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Temporal trends of in utero and early postnatal transfer of extremely preterm infants between 2011 and 2016: a UK population study
  1. Lara Shipley1,
  2. Gillian Hyliger2,
  3. Don Sharkey1
  1. 1 Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
  2. 2 Neonatal Intensive Care Unit, Nottingham Children's Hospital, Nottingham, UK
  1. Correspondence to Dr Don Sharkey, Academic Child Health, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; don.sharkey{at}nottingham.ac.uk

Abstract

Objective Early postnatal transfer (PNT) of extremely preterm infants is associated with adverse outcomes compared with in utero transfer (IUT). We aimed to explore recent national trends of IUT and early PNT.

Design Observational cohort study using the National Neonatal Research Database.

Setting Neonatal units in England, Scotland and Wales.

Patients Extremely preterm infants 23+0–27+6 weeks’ gestation admitted for neonatal care from 2011 to 2016.

Main outcome The incidence of IUT or PNT within 72 hours of life. Secondary outcomes included mortality, hospital transfer level between centres and temporal changes across two equal epochs, 2011–2013 (epoch 1 (Ep1)) and 2014–2016 (epoch 2 (Ep2)).

Results 14 719 infants were included (Ep1=7363 and Ep2=7256); 4005 (27%) underwent IUT; and 3042 (20.7%) had PNT. IUTs decreased significantly between epochs from 28.3% (Ep1=2089) to 26.0% (Ep2=1916) (OR 0.90, 95% CI 0.84 to 0.97, p<0.01). Conversely, PNTs increased from 19.8% (Ep1=1416) to 21.5% (Ep2=1581) (OR 1.11, 95% CI 1.02 to 1.20, p=0.01). PNTs between intensive care centres increased from 8.1% (Ep1=119) to 10.2% (Ep2=161, p=0.05). Mortality decreased from 21.6% (Ep1=1592) to 19.3% (Ep2=1421) (OR 0.90, 95% CI 0.83 to 0.97, p=0.01). Survival to 90 days of age was significantly lower in infants undergoing PNT compared with IUT (HR 1.31, 95% CI 1.18 to 1.46), with the greatest differences observed in infants <25 weeks’ gestational age.

Conclusion In the UK, IUT of extremely preterm infants has significantly decreased over the study period with a parallel increase in early PNT. Strategies to reverse these trends, improve IUT pathways and optimise antenatal steroid use could significantly improve survival and reduce brain injury for these high-risk infants.

  • epidemiology
  • neonatology
  • mortality

Data availability statement

Data are available upon reasonable request. All data were extracted and supplied by the Neonatal Data Analysis Unit (NDAU) and are available from the corresponding author on reasonable request and with permission of the study team and NDAU.

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Data availability statement

Data are available upon reasonable request. All data were extracted and supplied by the Neonatal Data Analysis Unit (NDAU) and are available from the corresponding author on reasonable request and with permission of the study team and NDAU.

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Footnotes

  • Twitter @DrDonSharkey

  • Contributors LS and DS made substantial contributions to the concept, planning, design of the study and acquisition of data; and analysed and interpreted the data. All authors assisted in drafting and editing the manuscript. All authors approved the final version for publication.

  • Funding This study was partly supported by a University of Nottingham, School of Medicine Impact Funding award.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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