Adverse events and clinical risk factors during intrahospital transport of critically ill neonates: a prospective pilot study at a tertiary center in Vietnam.

Background: Intrahospital transport is often unavoidable in neonatal intensive care, but it may expose critically ill neonates to physiological instability and adverse events. Data from low- and middle-income settings remain limited, and differing hypothermia thresholds across studies may underestimate the true burden of transport-related harm. Methods: We conducted a prospective observational pilot study of intrahospital transport episodes from the neonatal intensive care unit (NICU) at a tertiary pediatric center in Ho Chi Minh City, Vietnam, between May and July 2024. Each transport episode was analyzed as a separate event. The primary outcome was unsafe transport, defined as at least one adverse event-including hypothermia <36.5°C, respiratory deterioration, hemodynamic instability, or device-related events-occurring during transport or within 24 h of NICU readmission. The secondary outcome excluded mild hypothermia and included only moderate hypothermia (32°C-35.9°C) and other clinically significant events. Results: Of the 172 screened transport events, 138 involving 96 neonates were included. Under the primary definition, 71 transport events (51.4%) were unsafe, generating 100 adverse events; 89% occurred during the return leg or post-return period. Hypothermia was the most frequent event (74.0%): 40 mild (36.0°C-36.4°C) and 34 moderate (32°C-35.9°C). Under the secondary definition, 44 transport events (31.9%) were unsafe, with 60 adverse events. Transport was significantly associated with increased FiO Conclusions: Intrahospital transport of critically ill neonates is frequently associated with adverse events, predominantly hypothermia occurring on the return leg. A surgical indication-particularly for esophageal atresia, gastroschisis, or urgent procedures - is the dominant independent risk factor. Improved thermal protection (including routine incubator use for surgical cases), standardized postreturn temperature assessment, and enhanced preparation for surgical transport are the highest-priority evidence-based interventions.