O1058 Oct.4: 1:52pm - Potential Risk Modifiers for Severe Intraventricular Hemorrhage in Very Low Birthweight Infants Requiring Transport

Background: Necessity requires transfer to a tertiary care facility when a very low birthweight (VLBW, <1500g) infant is born at a facility unequipped for its care. Previous research suggests an increased risk for intraventricular hemorrhage (IVH) in outborn vs. inborn VLBW infants. It is currently unknown whether logistical aspects of transport, particularly mode and distance, or skill level of the resuscitation team at delivery may place outborn VLBW infants at increased risk for IVH, impairing efforts to optimize neurologic outcomes.

Objective: To determine if mode of transport, distance traveled, or absence of an advanced resuscitation team increased risk for severe IVH in outborn VLBW infants.

Design/

Methods: Outborn VLBW infants, transported by a specialized pediatric team by helicopter or ambulance to a Level IV NICU from 2009-2015 were eligible for inclusion, with all inborn VLBW infants admitted from 2009-2012 analyzed as controls. Infants transported >24 hours after birth, by referring center’s team, or without documented head ultrasound were excluded. Data were collected on birthweight, gestational age (GA), sex, antenatal steroids, delivery method, and grade of IVH, along with mode of transport, distance traveled, and skill level of resuscitation team. Severe IVH was defined as grade III or IV using the Papile scale. Statistical analysis included Pearson’s Chi-square and multivariate logistic regression in SPSS 25.

Results: 294 outborn and 600 inborn infants were eligible for analysis. Outborn infants had increased incidence of severe IVH even when controlling for GA, sex, antenatal steroids, and delivery method (19% vs. 13%, OR 1.7, 95% CI 1.1-2.7). Despite this increased incidence, severe IVH was not statistically different in uni- or multi-variate analysis amongst the outborn population in regard to mode of transport (p=0.90; OR 0.76, 95% CI 0.34-1.7), distance traveled (p=0.13; OR 0.84, 95% CI 0.60-1.2), or skill of resuscitation team (p=0.18; OR 0.49, 95% CI 0.21-1.1).

Conclusion(s): Despite increased risk of severe IVH in outborn VLBW infants, mode of transport, distance traveled, and skill of resuscitation team did not significantly impact risk. When the newborn VLBW infant must be transferred, providers should feel reassured that their decision of vehicle can be based on whichever mode delivers the patient most safely and efficiently. To best optimize outcomes, further research is needed to identify other transport or initial resuscitation related factors that increase risk of IVH in outborn VLBW infants.