Modern Neonatal Transport: Sound and Vibration Levels and Their Impact on Physiological Stability

Abstract

Objective To measure sound and vibration in rotary wing air transport (RWAT) and ground ambulance transport (GAT), comparing them to current recommendations, and correlating them with physiological stability measures in transported neonates.

Study Design This is a prospective cohort observational study including infants ≤ 7 days of age transported over an 8-month period. Infants with neurologic conditions were excluded. Sound and vibration was continuously measured during transport. Transport Risk Index of Physiologic Stability (TRIPS) scores were calculated from vital signs as a proxy for physiological stability.

Results In total, 118 newborns were enrolled, of whom 109 were analyzed: 67 in RWAT and 42 in GAT. Peak sound levels ranged from 80.4 to 86.4 dBA in RWAT and from 70.3 to 71.6 dBA in GAT. Whole-body vibration ranged from 1.68 to 5.09 m/s² in RWAT and from 1.82 to 3.96 m/s² in GAT. Interval TRIPS scores for each infant were not significantly different despite excessive sound and vibration.

Conclusion Noise levels during neonatal transport exceed published recommendations for both RWAT and GAT and are higher in RWAT. Transported infants are exposed to vibration levels exceeding acceptable adult standards. Despite excessive noise and vibration, levels of physiological stability remained stable after transport in both RWAT and GAT groups.

Keywords

newborn - transport - sound - vibration

Condensation

This study measures sound and vibration during neonatal transport in modern air and ground vehicles and evaluates their impact on physiological stability.

Authors' Contributions

Vickie Bailey conceptualized and designed the study, coordinated and supervised data collection, performed the initial data analyses, drafted the initial manuscript, and approved the final manuscript as submitted. Edgardo Szyld contributed to the study design and the design of the data collection spreadsheet, performed initial data analysis, critically reviewed the manuscript, and approved the final manuscript as submitted. Kristi Cagle assisted in the design of the data collection spreadsheet, participated in data collection, assisted in initial data analyses, critically reviewed the manuscript, and approved the final manuscript as submitted. Deborah Kurtz participated in data collection, assisted with initial data analysis, critically reviewed the manuscript, and approved the final manuscript as submitted. Hala Chaaban contributed to the conceptualization and design of the study, critically reviewed the manuscript, and approved the final manuscript as submitted. Dee Wu contributed to the conceptualization and design of the study and the selection of study equipment, provided equipment training for the transport team members, critically reviewed the manuscript, and approved the final manuscript as submitted. Patricia Williams contributed to the conceptualization of the study and the study design, oversaw all aspects of the study, including the collection of and analysis of data, critically reviewed the manuscript, and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

• References

• 1 Karlsen KA, Trautman M, Price-Douglas W, Smith S. National survey of neonatal transport teams in the United States. Pediatrics 2011; 128 (04) 685-691
• 2 McEvoy CG, Descloux E, Barazzoni MS, Diaw CS, Tolsa JF, Roth-Kleiner M. Evaluation of neonatal transport in western switzerland: a model of perinatal regionalization. Clin Med Insights Pediatr 2017; 11: 1179556517709021
• 3 Schierholz E. Flight physiology: science of air travel with neonatal transport considerations. Adv Neonatal Care 2010; 10 (04) 196-199
• 4 Sittig SE, Nesbitt JC, Krageschmidt DA, Sobczak SC, Johnson RV. Noise levels in a neonatal transport incubator in medically configured aircraft. Int J Pediatr Otorhinolaryngol 2011; 75 (01) 74-76
• 5 Macnab A, Chen Y, Gagnon F, Bora B, Laszlo C. Vibration and noise in pediatric emergency transport vehicles: a potential cause of morbidity?. Aviat Space Environ Med 1995; 66 (03) 212-219
• 6 Stroud MH, Trautman MS, Meyer K. , et al. Pediatric and neonatal interfacility transport: results from a national consensus conference. Pediatrics 2013; 132 (02) 359-366
• 7 Campbell AN, Lightstone AD, Smith JM, Kirpalani H, Perlman M. Mechanical vibration and sound levels experienced in neonatal transport. Am J Dis Child 1984; 138 (10) 967-970
• 8 Mistrot P, Donati P, Galmiche JP, Florentin D. Assessing the discomfort of the whole-body multi-axis vibration: laboratory and field experiments. Ergonomics 1990; 33 (12) 1523-1536
• 9 Prehn J, McEwen I, Jeffries L. , et al. Decreasing sound and vibration during ground transport of infants with very low birth weight. J Perinatol 2015; 35 (02) 110-114
• 10 Kirchner DB, Evenson E, Dobie RA. , et al; ACOEM Task Force on Occupational Hearing Loss. Occupational noise-induced hearing loss: ACOEM Task Force on Occupational Hearing Loss. J Occup Environ Med 2012; 54 (01) 106-108
• 11 Lee SK, Aziz K, Dunn M. , et al; Canadian Neonatal Network. Transport Risk Index of Physiologic Stability, version II (TRIPS-II): a simple and practical neonatal illness severity score. Am J Perinatol 2013; 30 (05) 395-400
• 12 Gädeke R, Döring B, Keller F, Vogel A. The noise level in a childrens hospital and the wake-up threshold in infants. Acta Paediatr Scand 1969; 58 (02) 164-170
• 13 Shenai JP, Johnson GE, Varney RV. Mechanical vibration in neonatal transport. Pediatrics 1981; 68 (01) 55-57
• 14 Mohamed MA, Aly H. Transport of premature infants is associated with increased risk for intraventricular haemorrhage. Arch Dis Child Fetal Neonatal Ed 2010; 95 (06) F403-F407
• 15 Gleissner M, Jorch G, Avenarius S. Risk factors for intraventricular hemorrhage in a birth cohort of 3721 premature infants. J Perinat Med 2000; 28 (02) 104-110
• 16 Shlossman PA, Manley JS, Sciscione AC, Colmorgen GH. An analysis of neonatal morbidity and mortality in maternal (in utero) and neonatal transports at 24-34 weeks' gestation. Am J Perinatol 1997; 14 (08) 449-456
• 17 Towers CV, Bonebrake R, Padilla G, Rumney P. The effect of transport on the rate of severe intraventricular hemorrhage in very low birth weight infants. Obstet Gynecol 2000; 95 (02) 291-295
• 18 Yoder BA. Long distance perinatal transport. Am J Perinatol 1992; 9 (02) 75-79
• 19 Bouchut JC, Van Lancker E, Chritin V, Gueugniaud PY. Physical stressors during neonatal transport: helicopter compared with ground ambulance. Air Med J 2011; 30 (03) 134-139
• 20 Arora P, Bajaj M, Natarajan G. , et al. Impact of interhospital transport on the physiologic status of very low-birth-weight infants. Am J Perinatol 2014; 31 (03) 237-244
• 21 Romanzeira JC, Sarinho SW. Quality assessment of neonatal transport performed by the Mobile Emergency Medical Services (SAMU). J Pediatr (Rio J) 2015; 91 (04) 380-385
• 22 Lee SK, Zupancic JA, Pendray M. , et al; Canadian Neonatal Network. Transport risk index of physiologic stability: a practical system for assessing infant transport care. J Pediatr 2001; 139 (02) 220-226
• 23 Roth R, Baxter J, Vehik K. , et al; TEDDY Study Group. The feasibility of salivary sample collection in an international pediatric cohort: The TEDDY study. Dev Psychobiol 2017; 59 (05) 658-667