Neonatal transport and therapeutic hypothermia: A focus on hypoxic-ischemic encephalopathy outcomes in a tertiary center in northern Taiwan.

BACKGROUND Neonatal transport is a critical component of regionalized perinatal care and it has played a significant role in improving neonatal survival. However, contemporary clinical practices of neonatal transport in Taiwan remain underreported. This study aimed to comprehensively analyze the characteristics and outcomes of neonates transported to a tertiary medical center in northern Taiwan, with particular focus on those diagnosed with hypoxic-ischemic encephalopathy (HIE) and treated with therapeutic hypothermia (TH).

METHODS We retrospectively reviewed medical and transport records of neonates transported to the neonatal care center at Chang Gung Memorial Hospital, Linkou Branch, between January 2019 and December 2021. A subgroup analysis was performed comparing inborn and outborn neonates who received TH.

RESULTS During the study period, 835 neonates were transported, accounting for 15.8 % of total admissions. Among them, 550 (66 %) were term neonates, and 39 (5 %) were very or extremely preterm. The predominant reason for transport was respiratory distress (56 %), followed by gastrointestinal (12 %) and cardiovascular (10 %) issues. Endotracheal intubation was required in 13.0 % of neonates during transport, with 44.0 % of these performed by the transport team. A total of 21 (2.5 %) died before discharge, including 14 (1.7 %) within the first week and 7 (0.8 %) within 24 h post-transport. Seventeen outborn and four inborn neonates received TH during the study period. Three outborn neonates initiated TH beyond the first 6 h. Most delays were marginal and associated with longer admission times. Notably, outborn neonates diagnosed with HIE who underwent TH had comparable short-term outcomes to the inborn group.

CONCLUSION Respiratory distress remained the predominant reason for neonatal transport, with over half of the cases requiring ventilator support. In neonates with hypoxic-ischemic encephalopathy, timely therapeutic hypothermia was generally achievable, and short-term outcomes were comparable to inborn counterparts.