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29.03.2016 Category: News

Guest article: Neonatal transport in the central region of Hungary

Neonatal transport in the central region of Hungary

By Zsolt Somogyvári MD PhD MSc., Neonatal Emergency and Transport Service of the Peter Cerny Foundation Budapest/Hungary

The Neonatal Emergency and Transport Service of the Peter Cerny Foundation (NETS-PCA) covers the central region of Hungary including Budapest and six counties with all together four million inhabitants in a 120-140km radial surroundings with a driving distance of 60-70 minutes.

The NETS-PCA provides neonatal transportation between 11 NICUs of Level-III, and 31 referral hospitals with delivery rooms, and 10 diagnostic centers and 25 hospitals for bedside retinopathy of prematurity (ROP) telemetric screening. In the last 27 years, 67,618 premature and sick newborns have been transported, 13,858 have received ventilatory support, 1,361 resuscitations were made with a 90 per cent success outcome and 157 active controlled hypothermic treatments were started at the referral hospital and continued during the transport. 

The yearly activity of the NETS-PCA – working as a mobile NICU Level III – includes about 3,000-4,000 neonatal transfers per year, up to 43 on a single day. There are about 600-1,000 emergency cases, many with acute interventions, and about 1,000-1,400 cases back or return transfers to lower level NICU-s. There are about 1,000 inter-hospital transports for diagnostic interventions. The activities of the NETS-PCA also include mechanical ventilations (700-1,000 per year) with measuring oxygen saturation, respiratory rate, heart rate, and 300-400 mobile blood-gas analysis, 35-50 resuscitations per year in delivery rooms (DR) of the referral hospitals (!), 40-50 Surfactant treatment at DR, 20-30 newly born baby per year from home deliveries and 30-40 active hypothermia treatment of asphyxiated newborns during transport.

Before 2010, the NETS-PCA dedicated only to special neonatal transport had got 150-200 calls per year to transfer premature for ROP examinations and laser-treatment. It is an enormous burden on the emergency and transport service, and poses significant risk to the fragile extremely low birth weight infants (ELBWI). In addition it incurs costs due to the mileage and the transport-time, decreasing significantly the NETS-PCA efficiency.

To solve this problem, we developed a state-of-the-art modality for bed-side, portable, non-invasive ROP screening, treatment and follow-up telemedicine system, named “Premature Eye Rescue Program” for avoiding transport of premature, which fit together the preexisting facilities of the NETS-PCA. The transport-based remote ROP screening, offered not only in the central region of Hungary, is based on a collaboration between a nonprofit organization (PCA), and a University Department. The NETS-PCA offers logistics (24/7 dispatch service), infrastructure (RetCamShuttle Clarity Co/USA), dedicated screening staff (four transport nurses) and covers the cost of the project. The Dept. Ophthalmology of the Semmelweis University ensures the ROP-expert, the scientific and educational backgrounds. The ROP specialist on-call has given not only diagnosis via Wide-field digital imaging-based telemedicine-telemedicine, but as a ”flying ROP specialist” he can locally treat the ELBWIs with laser for which NETS-PCA provides its own incubators.

Results of the “Premature Eye Rescue Program”, as a regional “store and forward” telemetric ROP screening are 5,726 retino-telemetric bedside ROP screenings, 399 patients with bed-side laser surgery without transport, and 71,396 “spared” kms with telemetric screening.
In conclusion, the transport-based remote ROP screening as an “off label transport activity” is an unorthodox system utilizing the preexisting facilities of the neonatal transport service, with a reading center at the university hospital and continuous professional control and education from leading experts in ROP and non-ROP screening and treatment. Besides eliminating the avoidable transport of preterm babies, and recording the objective status of the current ROP stages, telemedicine consultation, second medical opinion and quality control have also become available. The logistic system of ambulance effectively provides the continuous availability of the remote eye screening system, while allowing its capacity to be focused on emergency neonatal care.

Staffing of the NETS-PCA
Teams operating 24/7:
1 x MD, RN, and driver
1 x RN, (NNP), and driver
1 x Dispatch Service

Teams operating 8:00 to 17:00 hours:
1 x RN + driver
1 x RN (ROP) + driver

Family Centered Care interventions of the NETS-PCA
- no-pain interventions (sucrose)
- transport with minimized stress: anti-vibration tools; acceleration - speed limit
- psychological support: emotional tasks; giving photos, early skin-skin contact

For answering special neonatal emergency challenges of the Central Area of Hungary, the Peter Cerny Ambulance developed an interfacility neonatal transport system with a dedicated team for all babies, who are less than 6kg of bodyweight and/or 60cm of body length independently of their age. The nongovernmental organisation solved problems of the very vulnerable population of sick babies, in the fields of emergency care of the newly-born and neonates; mobile NICU Level-III; reverse transport; bedside diagnostics and interventions; post-discharge prehospital emergency care; outreach education of medical staff, parents and lay people; for ensuring the welfare of preterm born infants.

For more information on the service, have a look at their multilingual website: http://www.cerny.hu

Special Thanks

Zsolt Somogyvári, MD PhD MSc.

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