Medical Journal of Dr. D.Y. Patil Vidyapeeth

COMMENTARY
Year
: 2021  |  Volume : 14  |  Issue : 4  |  Page : 469--470

Analysing neonatal transport


Manas Pratim Roy 
 Department of Trauma and Burn, Assistant Director General, Dte. GHS, MoHFW, Nirman Bhawan, New Delhi, India

Correspondence Address:
Manas Pratim Roy
Department of Trauma and Burn, Assistant Director General, Dte. GHS, MoHFW, Nirman Bhawan, New Delhi
India




How to cite this article:
Roy MP. Analysing neonatal transport.Med J DY Patil Vidyapeeth 2021;14:469-470


How to cite this URL:
Roy MP. Analysing neonatal transport. Med J DY Patil Vidyapeeth [serial online] 2021 [cited 2021 Sep 21 ];14:469-470
Available from: https://www.mjdrdypv.org/text.asp?2021/14/4/469/318699


Full Text



India suffers 0.75 million neonatal deaths annually. Over the years, the reduction in the neonatal mortality rate has been slow, reaching 25.4/1000 live births in 2016. Despite recording a gradual reduction in such deaths in the last decade, India provides ample scopes for improving global status on newborn care.[1]

Mondal et al, highlights the need for putting our focus on the same, with emphasis on existing transport mechanisms to nearest equipped hospital. Out of 961 newborns, half did not get any prereferral intervention, while one-third was referred without any clinical note.[2] There is an unfelt need of networking for newborn transfer, comprising both private and public hospitals. It might happen that the required facility for management is not available at the receiving hospital, thus posing risk to the critical cases. Having a network will reduce unnecessary delay in getting the right treatment for the ailing newborn. The network should be analyzed from time to time, based on case load, provisions available for treating critical cases and existing transport mechanism. A special plan need to be there in place for children with major congenital anomalies.

In addition, there will always be need for transport between facilities for already ill neonates.[3] One policy could be bringing the neonatal directly to neonatal intensive care unit (NICU), and not to ED. This will save some valuable time for critical newborns. The composition of the transport team is another essential point-it may constitute of pediatrician, respiratory specialist, nurse, NICU nurse, emergency medical technician, technical staff and driver. Air transfer might be an option where the distance between the hospitals may put additional risk to the newborn.[4] However, there are relevant financial implications attached to it and may not be affordable for developing countries.

There are several other areas where we need to improvise further. Clearly, there is some interruption in the continuity of medical care, if the referring hospital does not communicate properly to the higher hospital for each case. In fact, there may not be provision for required facilities or scope for admission in NICU in the referred hospital.[5] Intervention like “Janani Shishu Suraksha Karyakaram” is aiming to enhance accessibility to hospital care, by providing free transport. Introduced in 2011, the initiative provides free transport for newborns from home to facility, inter-facility transfer and dropping back home after discharge. Still, more than 75% newborns, even in Delhi, reach Emergency Room by auto/cycle rickshaw/bus/train/two-wheeler.[6]

Fact, National Health Mission has revolutionized maternal and child health care, by pushing institutional delivery (ID), introducing Navjaat Shishu Shuraksha Karyakaram and bringing in the concept of performance based incentive. However, it is not necessary that high ID would eventually lead to a reduction in perinatal mortality. The reasons could be multi-fold, starting from lack of trained manpower to suboptimal quality to unavailability of timely transport of neonates to equipped hospitals.[7] Unfortunately, the exclusive priority for labour care and delivery has virtually sidelined all other aspects of newborn care including inter-hospital and community-to-hospital shifting.[8]

It is clear that required triad of motorable roads, transport mechanism and sick neonate needs to put in the same frame to establish close links.[5] The next could be extending the quality concept to the triad. Assuming that the mere presence of an ambulance will do drastic reduction in neonatal deaths is probably too unreal. In a system where every intervention runs vertical, there is need for integration between community care, hospital care and care during transport.

For the sake of closing the loops, there is additional need of training health workers for raising awareness among the community. There should be demand for better transport to the next level of health care, which in turn, would complement the existing system, by ensuring that newborn gets the best services available. One study from Bangladesh indicated 5.5% of neonatal death during transfer to hospitals.[9] Such analysis should be used for setting up priority areas for intervention, particularly in countries with limited resources. Knowing “what works” is of utmost importance.

References

1Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: An updated systematic analysis. Lancet 2015;385:430-40.
2Mondal T, Khatun M, Md Habibulla S K, Ray S, Hazra A, Ivan M D, et al. Epidemiology of newborn transport in India - The reality check. Med J DY Patil Vidyapeeth 2021;14:308-13.
3Finnstrom O, Otterblad Olausson P, Sedin G, Serenius F, Svenningsen N, Thiringer K, et al. The Swedish national prospective study on extremely low birth weigth (ELBW) infants. Incidence, mortality, and survival in relation to level of care. Acta Paediatr 1997;86:503-11.
4Narli N, Kırımi E, Uslu S. Turkish Neonatal Society guideline on the safe transport of newborn. Turk Pediatri Ars 2018;53:S18-S31.
5Roy MP, Gupta R, Sehgal R. Neonatal transport in India: From public health perspective. Med J DY Patil Univ 2016;9:566-9.
6Jajoo M, Kumar D, Dabas V, Mohta A. Neonatal transport: The long drive has not even begun. Indian J Community Med 2017;42:244-5.
7Singh SK, Kaur R, Gupta M, Kumar R. Impact of national rural health mission on perinatal mortality in rural India. Indian Pediatr 2012;49:136-8.
8Hodgins S. Achieving better maternal and newborn outcomes: Coherent strategy and pragmatic, tailored implementation. Glob Health Sci Pract 2013;1:146-53.
9Halim A, Dewez JE, Biswas A, Rahman F, White S, van den Broek N. When, Where, and Why Are Babies Dying? Neonatal Death Surveillance and Review in Bangladesh. PLoS One 2016;11:e0159388.