Observational studyBMJ (Clinical research ed.)2019
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.
Observational study in BMJ (Clinical research ed.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
55 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- Impact of regionalisation and case-volume on neonatal and perinatal mortality: an umbrella review.BMJ open · 2020Pooled it
- The amniotic fluid cell-free transcriptome in spontaneous preterm labor.Scientific reports · 2021Trial
- Trial
- Article
- Neonatal Interfacility Transport to Tertiary and Quaternary Centres: Clinical Outcomes and System-Level Determinants-A Systematic Review.Children (Basel, Switzerland) · 2026Review
- Review
- Assessing Neonatal Transport, Health Outcomes, and Psychosocial Inequities Among Black, Very Preterm Infants and Their Families to Advance Health Equity: Protocol for a Mixed Methods Study.JMIR research protocols · 2026Article
- Term neonatal admissions for hypoglycaemia in England and Wales, 2012-2020: a population-based study using the National Neonatal Research Database.Archives of disease in childhood. Fetal and neonatal edition · 2026Article
- Comparison and trends in outcomes of inborn and outborn infants born before 33 weeks' gestation.PloS one · 2026Article
- Changes in admissions, care processes and outcomes for very and extremely preterm infants in England and Wales: an 11-year whole population study.BMJ public health · 2026Article
- Barriers and enablers to the implementation of a perinatal care bundle: the Perinatal Excellence to Reduce Injury in Premature Birth project.Frontiers in pediatrics · 2026Article
- [Expert recommendations on antenatal counseling for extremely preterm infants].Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics · 2025Article
- Neonatal Morbidities and Hospitalization in the First 2 Years of Life Among Infants Born Very Preterm.JAMA network open · 2025Article
- Improving outcomes for very preterm babies in England: does place of birth matter? Findings from OPTI-PREM, a national cohort study.Archives of disease in childhood. Fetal and neonatal edition · 2025Observational
- Using a novel smartphone app to track noise and vibration exposure during neonatal ambulance transport.Archives of disease in childhood. Fetal and neonatal edition · 2025Observational
- Transition from neonatal to paediatric intensive care of very preterm-born children: a cohort study of children born between 2013 and 2018 in England and Wales.Archives of disease in childhood. Fetal and neonatal edition · 2025Article
- Delivery unit volume and neonatal mortality - A nationwide register study in Finland from 2008 to 2023.European journal of pediatrics · 2025Article
- Considerations for obstetric management of births 22-25 weeks' gestation.Journal of perinatology : official journal of the California Perinatal Association · 2025Review
- Inter-organizational pooling of NICU nurses in the Dutch neonatal network: a simulation-optimization study.Health care management science · 2025Article
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6 authors.
Funding
Abstract
objectiveTo determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes.
designObservational cohort study with propensity score matching.
settingNational health service neonatal care in England; population data held in the National Neonatal Research Database.
participantsExtremely preterm infants born at less than 28 gestational weeks between 2008 and 2015 (n=17 577) grouped based on birth hospital and transfer within 48 hours of birth: upward transfer (non-tertiary to tertiary hospital, n=2158), non-tertiary care (born in non-tertiary hospital; not transferred, n=2668), and controls (born in tertiary hospital; not transferred, n=10 866). Infants were matched on propensity scores and predefined background variables to form subgroups with near identical distributions of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio.
main outcome measuresDeath, severe brain injury, and survival without severe brain injury.
results2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly higher odds of severe brain injury (2.32, 1.78 to 3.06; number needed to treat (NNT) 8) and significantly lower odds of survival without severe brain injury (0.60, 0.47 to 0.76; NNT 9). Compared with controls, infants in the non-tertiary care group had significantly higher odds of death (1.34, 1.02 to 1.77; NNT 20) but no significant difference in the odds of severe brain injury (0.95, 0.70 to 1.30) or survival without severe brain injury (0.82, 0.64 to 1.05). Compared with infants in the upward transfer group, infants in the non-tertiary care group had no significant difference in death before discharge (1.10, 0.84 to 1.44) but significantly lower odds of severe brain injury (0.41, 0.31 to 0.53; NNT 8) and significantly higher odds of survival without severe brain injury (1.37, 1.09 to 1.73; NNT 14). No significant differences were found in outcomes between the horizontal transfer group (n=305) and controls (n=1525).
conclusionsIn extremely preterm infants, birth in a non-tertiary hospital and transfer within 48 hours are associated with poor outcomes when compared with birth in a tertiary setting. We recommend perinatal services promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.
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