Service, data on total in-utero requests within the London area was collected.
Results: Over the 5-month study period NTS carried out 600 postnatal transfers, 66 (11%) on infants <29 weeks gestation, <24 hours old. Within this preterm group 12 (18%) met our criteria as “missed” in-utero transfers. “Missed” cases had been present for a median of 36 hours (IQR 13-60) prior to delivery. An average of 7 units (SD 3) had been contacted, requiring on average 220 minutes (SD 128) of clinical time. Maternal condition changed during attempted in-utero transfer, making in-utero transfer inappropriate, in all “missed” cases. A neonatal cot was identified in 5 (41.7%) cases, with subsequent maternal bed being identified in 1 case (8.3%). Over the study period EBS received 404 requests for in-utero transfer, 228 resulted in successful in-utero transfers (56%), median EBS involvement time 183 minutes (IQR 135.5-369.5).
Conclusion: “Missed” in-utero transfers make up a significant proportion of emergency preterm post-natal transfers carried out by the London NTS. Significant clinical time is involved in arranging unsuccessful in-utero transfer. A dedicated, centralised in-utero planning service would save clinical time and may reduce missed in-utero transfers, with consequent beneficial effects on neonatal outcome.
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2. Harris TR, Isaman J, Giles HR. Improved neonatal survival through maternal transport. Obstet Gynecol. 1978 Sep;52(3):294-300
3. Kempley ST, Baki Y, Hayter G, Ratnavel N, Cavazzoni E, Reyes T. Effect of a centralised transfer service on characteristics of inter-hospital neonatal transfers. Arch Dis Child Fetal Neonatal Ed. 2007 May;92(3):F185-8