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

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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.

About the authors

Rustam F. Mukhametshin

Ural State Medical University; Regional Children’s Clinical Hospital

Author for correspondence.
Email: rustamFM@yandex.ru
ORCID iD: 0000-0003-4030-5338
SPIN-code: 4206-3303

MD, Cand. Sci. (Med.), anesthesiologist-resuscitator

Russian Federation, Yekaterinburg; Yekaterinburg

Olga P. Kovtun

Ural State Medical University

Email: kovtun@usma.ru
ORCID iD: 0000-0002-5250-7351
SPIN-code: 9919-9048

Dr. Sci. (Med.), professor, academician of Academy of Sciences

Russian Federation, Yekaterinburg

Nadezhda S. Davydova

Ural State Medical University

Email: davidovaeka@mail.ru
ORCID iD: 0000-0001-7842-6296
SPIN-code: 3766-8337

Dr. Sci. (Med.), professor of the Department of Anesthesiology, Intensive Care, Toxicology

Russian Federation, Yekaterinburg

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2. Pic. 1. Comparison of ROC curves of mass and gestational age in relation to repeated evacuation of newborns

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3. Pic. 2. Comparison of ROC curves of mass, gestational age, saturation index of oxygenation and SpO2/FiO2 ratio in relation to repeated evacuation of newborns on a ventilation

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