Outcomes poorer for extreme preemies transferred after birth

(HealthDay)—Birth in a nontertiary hospital and transfer within 48 hours is associated with poorer outcomes compared with birth in a tertiary hospital for extremely preterm infants, according to a study published online Oct. 16 in The BMJ.

Kjell Helenius, M.D., from Turku University Hospital in Finland, and colleagues conducted an observational study involving 17,577 extremely preterm infants born at less than 28 gestational weeks. After propensity matching, 727 infants were included from each group: upward transfer (nontertiary to tertiary hospital); nontertiary care; and controls born in a tertiary hospital and not transferred.

The researchers found that infants in the upward transfer group had no significant difference in the odds of death before discharge compared with controls (odds ratio, 1.22; 95 percent confidence interval [CI], 0.92 to 1.61), but they had significantly higher odds of severe brain injury (odds ratio, 2.32; 95 percent CI, 1.78 to 3.06) and significantly lower odds of survival without severe brain injury (odds ratio, 0.60; 95 percent CI, 0.47 to 0.76). Infants in the nontertiary care group had significantly higher odds of death compared with controls (odds ratio, 1.34; 95 percent CI, 1.02 to 1.77), but there was no significant difference in the odds of severe brain injury (odds ratio, 0.95; 95 percent CI, 0.70 to 1.30) or survival without brain injury (odds ratio, 0.82; 95 percent CI, 0.64 to 1.05).

"This has important policy implications for perinatal health services, indicating that care pathways that promote the birth of extremely preterm infants in hospitals with tertiary perinatal facilities should be considered a priority," the authors write.

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