The effect of transport on the physiologic stability of neonates with ductal-dependent single-ventricle lesions

Abstract

Objective: To compare the status of infants with hypoplastic left heart syndrome (HLHS) or pulmonary atresia-hypoplastic right heart (PA-HRH) before and following transport using the validated Transport Risk Index of Physiologic Stability (TRIPS) score.

Methods: In this retrospective review of infants with HLHS or PA-HRH transported to a Children’s Hospital by a pediatric transport team, an increase in TRIPS score (temperature, blood pressure, respiratory status, and response to stimuli) following transport was defined as deterioration. Statistical analyses included t-test (paired and independent), χ², and McNemar’s tests for comparisons between groups with and without deterioration and before and after transport.

Results: Our cohort [n = 64; 39 (61%) HLHS and 25 (39%) PA-HRH] was predominantly female (61%), black (56%), and diagnosed antenatally (78%). Median transport time was 20 (10–30) min and age was <12 h in 48 (75%) infants. TRIPS scores worsened after transport in 24 (37.5%) infants, due to temperature (n = 10) or respiratory (n = 7) dysregulation. Infants who deteriorated during transport had HLH more often (83 versus 48%) and lower pH [7.27 (0.12) versus 7.33 (0.07)]. HLH was significantly predictive of deterioration during transport [OR 5.60 (95% C.I. 1.18–26.62)].

Conclusions: The physiologic deterioration in a third of infants with single ventricle following short transports is intriguing and may have implications on their optimal place of birth.

Keywords:

• Transport
• neonate
• hypoplastic left heart
• single ventricle

Disclosure statement

There is no conflict of interest and all the authors have approved the manuscript.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.