Abstract: Background A trinity of emergency referral networks consisting of transferring hospitals, medical emergency centers and receiving hospitals has been established based on 5G and blockchain so as to improve the quality of critical neonatal transfers by realizing admission on the ambulance. Objective To construct a standardized knowledge base for drug administration under multi-scenarios during neonatal transport (NT), followed by developing a NT drug administration clinical decision support system (CDSS). Design Quality improvement research. Methods Through expert consensus after retrieving guidelines or consensus on the drug administration during NT under emergent and critical conditions and extracting the evidence of drug administration under different transport scenarios, a knowledge base for NT drug administration was built to help doctors in transport team standardize drug administration by the CDSS and analyze the drug usage during NT in Shanghai before (control group) and after (intervention group) the application of the CDSS.Main outcome measuresNT drug types and the frequency of drug usage. Results A total of 149 articles were retrieved from Chinese, English literature databases and other resources. One expert consensus was included after duplication removal, primary screening, and full-text screening. Meanwhile, three authoritative monographs were added. The regimens of drug administration during NT were extracted from the above evidence sources. The consensus expert group refined the scenario settings of hypoglycemia for symptomatic and asymptomatic types and the regimens of 12 drugs administration. Finally, 16 drugs were confirmed in the knowledge base for NT drug administration. There were 30 cases in the control group and 61 cases in the intervention group. There was no significant difference in gender, disease type and gestational age between the two groups (P> 0.05), but there was significant difference in birth weight (P=0.02). Four drugs were used in the control group during NT for 33 times, and 11 drugs for 88 times in the intervention group, of which 74 (85.9%) were triggered by the CDSS and 14 (14.1%) by the subjective judgment of the doctors. The types of drugs used in the intervention group covered those in the control group. The mean of drug usage times in the control group was 1.1 (33/30), which was statistically significant compared with that of 1.4 in the intervention group (88/61). The proportion of drug usage per newborn in the control group was 25% (4/16), which was statistically significant compared with that of 62.5% in the intervention group (11/16) (P=0.031). Conclusion The construction of the knowledge base and CDSS for drug administration during NT has promoted standardized and on-demand drug administration.

Key words: Neonate, Inter-hospital transport, Procedural, Medication, Knowledge base, Decision support systems