{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T14:00:23Z","timestamp":1793196023840,"version":"4.5.0"},"update-to":[{"DOI":"10.12688\/f1000research.150058.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T00:00:00Z","timestamp":1735776000000}}],"reference-count":31,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T00:00:00Z","timestamp":1735776000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns7:p>\n                    Background Quality of neonatal transport services may impact outcomes. We assessed the effect of skill-based education of ambulance personnel (AP) on outcomes of transported neonates. Methods We conducted a single-arm intervention study (pre and post) over 18 months. We assessed the perceptions and practices of AP on neonatal transport along with ambulance equipment availability\/usage. We compared neonatal clinical vital parameters at arrival and clinical outcomes from Neonatal Intensive Care Unit (NICU) pre versus post intervention. We analysed data using SPSS version 25. Results Of 77 AP receiving education, there was significant\n                    <ns7:italic>(<\/ns7:italic>\n                    p &lt; 0.001) improvement in the perceptions\/practices towards temperature regulation (44.55 \u00b1 23.94\n                    <ns7:italic>vs<\/ns7:italic>\n                    . 25.94 \u00b1 21.36), glucose homeostasis (46.27 \u00b1 18.83\n                    <ns7:italic>vs.<\/ns7:italic>\n                    18.60 \u00b1 17.50), maintaining asepsis (67.05 \u00b1 17.53\n                    <ns7:italic>vs.<\/ns7:italic>\n                    39.35 \u00b1 16.85), supporting airway (47.73 \u00b1 25.39), circulation (85.26 \u00b1 23.27\n                    <ns7:italic>vs.<\/ns7:italic>\n                    48.45 \u00b1 25.10), along with ambulance equipment availability\/usage postintervention. Of 53 neonates studied post intervention, there was a significant reduction in hypothermia (17%\n                    <ns7:italic>vs.<\/ns7:italic>\n                    48.4%, p &lt; 0.001), hypoglycemia (16.9%\n                    <ns7:italic>vs.<\/ns7:italic>\n                    38.7%, p=0.010), and prolonged capillary refill time (71.7%\n                    <ns7:italic>vs.<\/ns7:italic>\n                    46.8%, p=0.042), improvement in the use of intravenous fluids (69.8%\n                    <ns7:italic>vs.<\/ns7:italic>\n                    29%, p &lt;0.001), a reduction in growth from umbilical swabs (15.1%\n                    <ns7:italic>vs.<\/ns7:italic>\n                    42%, p=0.002) and duration of NICU stay (p = 0.001). Conclusions After educational intervention there was significant improvement in the perceptions and practices of \u2018108\u2019 ambulance personnel towards transporting neonates and a significant decrease in hypothermia, hypoglycemia, and duration of NICU stay with improvement in maintenance of circulation and asepsis in neonates.\n                  <\/ns7:p>","DOI":"10.12688\/f1000research.150058.2","type":"journal-article","created":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T12:10:07Z","timestamp":1735819807000},"page":"767","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of skill-based educational training for ambulance personnel on neonatal transport\u00a0for newborn care in coastal South India \u2013 a single arm intervention study"],"prefix":"10.12688","volume":"13","author":[{"given":"Santosh","family":"Kalyan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7902-1012","authenticated-orcid":false,"given":"Sowmini Padmanabh","family":"Kamath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0695-1822","authenticated-orcid":false,"given":"Subhodh","family":"Shetty S","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2296-3719","authenticated-orcid":false,"given":"Ramesh","family":"Holla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3467-6821","authenticated-orcid":false,"given":"Leslie","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harsha","family":"Lashkari P","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1425-0097","authenticated-orcid":false,"given":"Suchitra","family":"Shenoy M","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shantharam","family":"Baliga B","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2025,1,2]]},"reference":[{"key":"ref1","article-title":"Newborn Mortality.","year":"2024, Mar 14","journal-title":"Key facts."},{"key":"ref3","first-page":"920-922","article-title":"Long distance neonatal transport--the need of the hour.","volume":"45","author":"P Kumar","year":"2008","journal-title":"Indian Pediatr."