Adverse events and clinical risk factors during intrahospital transport of critically ill neonates: a prospective pilot study at a tertiary center in Vietnam.

BACKGROUND

Intrahospital transport is often unavoidable in neonatal intensive care, but it may expose critically ill neonates to physiological instability and adverse events. Data from low- and middle-income settings remain limited, and differing hypothermia thresholds across studies may underestimate the true burden of transport-related harm.

METHODS

We conducted a prospective observational pilot study of intrahospital transport episodes from the neonatal intensive care unit (NICU) at a tertiary pediatric center in Ho Chi Minh City, Vietnam, between May and July 2024. Each transport episode was analyzed as a separate event. The primary outcome was unsafe transport, defined as at least one adverse event-including hypothermia <36.5°C, respiratory deterioration, hemodynamic instability, or device-related events-occurring during transport or within 24 h of NICU readmission. The secondary outcome excluded mild hypothermia and included only moderate hypothermia (32°C-35.9°C) and other clinically significant events.

RESULTS

Of the 172 screened transport events, 138 involving 96 neonates were included. Under the primary definition, 71 transport events (51.4%) were unsafe, generating 100 adverse events; 89% occurred during the return leg or post-return period. Hypothermia was the most frequent event (74.0%): 40 mild (36.0°C-36.4°C) and 34 moderate (32°C-35.9°C). Under the secondary definition, 44 transport events (31.9%) were unsafe, with 60 adverse events. Transport was significantly associated with increased FiO2 (p = 0.008) and reduced SpO2/FiO2 ratio (p = 0.020). A surgical indication was the strongest independent predictor: moderate Bayesian model averaging evidence for the primary outcome [posterior inclusion probability (PIP) 0.616] and strong evidence for the secondary outcome (PIP 0.880; odds ratio 4.95, 95% credible interval 1.43-17.2). Moderate hypothermia was independently associated with support escalation (41.2% vs. 18.6%, p = 0.018), whereas mild hypothermia was not. The vasoactive-inotropic score showed negligible predictive value, equivalent to vasoactive drug count.

CONCLUSIONS

Intrahospital transport of critically ill neonates is frequently associated with adverse events, predominantly hypothermia occurring on the return leg. A surgical indication-particularly for esophageal atresia, gastroschisis, or urgent procedures - is the dominant independent risk factor. Improved thermal protection (including routine incubator use for surgical cases), standardized postreturn temperature assessment, and enhanced preparation for surgical transport are the highest-priority evidence-based interventions.