Morbidity And Mortality Outcomes In Neonates Who Were Transferred From To The Neonatal Intensive Care Unit In Sfax-Tunisia

Background In view of the multiplicity of places of birth and the scarcity of neonatal intensive care units, the transfer of sick newborns is necessary in several situations in order to provide them with the necessary care not available at the birth places. This transport exposes the newborn to some risks that may affect morbidity and mortality. Aims of the study To study the characteristics of transported newborns and the conditions of their transfer in order to identify the factors that can influence morbidity and mortality. Methods Retrospective chart review: the medical records of 273 newborns transported and admitted in NICU over a period of 3 years, from January 1, 2012 to December 31, 2014. Results The transfer rate during the study period was 6.4%. The private sector contributed in 57.5% of the transfers while the rest of the cases were originated from the peripheral maternities (25.2%). The main reasons for transfer were neonatal respiratory distress (62.3%), neonatal infection (43.2%) and prematurity (24.2%).Surgical diseases (or other malformations) were addressed mainly from peripheral maternities with a significant difference compared to the private sector. 89.4% of cases were transported in an ambulance with a very limited equipment (incubator, oxygen cylinder, rarely a scope) and in the presence of a single nurse and exceptionally a doctor. Incidents occurred during the transfer and were observed in 6 cases: accidental extubation, depletion of the oxygen cylinder. Complications were observed in 48.4 of the cases, the main one was iatrogenic infection (19.75%). The death rate was 13.6%: this rate is influenced by hypoglycaemia, hypoxia, surgical diseases and the use of mechanical ventilation. Conclusion The severity of the initial neonatal pathology conditionned the prognosis of the newborns transported which is also influenced by the conditions of the transport.