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Short- and Long-Term Outcomes of Extremely Preterm Infants in Japan According to Outborn/Inborn Birth Status

Yoshihito Sasaki1, Kaoru Ishikawa2, Akira Yokoi3

  • 1Department of Obstetrics and Neonatology, Funabashi Central Hospital, Funabashi, Japan.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|June 25, 2019
PubMed

Insights

Outborn extremely preterm infants face higher risks for severe intraventricular hemorrhage, necrotizing enterocolitis, and cognitive impairment compared to inborn infants. While short-term outcomes differ, long-term results showed no significant differences except for cognitive impairment.

Area of Science:

  • Neonatal Medicine
  • Perinatal Outcomes
  • Public Health

Background:

  • Outborn infants, particularly extremely preterm infants, exhibit increased mortality and morbidity risks compared to inborn infants.
  • Extremely preterm infants require specialized neonatal care, equipment, and environments.
  • Timely maternal transport is crucial to prevent deliveries in facilities lacking necessary capabilities for extremely preterm infants.

Purpose of the Study:

  • To compare short- and long-term outcomes between outborn and inborn extremely preterm infants.
  • To identify areas for improvement in regional perinatal systems.

Main Methods:

  • Retrospective cohort study utilizing the Neonatal Research Network of Japan database (2003-2011).
  • Analysis included 12,164 extremely preterm infants (22 weeks 0 days to 27 weeks 6 days gestational age).
  • Comparison of demographic, clinical factors, and short- and long-term outcomes between outborn and inborn groups.

Main Results:

  • Outborn infants (6.5%) showed significantly higher odds of severe intraventricular hemorrhage (aOR, 1.49), necrotizing enterocolitis (aOR, 1.49), and focal intestinal perforation (aOR, 1.58).
  • No significant differences in most long-term outcomes were observed.
  • A significant difference was found in the rate of cognitive impairment, with higher odds in outborn infants (aOR, 1.49).

Conclusions:

  • Outborn status is associated with increased risks of severe intraventricular hemorrhage, necrotizing enterocolitis, focal intestinal perforation, and cognitive impairment in extremely preterm infants.
  • Birth location (outborn vs. inborn) appears to influence both short- and long-term outcomes.
  • Further research and evaluation of perinatal system improvements are necessary.
Abstract

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