ISSN - 0973-0958
Importance of Temperature, Oxygen Saturation, Perfusion, Sugar (TOPS) Parameters and the concept of TOPS score for Neonatal Transport in India - A pilot Project
Akash Chheda, Sandhya Khadse, Chhaya Valvi, Rajesh Kulkarni, Ashwini Hiremath.
Department of Pediatrics, BJ Government Medical College and Sassoon General Hospitals, Pune, Maharashtra.

Aim: The importance of TOPS parameters (temperature, oxygen saturation, perfusion and sugar) in predicting neonatal outcome is well established and TOPS parameters on admission reflect the care taken before and during transport of neonate while referral. The objective was to introduce the concept of TOPS score from TOPS parameters and to formulate optimal TOPS score (score at which neonatal outcome is the best) which will help regional health centers and peripheral health centers (PHCs) in safely referring newborns.
Methods: This observational study was carried out from August 2013- July 2014. TOPS parameters were taken on admission of neonates referred to our center and outcome of these neonates were noted as survived/dead. When no TOPS parameters were deranged, it was scored as 0. When 1 TOPS parameter was deranged, the score of 1 was given. When 2 TOPS parameters were deranged, score of 2 was given and so on. Optimal TOPS score was defined as the score at which neonatal outcome was best. Effect of TOPS score and outcome was determined
Results: Five hundred twenty nine neonates were included in the study, of which 417 (78.8%) survived and 112 (21.2%) died. Hypothermia was present in 315 (59.6%), hypoxemia in 252 (47.6%), prolonged perfusion in 230 (43.5%) and hypoglycemia in 78 (14.7%) babies. One hundred forty five babies had score of 0 of which all survived, this was considered optimal TOPS score. Single TOPS parameter (score 1) was seen in 120 babies of which 117 (97.5%) survived, 91 babies had derangement of 2 TOPS parameters (score 2) of which 79 (86.8%) survived, 119 babies had derangement of 3 TOPS parameters (score 3) of which 65 (54.6%) survived and 54 babies had derangement of all the 4 TOPS parameters (score 4) of which 43 (79.6%) babies survived.
Conclusions- Concept of TOPS score is introduced for stressing that derangement of TOPS parameters when found together is more harmful and significantly increases the risk of neonatal mortality. TOPS score sensitizes the need to attempt at achieving optimal TOPS score by taking care of the easily correctable conditions of hypothermia, hypoxemia, poor perfusion and hypoglycemia before and during the referral of neonate.
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