Audit of neonatal transfers to a tertiary centre in the Tshwane metropolitan area

Abstract

Aim: This is an audit to determine the referral diagnosis, any resuscitation or interventional measures taken, the condition on arrival and the outcome of neonates transferred from Mamelodi Hospital to Pretoria Academic and Kalafong hospitals. Methods: Data was collected of all neonates transferred from Mamelodi hospital to the neonatal intensive care units (NICU) at Pretoria Academic and Kalafong hospitals between September 2003 and October 2004. The data was analysed for referral criteria, pre-transport resuscitation, condition on arrival and outcomes. Results: There were 42 neonates enrolled in the study. The most common reason for referral was prematurity (71.4%). Forty six percent of the full term baby referrals were for birth asphyxia. Hypothermia was found in 79% of all patients on arrival at the tertiary care NICU. There were no intravenous lines in 52% of patients, while 23% had hypoglycaemia on arrival at the receiving hospital. The mortality rate was 26.1% with five of 12 full term neonates and six of 30 preterm neonates dying. Conclusion: The study highlights the need for adequate pre-transport stabilization of neonates, which include interventions to avoid hypothermia and insertion of intravenous line with 10% Dextrose solution to prevent hypoglycaemia. There is a need to train health care staff to effectively resuscitate neonates to prevent or minimise birth asphyxia. Mothers in pre-term labour should be referred early to centres that can manage premature babies. This data will be used to develop transport protocols for transfers of high-risk neonates.