NEONATAL TRANSPORT IN TEHRAN: A CAUSE FOR MUCH CONCERN

Background – The best way to transport high-risk infants is so called “In utero” transport. In many developed countries, perinatal regionalization programs have been established and expectant mothers and/or their neonates are assigned and referred to different centers according to the level of care they may need. Unfortunately, we do not yet have such a program in Iran; therefore, many of the premature and sick neonates must be transported to the few neonatal intensive care units (NICUs) that are available in Tehran. The present study looks into the problem of neonatal transport in Tehran. Methods – In this study, 16 maternity hospitals in different locations of Tehran were selected randomly for participation in data collection between November 1st – 30th, 2002. Questionnaires regarding clinical data for the participating patients (critically ill neonates) were distributed to the head nurses of selected hospitals. Questionnaires catalogued which patients required transport to NICUs; data were analyzed using SPSS software. Results – During the study period, 3,125 infants were born in the participating hospitals. Three-hundred and twenty patients (10.24%) needed transport but, of these, only 22 (6.87%) infants obtained admission to NICUs. The mean ± SD waiting time for obtaining admission was 110 ± 50 minutes and the mean ± SD elapsed interval between obtaining admission and exit from primary hospital was 50 ± 26 minutes. The reason for transport in 17 of the 22 cases (72.27%) was respiratory distress and in the remaining five (22.73%) the problem was surgical. Three premature infants (of the 22 total referral cases) died before they could get admission. The mean ± SD interval between leaving referring hospital and arriving at referral hospital was 46 ± 17 minutes. None of the health care professionals who accompanied the infants had experience with neonatal tracheal intubation. Conclusion – The neonatal transport in Tehran is not optimal and has many inadequacies regarding communication systems, optimal equipment, trained personnel, etc. We recommend that a perinatal regionalization system to be established in Iran in order to facilitate the detection of high-risk pregnancies and newborns, and to transport them, according to need, to different levels of perinatal care facilities.