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.
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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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.
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