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Browning Carmo et al showed that neonates with duct‐dependent congenital heart disease (CHD) treated with low‐dose prostaglandin E1 (PGE1) may not require mechanical ventilation for safe transport.1 The Pediatric Department, University of Padova Neonatal Emergency Transport Service undertakes about 200 neonatal transports every year in the East‐Veneto Region, Italy. The service has a population referral base of 2.3 million people over a radius of approximately 150 km. In the referral area, there are approximately 25 700 births/year in 25 units. The transfers are generally undertaken by ground ambulance and the average time for each transport is about 185 min (range 60–346 min).2 According to the transport protocol, babies with known or suspected CHD with ductal dependency or with signs of circulatory or respiratory failure are suitable to be cared for by the dedicated transport team (a neonatologist, a nurse and paramedic ambulance personnel). The transport protocol does not recommend routine intubation for prevention of apnoea during PGE1 infusion.
Between 1 January 2002 and 31 December 2006, 115 transferred neonates had cardiovascular problems; 51 (44%) were treated with PGE1 infusion for CHD (59% cyanogen, 41% left outflow obstruction) and 9 (18%) were intubated as they had severe hypoxia or acidosis before the arrival of the transport team. Our PGE1 starting dose (25–50 ng/kg/min) was higher than that reported by Browning Carmo et al.1 Among the spontaneously breathing neonates, none required ventilation or emergency intubation and no adverse events were recorded. In agreement with Browning Carmo et al,1 our data show that for short distances, ground transport transfer of otherwise stable newborns with CHD needing PGE1 infusion may be safe without routine mechanical ventilation, even with higher PGE1 doses. An improved prenatal diagnosis (only 14% in our population) could help to prevent haemodynamic instability after birth, ensuring earlier and safer transfer. However, because of the potential deleterious effects of physiological derangements in these patients, the presence of personnel with expertise in neonatal resuscitation is advisable.3
Competing interests: None declared.