Quantification of impulse experienced by neonates during inter- and intra-hospital transport measured by biophysical
Shetal Shah1, Adina Rothberger, Martha Caprio
1Division of Neonatology, Department of Pediatrics, State University of New York at Stonybrook School of Medicine, Stonybrook, NY, USA.
Insights
Transporting premature infants can cause harm. A specialized air-foam mattress significantly reduced the impulse (force) experienced by neonates during transport, especially in the front-to-back and up-and-down directions.
Area of Science:
- Biomedical Engineering
- Neonatal Transport Safety
- Pediatric Biomechanics
Background:
- Premature infant transport is linked to morbidity, including intraventricular hemorrhage, a precursor to cerebral palsy.
- Motion-induced forces during transport may exacerbate neonatal morbidity through direct trauma or physiological stress.
- Quantifying transport-related impulse (acceleration per unit time) is crucial for understanding and mitigating risks.
Purpose of the Study:
- To quantify the impulse experienced by neonates during inter- and intra-hospital transport.
- To evaluate the efficacy of a novel biophysical model for impulse measurement.
- To determine if a specialized air-foam mattress reduces transmitted impulse to neonates.
Main Methods:
- Utilized a computerized accelerometer on a neonatal mannequin during ambulance and isolette transport trials.
- Measured impulse in X, Y, and Z planes, integrating acceleration over time.
- Compared standard transport configurations with those using an air-foam mattress, gel pillow, or both.
Main Results:
- Transport significantly increased impulse compared to a resting state.
- The air-foam mattress reduced impulse in the X (front-to-back) and Z (up-and-down) dimensions.
- For intra-hospital transports, all tested configurations reduced cumulative impulse compared to the standard isolette.
Conclusions:
- The developed system effectively measures and quantifies transport-induced mechanical trauma.
- Air-foam mattresses demonstrably decrease impulse in critical dimensions during neonatal transport.
- Combined air-foam mattress and gel pillow use showed significant reduction in total impulse for intra-hospital transports.
Background:
Transport of premature infants incurs transfer-related morbidity, including intraventricular hemorrhage, a contributing factor to cerebral palsy. The force transmitted to the neonate during transport as a consequence of motion may be implicated in the increased morbidity in this population. Morbidity may occur via direct concussive force to a vulnerable germinal matrix, induction of an inflammatory reaction, or via transient desaturation via extubation. This transmitted force, measured as accelerations per unit time (impulse), is not well characterized. Any modification of a neonatal transporter which increases the time for a neonate in motion to come to rest may decrease the impulse experienced by the infant.
Objective:
The objective of the study was to quantify the magnitude of impulse experienced by neonates during inter- and intra-hospital transport using a novel biophysical model and determine whether a specialized air-foam mattress can reduce the transmitted impulse on the neonate.
Methods:
Five roundtrip trials were conducted for a transported neonate using a standard medical ambulance and transport isolette outfitted with an air-foam mattress. During the trials, measurements were made per second in the X (front-to-back), Y (side-to-side), and Z (up-and-down) planes using a computerized accelerometer attached to a neonatal resuscitation mannequin. Results were integrated over the trial time in each dimension to yield a measure of impulse (acceleration-per-unit-time). Total impulse for the trial was calculated. A second design included five trials from the delivery room to the NICU utilizing four different transport configurations with a standard neonatal isolette outfitted with a gel pillow, air-foam mattress, and air-foam mattress with gel pillow.
Results:
Mean impulse for the transport model was statistically greater than at rest. In the X and Z dimensions, the mean impulse was significantly lower using the air-foam mattress. The impulse of the Z dimension with the air-foam mattress did not differ from that experienced by the experimental model at rest. For the intra-hospital trial, all experimental set-ups produced significantly less cumulative impulse than the standard isolette, though in each specific dimension, no significant differences were noted. For cumulative impulse, no significant differences between any of the three experimental designs were observed. A trend toward decreased transport time was seen with the addition of the air-foam mattress and gel pillow.
Conclusions:
The mechanical trauma induced by transport can be measured and quantified using this system. Neonates transported with the air-foam mattress experienced less impulse in the front-to-back and up-and-down dimensions. For transports between the delivery room and NICU, neonates transported using the air-foam mattress and gel pillow experienced significantly less total impulse.
