Timely referral and safe transport of neonates admitted to neonatal intensive care unit of tertiary care government hospital of Agra district: a cross sectional study

Rudresh Negi, Renu Agrawal, Sunil K. Kaushal, Sunil K. Misra


Background: Timely referral and safe transport form a crucial link for the survival and safety of sick newborn. Thus the study aimed at assessing referral and transport of sick neonates admitted to NICU of a tertiary care government hospital and the factors associated with direct referral and safe final transport.

Methods: A hospital based cross-sectional study was carried out in among 450 neonates and was based on face to face interview with caregivers. The data was analyzed using proportions and mean values Chi square test of significance and independent t test were appropriately applied and p<0.05 was taken to be statistically significant. Odds ratios were calculated for dichotomous variables.

Results: 72.6% of high risk pregnancies were transferred timely in utero to district hospitals. Around two thirds (65.8%) of neonates were referred by doctors. Treatment during transportation was administered to 29.6% of the neonates. 50.2% of neonates have used the services of an ambulance at some point of time during their travel. Highly significant association of direct referral was observed with earlier age at admission (2.3 days), early development of neonatal symptoms (1.45 days), lesser gestational age (33.1 weeks) and lesser total distance travelled (15.7 km). The odds of final transport of newborns in ambulance was significantly more in males (OR=1.5), rural residents (OR=1.5) and registered pregnancies (OR=4.3).

Conclusions: Wide variations remain in neonatal referral and transport with some glaring gaps which need to be adequately addressed.


Neonate, Newborn, Referral, Transport

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WHO. Infant, Newborn. WHO. World Health Organization; 2018. Available at: Accessed on 13 August 2018.

India Newborn Action Plan. (2018). Available at: Accessed on 13 August 2018.

UNICEF, WHO, World Bank Group and United Nations. Levels and Trends in Child Mortality Report 2018. Available from: Accessed on 13 August 2018.

UNICEF WHO. WHO/UNICEF Joint Statement - Home visits for the newborn child:a strategy to improve survival. Geneva: World Health Organization; 2009.

Bose A. Transfer of the sick neonate:What is needed? J Trop Pediatr. 2017;63(3):165–6.

Buch PM, Makwana AM, Chudasama RK, Doshi SK. Status of newborn transport in periphery and risk factors of neonatal mortality among referred newborns. J Phram Biomed Sci. 2012;16:1‑6.

Fullerton JT, Killian R, Gass PM. Outcomes of a community- and home-based intervention for safe motherhood and newborn care. Health Care Women Int. 2005;26(7):561–76.

Peter WF, Phillip B, Charles HS. Moving the preterm infant. BMJ. 2004;329;904-6.

NNF Teaching Aids: Newborn Care Neonatal Transport. Available at: AND MANUALS/neonataltransport.pdf Accessed on 14 September 2018.

Jony L, Baskett TF. Emergency air transport of obstetric patients. J Obstet Gynaecol Can 2007;29(5):406-8.

Zelop CM, Martin SR, editors. Critical care obstetrics for the Obstetrician and Gynecologist. 2016

Self-referral. Definition of self-referral in English by Oxford Dictionaries. Available at: Accessed on 13 August 2018

Sampathkumar P, Gobinathan S. A study on status of neonatal transport to a level III neonatal intensive care unit. Int J Contemp Pediatr 2018;5:1040-3.

Jajoo M, Kumar D, Dabas V, Mohta A. Neonatal transport: The long drive has not even begun. Indian J Community Med 2017;42:244-5.

Kumar MK, Thakur SN, Singh BB Study of the morbidity and the mortality patterns in the neonatal intensive care unit at a tertiary care teaching Hospital in Rohtas District, Bihar, India. J Clin Diagnostic Res. 2012;6(2):282–5.

Shalini B, Nikhila C V, Alimelu M. Pre-Admission Factors Influencing Neonatal Mortality. J Dent Med Sci. 2017;16(11):13–9.

Narang M, Kaushik JS, Sharma AK, Faridi M. Predictors of mortality among the neonates transported to referral centre in Delhi, India. Indian J Public Health. 2013;57:100-4.

Buch PM, Makwana AM, Chudasama RK, Doshi SK. Status of Newborn Transport in Periphery and Risk Factors of Neonatal Mortality among Referred Newborns. J Pharm Biomed Sci. 2012;16(16):3.

Akhani S, Munshi S. Study of neonatal transport at tertiary care centre and role of tops scoring for prediction of mortality. MedPulse-Int Med Journl December 2016;3(12):1030-3

Parekh ZR, Bharadwaj R, Parmar G, Shah A. Study of Referral Pattern of Neonates at Tertiary Care Centre and Role of TOPS Score in Assessing Morbidity and Mortality. Natl J Community Med. 2018;9(3):157-60

Mishra AK, Panda SC. Status of neonatal death in sick newborn care unit of a tertiary care hospital. Int J Contemp Pediatr. 2017;4:1638-43.

Dalal E, Vishal G, Solanki D. Study on Neonatal Transport at Tertiary Care Centre. Int J Sci Res. 2013;2(12):289–92.

Thenmozhi M, Sathya J. Impact of mode of transport on the outcome of extramural newborns in a tertiary care centre. Int J Contemp Pediatr. 2017;4:1817-9.

Kumar PP, Kumar CD, Shaik FAR, Ghanta SB, Venkatalakshmi A. Prolonged neonatal interhospital transport on road: Relevance for developing countries. Indian J Pediatr. 2010;77(2):151–4.

Kawale S, Kotnis SD. Study of Epidemiological Factors Affecting Neonatal Morbidity and Mortality in the Neonates Admitted to Nicu of Tertiary Care Center Indian J Appl Res. 2016;6(2):198–201.

Rathod D, Adhisivam B, Bhat BV. Transport of sick neonates to a tertiary care hospital, south India: Condition at arrival and outcome. Trop Doct. 2015;45(2):96–9.

Punitha P, Kumaravel KS, Pugalendhiraja KV S. A study on the current status of neonatal transport to a special newborn care unit. Stanley Med J. 2016;(October):55–9.

Rao SK, Bajaj N, Rawat A. Pre Transport Factors and Transport Quality affecting the Neonatal Outcome. J Evol Med Dent Sci. 2015;4(12):1991–5.

Mehta N, Sharma MK. Correlation of acute physiological parameters with immediate outcomes among neonates transported to special care newborn unit: A prospective study. Indian J Child Health. 2018;5(4):280-3.