Women facing premature labour should be enabled to give birth in hospitals with specialist neonatal intensive care units, researchers say today.
A major research project has found that these babies fare much better if they are born close to the unit – rather than being transferred to a specialist centre.
The study, reported in The BMJ, also showed that premature babies were more likely to die if they were born in a non-specialist hospital – and stayed there- than in a specialist hospital.
The researchers, from Imperial College, London, UK, and the University of Turku, Finland, studied outcomes for 17,577 babies born earlier than 28 weeks of gestation.
They found that 20% of babies were transferred after birth and that the rate of transfer is increasing.
The study showed that babies not transferred from non-specialist hospitals had similar brain injury rates to those born in specialist hospitals – but higher mortality rates. Transfer was associated with an increased rate of brain injury.
There was some evidence of no ill-effects from transfer between specialist hospitals – although the sample number was small.
Some 26.3% of babies given care in non-specialist units died while 21% of those born in a specialist centre died.
Researcher Dr Chris Gale, from Imperial College, said: “This is the largest study to date to show that for extremely preterm babies, being born in the wrong place can have grave consequences.
"Establishing national systems and processes to ensure women are moved to the right hospital at the first indications of premature labour should be a health service priority to ensure the most premature babies are born in the right place.”
Finnish researcher Dr Kjell Helenius said: “Countries with much larger distances between hospitals, such as Finland and Australia, are more effective at ensuring babies are born in the right hospital. We need to look at the systems used in other countries and how they could be implemented in the UK.”
Association of early postnatal transfer and birth outside a tertiary hospital with mortality and severe brain injury in extremely preterm infants: observational cohort study with propensity score matching. The BMJ 17 October 2019
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