},{"key":"ref4","first-page":"1289-1294","article-title":"Factors contributing to outcome in newborns delivered out of hospital and referred to a teaching institution.","volume":"38","author":"A Sehgal","year":"2001","journal-title":"Indian Pediatr."},{"key":"ref5","article-title":"Evidence based clinical practice guidelines.","year":"2010"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"488-492","DOI":"10.1136\/adc.80.5.488","article-title":"A regionalised transport service, the way ahead?","volume":"80","author":"A Rashid","year":"1999","journal-title":"Arch. Dis. Child."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"326-334","DOI":"10.1016\/j.siny.2015.07.003","article-title":"The GVK EMRI maternal and neonatal transport system in India: a mega plan for a mammoth problem.","volume":"20","author":"J Kumutha","year":"2015 Oct","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref9","article-title":"Every newborn: an action plan to end preventable deaths.","year":"2014"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1-4","DOI":"10.4103\/0970-0218.170955","article-title":"Millennium Development Goals (MDGs) to Sustainable Development Goals (SDGs): Addressing Unfinished Agenda and Strengthening Sustainable Development and Partnership.","volume":"41","author":"S Kumar","year":"2016","journal-title":"Indian J. Community Med."},{"key":"ref11","article-title":"National Health Mission. INAP India Newborn Action Plan.","year":"2014"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"435-438","DOI":"10.4103\/2249-4863.161348","article-title":"Mortality in newborns referred to tertiary hospital: An introspection.","volume":"4","author":"K Aggarwal","year":"2015","journal-title":"J. Family Med. Prim. Care."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"F521-F526","DOI":"10.1136\/adc.2003.029017","article-title":"Census of neonatal transfers in London and the Southeast of England.","volume":"89","author":"S Kempley","year":"2004","journal-title":"Arch. Dis. Child Fetal Neonatal Ed."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"328-331","DOI":"10.1177\/0973217920050407","article-title":"Transport in community.","volume":"19","author":"S Ramji","year":"2005","journal-title":"J. Neonatol."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"860-862","DOI":"10.1007\/s12098-010-0362-0","article-title":"Transported neonates by a specialist team - how STABLE are they.","volume":"78","author":"P Kumar","year":"2011","journal-title":"Indian J. Pediatr."},{"key":"ref16","article-title":"Navjaat Shishu Suraksha Karyakram: Resuscitation and essential Newborn Care Resource Manual.","year":"2020"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1991-1995","DOI":"10.14260\/jemds\/2015\/287","article-title":"Pre-transport factors and transport quality affecting the neonatal outcome.","volume":"04","author":"S Rao","year":"2015","journal-title":"J. Evol. Med. Dent. Sci."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1040-1043","DOI":"10.18203\/2349-3291.ijcp20181538","article-title":"A study on status of neonatal transport to a level III neonatal intensive care unit.","volume":"5","author":"P Sampathkumar","year":"2018","journal-title":"Int. J. Contemp. Pediatr."},{"key":"ref19","first-page":"96-99","article-title":"Transport of sick neonates to a tertiary care hospital, South India: condition at arrival and outcome.","volume":"45","author":"D Rathod","year":"2015","journal-title":"Trop. Dr."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e044625","DOI":"10.1136\/bmjopen-2020-044625","article-title":"Transport characteristics and predictors of mortality among neonates referred to a tertiary care centre in North India: a prospective observational study.","volume":"11","author":"J Singh","year":"2021 Jul 6","journal-title":"BMJ Open."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e0269479","DOI":"10.1371\/journal.pone.0269479","article-title":"Referral challenges and outcomes of neonates received at Muhimbili National Hospital, Dar es Salaam, Tanzania.","volume":"17","author":"M Kiputa","year":"2022 Jun 15","journal-title":"PLoS One."},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.33552\/GJPNC.2020.02.000529","article-title":"Immediate Outcomes of Neonatal Transport in a Tertiary Hospital in South-West of Nigeria.","volume":"2","author":"O Tongo","year":"2020","journal-title":"Glob. J. Ped. Neonatol. Car."},{"key":"ref23","first-page":"3929-3934","article-title":"Status of Neonatal Transport and Impact of Facilitated Referral on the Outcome of Transported Sick Newborns: At Tertiary Care Hospital.","volume":"5","author":"D Manikyamba","year":"2017","journal-title":"Sch. J. App. Med. Sci."