Challenges in neonatal transport in Jamaica: A resource-limited setting

Abstract

Aim: This study aimed to determine challenges associated with neonatal transport in Jamaica, a resource-limited setting. Methods: This was a prospective descriptive study of neonates transported to the University Hospital of the West Indies (UHWI) over a 15 month period. Data on the clinical status of the neonates before, during and at the end of transport, as well as on accompanying staff and equipment, were collected. Neonatal demographics, reason for transfer and outcome at 48 h and at discharge were also collected. Descriptive analyses were performed. Results: Fifty neonates were transferred to the UHWI; the most common reason for transfer was for respiratory support [30 (60%)]. The most common mode of transport was by road ambulance [42 (84%)]. Seventeen (34%) neonates experienced at least one adverse event during transport. On arrival, 27 (54%) neonates required warming, 42 (84%) fluid resuscitation and 14 (28%) cardiopulmonary resuscitation (CPR). Eighteen (36%) neonates died. The need for CPR on arrival predicted mortality (odds ratio: 2.3, confidence interval: 0.01-0.75, p = 0.02). A lack of appropriate equipment and adequately trained personnel was also noted. Conclusion: Ensuring pre-transport stabilization of neonates, the availability of adequately trained staff and the provision of appropriate equipment must be urgently addressed to improve the outcome of neonatal transport in resource-limited settings like Jamaica.