269 Nasal continuous positive airway pressure facilitates early neonatal back transfer

Introduction: Neonatal networks and dedicated intensive care retrieval systems are evolving in the United Kingdom. Early back transfer to step-down level 2 units (as defined by the British Association of Perinatal Medicine [BAPM]) could facilitate more efficient use of tertiary level intensive care cots. Use of nasal continuous airway pressure (nCPAP) during neonatal transportation may allow earlier back transfer of nCPAP dependent babies who would otherwise have to remain at a tertiary centre. Aim: To examine the feasibility of nCPAP for transfer of nCPAP dependent babies to referral units. Methods: In a prospective study between July 2003 and October 2004, we used nCPAP as a means of respiratory support for nCPAP dependent infants during neonatal back-transfer to base/home hospitals.After two weeks, a telephone enquiry was made to each accepting unit to ascertain if any clinical deterioration had followed transfer. We compared the study group with an historical cohort of nCPAP dependent infants who had to wait until they were no longer fully nCPAP dependent before undergoing transfer. Results: Forty one infants in the study group were compared with 58 historical controls. Median (IQR) gestational age was 26 (25–28) weeks and 27 (25–29) weeks respectively, p=0.6. Infants transferred on nCPAP were significantly smaller and younger; at time of transfer, median (IQR) weight was 920g (739–1073g) vs 1128 g (832-1650g), p value< 0.001 and post menstrual age was 29 (28–31) weeks vs 32 (30–35) weeks, p< 0.001.The group transferred on nCPAP spent significantly less time in our neonatal unit: 8 (3–12) days vs 15 (6–33) days, p<0.01. There were no reports of clinical deterioration that could be attributed to the timing or mode of transfer. Conclusion: Transfer of selected small infants using nCPAP appears to be practical and safe and could increase intensive care cot availability.