},{"key":"ref24","first-page":"289-292","article-title":"Study on neonatal transport at tertiary care centre.","volume":"2","author":"E Dalal","year":"2013","journal-title":"Int. J. Sci. Res."},{"key":"ref25","first-page":"55-58","article-title":"A study on the current status of neonatal transport to a special newborn care unit.","volume":"3","author":"P Punitha","year":"2016","journal-title":"Stanley Med. J."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"726-732","DOI":"10.7326\/0003-4819-152-11-201006010-00232","article-title":"CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials.","volume":"152","author":"K Schulz","year":"2010 Jun 1","journal-title":"Ann. Intern. Med."},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.17605\/OSF.IO\/J5GQ7","author":"S Kalyan","year":"2024","journal-title":"OSF."},{"key":"ref30","article-title":"Teaching aids for facility based newborn care based newborn care at district level in neonatal resuscitation."},{"key":"ref31","first-page":"109-113","article-title":"Morbidity and mortality pattern of admissions into the Emergency Paediatric Unit of University of Abuja Teaching Hospital, Gwagwalada.","volume":"20","author":"A Okechukwu","year":"2011","journal-title":"Niger J. Med."},{"key":"ref32","article-title":"Reducing the Incidence of Hypothermia and Hypoglycemia during Neonatal Transport.","author":"S Kaushal","journal-title":"Paper presented at: AAP experience: National Conference and Exhibition; 2015 Oct 24-27; Washington, DC."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"302-310","DOI":"10.1177\/09732179221131634","article-title":"Neonatal Transport Facilities and Its Effect on Outcome: An Experience from Tertiary Care Hospital of Central Gujarat.","volume":"36","author":"M Rasania","year":"2022","journal-title":"J. Neonatol."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"283-295","DOI":"10.1016\/j.amj.2023.05.001","article-title":"Neonatal Transport Safety Metrics and Adverse Event Reporting: A Systematic Review.","volume":"42","author":"M Gray","year":"2023 Jul-Aug","journal-title":"Air Med. J."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"CD007485","DOI":"10.1002\/14651858.cd007485.pub2","article-title":"Specialist teams for neonatal transport to neonatal intensive care units for prevention of morbidity and mortality.","volume":"2015","author":"A Chang","year":"2015 Oct 28","journal-title":"Cochrane Database Syst. Rev."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/13-767\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/13-767\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/13-767\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T15:40:13Z","timestamp":1755618013000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/13-767\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,2]]},"references-count":31,"URL":"https:\/\/doi.org\/10.12688\/f1000research.150058.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/f1000research.150058.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.176171.r355414","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.176171.r355414","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,2]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/13-767\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.176171.r355414, A Shashidhar Rao, Dept of Neonatology, St Johns Medical College Hospital, Bangalore, Karnataka, 09 Jan 2025, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/13-767\/v2#referee-response-355414","order":0,"name":"referee-response-355414","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.164592.r301769, Rakesh Kotha, Osmania Medical College, Hyderabad, Telengana, 22 Jul 2024, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/13-767\/v1#referee-response-301769","order":1,"name":"referee-response-301769","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Sowmini Padmanabh Kamath<\/b>; \n<i>Posted: 20 Dec 2024<\/i>; \n<b>1. Mention who took the data; it is better to be the third person who is not involved in the study. Author response:&nbsp;<\/b>The duty resident at NICU collected the data. We agree that it is better if a third person who is not involved in the study collects the data  \n<b>2. Questionnaire validation to be done and mention who prepared Author response:&nbsp;<\/b>The questionnaire was prepared by the first four authors after a thorough review of the literature pertaining to the topic.