Abstract 1444 Poster Session III, Monday, 5/3 (poster 59)

Analysis of outcomes of transported outborn very low birth weight (VLBW: 500-1499 gm) newborns indicated that body temperature at the time of transport team arrival at the referring hospital (as a function of newborn stabilization) was significantly associated with subsequent morbidity and mortality. A nonconcurrent prospective study was conducted to better understand these observations. The study population consisted of all singleton VLBW newborns transported to the NICU of the Medical University of South Carolina Hospital from January, 1991 through March, 1997 (N=154). Normothermic newborns were defined as those with a body temperature greater than 96.6°F (35.9°C) at the time of transport team arrival at the referring hospital. Hypothermic newborns were defined as those with a body temperature less than or equal to 96.6°F. Of the transported newborns, 85 (55.2%) were normothermic and 69 (44.8%) were hypothermic. Hypothermic newborns, as compared to normothermic newborns, were more often of lighter birth weight, male, and had an increased incidence of subsequent central nervous system disorders and intraventricular hemorrhage. Hypothermic newborns also had a statistically significant increase in mortality. Surviving hypothermic newborns had an average increase in hospital length of stay of 43 days and approx. $123,000 in hospital and professional charges. Using regression methods to directly control for gender and birth weight, and limiting the analysis to survivors (to indirectly control for birth weight), hypothermic newborns remained at significantly increased risk for mortality, length of stay (25 days), and charges ($48,000).

During a portion of the study period, neonatologist (Neo) from the regional perinatal center were contracted to work in three of the eleven community hospitals in the perinatal region. Newborns transported from community hospitals without Neo-directed stabilization were at twice the risk for hypothermia as compared to newborns transported from community hospitals with Neo-directed stabilization. Neonatal mortality was significantly lower when there was a Neo-directed stabilization prior to transport. The birth weight distribution of transported newborns was similar between community hospitals with and without Neo coverage. In hospitals with Neo coverage, the newborn was approx. three hours old when a request for transport was received. In hospitals without Neo coverage, the newborn was approx. 45 minutes old when the request for transport was received. To expand this concept using South Carolina data, ≈ 100 VLBW newborns are transferred from community hospitals to regional centers per year, and assuming ≈ 56% overall survival and ≈ a 50% hypothermia rate, attention to newborn stabilization may have the potential of saving over 1,200 hospital days and $3.4 million in hospital charges annually in South Carolina alone. Implications for outreach education will be discussed.