Prematurity and Sepsis - Features and Approach Difficulties During Neonatal Emergency Transfer

Purpose - We aimed to identify conditions, means and methods of suspecting, certification and stratification of neonatal sepsis, to prioritize and define levels of management during evacuation, and to follow the neonatal sepsis succeeding the transfer. Material and method - An observational study was conducted between 1January 2011 - the 1 January 2015, that included 610 preterm newborns with suspected sepsis transferred by UTIM NN or HEMS Craiova. We statistically studied confirmation rate of suspected sepsis, the sepsis onset condition, severity stratification, and correlate with medical centers performance assisting newborns and planning transfers. A follow up performed two weeks after evacuation. Results - We detected low rate of detection and affirmed sepsis: n=38 (6.25%) - C.I. (95%): 4.454309335 and very high level of founded unsuspected sepsis: n=85 (13.98026316%) C.I. (95%): 4.982552268, 9of them being very low body weight newborns (1.480263158%). High rate of founded, unaffirmed respiratory distress 23.35526316% (n=142), C.I. (95%): 5.383960957, as sign of sepsis. High rate of accidental hypoglycemia/hypothermia founded by emergency evacuation team: n=131 (21.54605263%), especially to VLBW newborns, associate with sepsis, respiratory failure or confounding with. Conclusions - Newborns transfer its self generates multiple additional risks, including sepsis, but not neglected any stress generated by transport conditions, so that ,,in utero'' transfer has to be extended in current practice for high risk fetus, mother or special medical conditions to limit newborns transfers. Wider use of telemedicine would facilitate refining the transfer criteria.