&nbsp;The content was validated by three senior pediatricians working in NICU set-ups. The wordings of the questions with ambiguity were changed as per their suggestions  \n<b>3. Sample size justification is needed Author response:&nbsp;<\/b>All ambulance personnel of \u2018108\u2019 ambulances during the study time were recruited; thus, we did not have a separate sample size calculation &nbsp; \n<b>4. A low sample size is a limitation Author response:&nbsp;<\/b>We agree that the low sample size is a limitation.&nbsp;  \n<b>5. Reference for sample size is better to add- Author response:&nbsp;<\/b>All ambulance personnel of \u2018108\u2019 ambulances during the study time were recruited; thus, we did not have a separate sample size calculation  \n<b>6.&nbsp;SPSS country version better to mention- Author response:&nbsp;<\/b>New York is written as NY &nbsp; \n<b>7. Cause of attrition is better to mention Author response:&nbsp;<\/b>Postintervention, the three APs were excluded since they had been assigned emergency ambulance duties. Thus, for the final analysis, we included 77 APs to assess perceptions and practices &nbsp; \n<b>8. Is it a quasi-experimental study <\/b> \n<b>Author response:&nbsp;<\/b>It is a single arm intervention (pre-and post) study.  \n<b>9. Definitions need citations Author response:&nbsp;<\/b>citations included as suggested&nbsp;  \n<b>10. Significance of statistical errors as pre and post-test people are different Author response:<\/b>&nbsp;The subject population for AP was the same pre- and post-intervention, except that three APs could not give the post-test questionnaire because of their ambulance duties. However, the subject population for outcomes of neonatal transport ought to be different pre- versus postintervention, which could give a possibility of random error\/bias. &nbsp;  \n<b>11. Ambulance driver\u2019s qualifications may affect the internal study result; Knowing the data better for comparing other studies Author response:&nbsp;<\/b>We agree that the qualifications of ambulance personnel would affect the results of the internal study. We have included the educational status of AP in the baseline characteristics part of the results section. However, we did not assess the educational status with their mean perception and practice scores since it was not our study objective; we can include this as a limitation of our study.  &nbsp; \n<b>12. Any novelty, better to add Author response:&nbsp;<\/b>It is an intervention study that aims to improve the quality of transport of neonates. There is limited literature on pre-versus-post intervention studies on ambulance personnel, specifically \u2018108\u2019 ambulances.","URL":"https:\/\/f1000research.com\/articles\/13-767\/v2#referee-comment-13000","order":2,"name":"referee-comment-13000","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.164592.r301765, Sanoj Karayil Mohammad Ali, Division of Neonatology, Department of Pediatrics, Sidra Medicine, Doha, 22 Aug 2024, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/13-767\/v1#referee-response-301765","order":3,"name":"referee-response-301765","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Sowmini Padmanabh Kamath<\/b>; \n<i>Posted: 20 Dec 2024<\/i>; 1. This is a clinically relevant interventional study with a well-defined methodology and positive findings, which is similar to other studies. 2.&nbsp;Clear working title, which states the study design, setting, and population. 3. Objective outcome data along with subjective survey from personnel is appropriate for the study  \n<b>Author response:&nbsp;<\/b>Thank you  4. Unsure about the significance of umbilical swab colonization as a surrogate marker for compliance with asepsis measures. There was no significant reduction in blood culture positive rates, which can also be affected by factors other than transport. \n<b>Author response:<\/b>&nbsp;Umbilical care is a part of essential newborn care &amp; umbilical artery is an important site for entry of bloodstream infections in newborns. This study was to look for the colonization of the umbilical area but as not a surrogate marker for neonatal sepsis. The correlation between umbilical swabs &amp; blood culture was not a part of the study. As highlighted in the study's limitations section, we agree that factors other than transport could have affected blood culture growth. &nbsp;  5. Limitations of the study and risk of bias have been clearly outlined. \n<b>Author response:&nbsp;<\/b>Thank you","URL":"https:\/\/f1000research.com\/articles\/13-767\/v2#referee-comment-13001","order":4,"name":"referee-comment-13001","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}