@article {Davisfetalneonatal-2022-324749, author = {Jonathan W Davis and C E Seeber and Elizabeth A Nathan and Tobias Strunk and Andy Gill and Mary Sharp}, title = {Outcomes to 5 years of outborn versus inborn infants }, elocation-id = {fetalneonatal-2022-324749}, year = {2023}, doi = {10.1136/archdischild-2022-324749}, publisher = {BMJ Publishing Group}, abstract = {Objective We compared mortality and morbidity of inborn versus outborn very preterm infants \<32 weeks{\textquoteright} gestation in Western Australia (WA) between 2005 and 2018.Design Retrospective cohort study.Patients Infants \<32 weeks{\textquoteright} gestation who were born in WA.Main outcome measures Mortality was assessed as death before discharge home from the tertiary neonatal intensive care unit. Short-term morbidities included combined brain injury (intracranial haemorrhage grade >=3 and cystic periventricular leukomalacia) and other major neonatal outcomes. Developmental assessments at age 2, 3 and 5 years were evaluated. We performed multivariable logistic regression analysis of outborn status on outcomes, controlling for gestational age, birth weight z-score, sex and multiple birth.Results A total of 4974 infants were born in WA between 22 and 32 weeks{\textquoteright} gestation between 2005 and 2018 of which 4237 (89.6\%) were inborn and 443 (10.4\%) were outborn. Overall mortality to discharge was higher in outborn infants (20.5\% (91/443) vs 7.4\% (314/4237); adjusted OR (aOR) 2.44, 95\% CI 1.60 to 3.70, p\<0.001). Outborn infants had higher rates of combined brain injury than those inborn (10.7\% (41/384) vs 6.0\% (246/4115); aOR 1.98, 95\% CI 1.37 to 2.86), p\<0.001). No difference in up to 5-year developmental measures was detected. Follow-up data were available for 65\% of outborn and 79\% of inborn infants.Conclusions Outborn preterm infants \<32 weeks in WA had increased odds of mortality and combined brain injury than those inborn. Developmental outcomes up to 5 years were similar between groups. Loss to follow-up may have impacted the long-term comparison.Data are available on reasonable request.}, issn = {1359-2998}, URL = {https://fn.bmj.com/content/early/2023/02/16/archdischild-2022-324749}, eprint = {https://fn.bmj.com/content/early/2023/02/16/archdischild-2022-324749.full.pdf}, journal = {Archives of Disease in Childhood - Fetal and Neonatal Edition} }