Relationship Factors Between Transportation Of Extremely Low And Very Low Birth Weight Infants And Mortality

Objective To analyze the effects of transport and the risk factors of mortality for ELBWI and VLBWI.Method All infants whom transferred by our hospital transport team or local hospital transport team to our Neonatal Intensive Care Unit(NICU)from January 1,2014 to December 31,2015 were included.Collection data included transportation factors,prenatal factors,birth conditions,complications and treatment.Influential factors of death within and after 7 days of admission were analyzed with single factor analysis and multivariate logistic regression analysis.The ROC analysis was used to assess the accuracy of the scoring systems for predicting mortality.Results1.A total of 527 cases of ELBWI/VLBWI were included in our study,no case died during transport.Of 527 cases,322 cases(61.1%)were male.The mean gestational age was 29.56±2.21 w.The mean birth weight was 1190.54±183.43 g.471 cases(78.0%)were active transport,116 cases(22.0%)were passivly transported,47 cases(8.9%)were non-standard transport,and 28 cases(5.3%)had the second transport.There were 207 cases(39.3%)transfered with endotracheal intubation and resuscitation capsule.The average transport radius was 129.3 ± 95.3km,and the average one-way transit time was 2.1±1.2h.During hospitalization,328 cases(62.6%)had neonatal respiratory distress syndrome(NRDS),326 cases(61.9%)had bronchopulmonary dysplasia(BPD),196 cases(37.2%)had retinopathy of prematurity(ROP),126 cases(23.9%)had sepsis,35 cases(6.6%)had necrotizing enterocolitis(NEC),33 cases(6.3%)had intraventricular hemorrhage(IVH)?? degree,31 cases(5.9%)had periventricular ieukomalacia(PVL).2.There were 96 patients died and the total mortality rate was 18.2%(96/527),there were 54 patients died within 7 days of admission,the mortality rate was 10.2%(54/527).There were 42 died after 7 days of admission,the mortality rate was 8.9%(42/470).(1)The influential factors for 7 days of death included prenatal hormones,corrected gestational age,hospital weight,admission age,1 minute Apgar score,5 minute Apgar score,tracheal intubation,secondary transport,MINT score,TREMS score,NRDS,IVH ?? degree,sclerosis,gastrointestinal malformations,metabolic acidosis,mechanical ventilation,PS.Multivariate logistic regression analysis showed that sclerosis,secondary transport,gastrointestinal malformations,metabolic acidosis,high TREMS score,and high MINT score were risk factors of mortality within 7 days of admission for ELBWI/VLBWI.(2)The influential factors for the mortality after 7 days of admission included gestational age,birth weight,corrected gestational age,admission weight,admission age,1 minute Apgar score,5 minute Apgar score,tracheal intubation,TRIPS score,MINT score,TREMS score,NRDS,IVH ?? degree,sepsis,gastrointestinal malformations,mechanical ventilation and PS.Multivariate logistic regression analysis showed that NEC,IVH ?? degree,high MINT score and low admission weight were risk factors of mortality after 7 days of admission.3.The area under the ROC curve(AUC)for MINT score,TREMS score,TRIPS score predicting mortality within 7 days of admission were 0.672,0.655 and 0.655,respectively.The ROC curve cutoff analysis showed that when MINT score was 8,the sensitivity was 0.444,the specificity was 0.829;when TREMS score was 2,the sensitivity was 0.5,the specificity was 0.757,when TRIPS score was 20,the sensitivity was 0.444,the specificity was 0.829,the Youden index was the highest.Conclusions1.Secondary transport is the transport-related risk factor of mortality within 7 days of admission for ELBWI/VLBWI.2.High MINT score is the risk factor of mortality within and after 7 days of admission.High TREMS score is the risk factor of mortality within 7 days of admission.3.If MINT score ? 8,TREMS score ? 2,and TRIPS score ? 20,it might significantly increase the risk of mortality within 7 days of admission.4.Sclerosis,gastrointestinal malformations and metabolic acidosis are risk factors of death within 7 days of admission.NEC,IVH? ? degree,and low admission weight are risk factors of mortality after 7 days of admission.