Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

The number needed to transfer to a higher level of care

Journal of Perinatology volume 40, pages 831–832 (2020)Cite this article

Subjects

Term and late-preterm infants with hypoxic-respiratory failure (HRF) are often initially managed in centers where neonatal Extracorporeal Membrane Oxygenation (ECMO) is not available. Initial management of such infants usually consists of adequate ventilator support, support of cardiac function and circulation, minimizing energy expenditure, treatment of the underlying cause of respiratory failure, and use of inhaled nitric oxide (iNO) if available. When such management fails to improve oxygenation, the clinician is faced with a decision whether and when to transfer the infant to a center that offers ECMO. Another potential reason for transfer of such patients is the need for a high-quality echocardiogram to identify types of cyanotic congenital heart disease that may masquerade as HRF, e.g., total anomalous pulmonary venous return [1]. Timely transfer of an infant requiring ECMO to an ECMO center improves the likelihood that the infant is clinically stable at the time of cannulation, which in turn ensures a better outcome. Delayed transfer is accompanied by the risk of cardio-respiratory instability. Higher mortality and morbidity are observed in infants with severe HRF who require cardiopulmonary resuscitation at the time of cannulation [2]. While regionalization of perinatal service improves outcomes, it comes with the obligation that clinicians at lower level centers identify and transfer critically-ill patients in a timely fashion to ensure optimal outcomes [3].

The decision to transport a neonate with HRF to an ECMO center requires several factors to be considered, some of which may be planned for ahead of time and some decided as the patient’s condition dictates [4]. Delayed transfer of such infants can result from factors related to the healthcare delivery system, the patient’s condition, and clinician decision-making. Appraising the potential for such delays should be an integral part of decision-making regarding transfer of the infant to the ECMO center.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Mellander M. Diagnosis and management of life-threatening cardiac malformations in the newborn. Semin Fetal Neonatal Med. 2013;18:302–10. PubMed PMID: 23688937.

    Article  Google Scholar 

  2. Howard TS, Kalish BT, Rajagopal SK, Williams K, Zalieckas J, Thiagarajan RR, et al. Factors associated with mortality in children who successfully wean from extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2018;19:875–83. PubMed PMID: 29965888.

    Article  Google Scholar 

  3. O’Mahony L, Woodward GA. 28—Neonatal transport. In: Gleason CA, Juul SE, editors. Avery’s diseases of the newborn. 10th ed. Philadelphia: Content Repository Only!; 2018. p. 347–60.

  4. Kronforst KD. Interhospital transport of the neonatal patient. Clin Pediatric Emerg Med. 2016;17:140–6.

    Article  Google Scholar 

  5. Bigham MT, Schwartz HP, Ohio Neonatal/Pediatric Transport Quality Collaborative. Quality metrics in neonatal and pediatric critical care transport: a consensus statement. Pediatr Crit Care Med. 2013;14:518–24. PubMed PMID: 23867429.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

    K. Suresh Gautham & Caraciolo J. Fernandes

Authors
  1. K. Suresh Gautham
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Caraciolo J. Fernandes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Caraciolo J. Fernandes.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Suresh Gautham, K., Fernandes, C.J. The number needed to transfer to a higher level of care. J Perinatol 40, 831–832 (2020). https://doi.org/10.1038/s41372-020-0617-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-020-0617-1

Search

Advanced search

Quick links