O2100: Neonatal-pediatric Transport Literature Review: What’s New in the past Decade?

Background: Neonatal-pediatric transport medicine has become an established specialty in need of evidence-based research to guide clinical practice. We aim to review the recent neonatal-pediatric transport literature to characterize the current state of transport literature, ascertain the main areas of transport research, and assess the temporal trend of transport-related publications.

Methods: To identify relevant articles for the literature review, the PUBMED database was searched for all studies regarding neonatal and/or pediatric interfacility transport published between January 1, 2011 and December 31, 2021. The search strategy is included in Figure 1. One reviewer screened titles and abstracts for full-text review based on predetermined inclusion criteria. Data involving main areas of transport research, publication date, and publishing journal were extracted and analyzed.

Results: A total of 357 unique articles were identified for title and abstract review, yielding 199 articles which met inclusion criteria. The annual publication volume increased steadily over the study period, from 7-8 relevant publications/year in 2011-2012 to a record number of 31 publications in 2020, likely reflecting pre-pandemic research growth. This temporal trend is shown in Figure 2. The transport literature is comprised of mostly retrospective with fewer prospective single-center studies, survey studies, consensus statements, and quality improvement initiatives. There are a limited number of projects resulting from multicenter national and/or international collaboratives. Neonatal-pediatric transport research is published in transport medicine, emergency medicine, critical care medicine, neonatal-perinatal medicine, and pediatric journals. Specifically, 20 journals published ≥2 transport studies (144/199, 71%), with 37% (74/199) of the recent neonatal-pediatric transport research being published in Air Medical Journal, Pediatric Emergency Care, and Pediatric Critical Care Medicine. Of the 199 included studies, 147 (73.9%) focus on the following themes: pulmonary support in transport (airway management, intubation in transport, non-invasive respiratory support, inhaled nitric oxide, ventilator strategies and respiratory monitoring, airway equipment); transport safety and quality (adverse events in transport, transport safety, transport quality metrics, transport hand-off, critical events, cost of transport); patient outcomes (disposition post-transport, patient outcomes post-transport); transport team workforce (transport team composition, trainee involvement in transport medicine); temperature regulation in transport (thermoregulation, unintended hypothermia in transport, therapeutic hypothermia); clinically and/or logistically challenging transports (extracorporeal membrane oxygenation in transport, resuscitation in transport, transport of patients with trauma, burns, cardiac disease, neurologic and/or neurosurgical emergencies, palliative care transports, maternal-fetal transports, transport of patients with COVID-19 infection, assessment and management of pain in transport); transport hazards (vibration, noise and poor lighting, traffic stops, ambulance acceleration); transport triage (transport risk scores, transport stabilization time, mode of transport); technological advances in transport (telemedicine in transport, ultrasound use in transport); and family-centered care.

Conclusion: The annual neonatal-pediatric transport publication volume quadrupled over the past ten years. This expansion of transport literature mirrors the growth of the neonatal-pediatric transport medicine field.