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G528(P) To transfer or not transfer – the ethical and resources implications for transferring infants with a high risk of early death
  1. TM William Ibrahim1,
  2. S Broster2,
  3. W Kelsall3
  1. 1Neonatal Intensive Care Unit and Acute Neonatal Transport Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2Acute Neonatal Transport Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  3. 3Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

Abstract

Background Over the last decade neonatal transport services (TS) have developed significantly as networks have been established. The responsibility of the TS is to transfer sick neonates for specialist care usually to level III units for medical or surgical treatment.1 Medical and nursing expertise in network units varies, with staff on neonatal tertiary intensive care units managing neonatal deaths more frequently. This study aims to review deaths across a single network particularly considering cases that were referred for transfer.

Methods A retrospective review of neonatal deaths and the infants referred to the TS between January 2011 and December 2012. Data was collected from the network SEND and TS databases.

Results Over 2 years there were approximately 150,000 live births in the network, with 1445 (1%) infants referred as an emergency for neonatal TS. There were 219 deaths with an overall mortality rate of 1.46 deaths per 1000 live births. The gestational age of babies who died was median 28 (range 23–41) weeks and birth weight 900 (400–3500) gram. Of these 219 babies 107 (49%) were referred for neonatal transfer. Of the referrals, 73 (68%) transfers were completed with 14 (19%) of these babies dying within 24 h, 13 (18%) dying between 24 – 48 h and 46 (63%) dying more than 48 h after transfer. Of the 34 cases that were not transferred 15 (44%) died before the TS was despatched, 18 (53%) were deemed too sick to transfer by the TS after arrival in the referring unit and 1 (3%) transfer was declined by the parents.

Conclusion The study demonstrates that careful communication between TS and local consultants has avoided the unnecessary transfer of a small number of neonates in whom it was felt that death was inevitable. A small but significant number of transferred infants die within 24 h of transfer. It could be argued that these babies should not have been moved. However the reasons for transfer may be more complicated: with parents wanting everything possible done or local clinicians wanting to work with specialist centres in managing all aspects of care including a neonatal death.

Reference

  1. BAPM criteria (2001) for emergency transfer.

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