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Published on: November 20, 2015
Extremely preterm infants born outside a provincial tertiary perinatal center and transferred postnatally associated
Sicong Peng1,2, Xianjing He1, Shiwen Xia1,2,3
1Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Insights
Extremely preterm infants born at lower-level hospitals and transferred postnatally had similar survival and severe complication rates. However, risks of birth asphyxia, periventricular-intraventricular hemorrhage, and growth retardation were higher, suggesting benefits of in utero transfer.
Area of Science:
- Neonatology
- Perinatal Medicine
- Public Health
Background:
- Extremely preterm infants (EPIs) face high risks of morbidity and mortality.
- Optimal delivery is recommended at tertiary perinatal centers (inborn).
- Many EPIs in central China are born at lower-level hospitals and transferred postnatally, with outcomes needing investigation.
Purpose of the Study:
- To investigate the outcomes of extremely preterm infants (EPIs) born in lower-level hospitals and transferred postnatally compared to inborn EPIs.
- To analyze neonatal and maternal characteristics, neonatal outcomes, and treatment of survival EPIs.
Main Methods:
- Retrospective cohort study of EPIs admitted to a tertiary center from January 2013 to December 2022.
- Division into two groups: inborn (control) and born in other hospitals (transfer).
- Analysis of neonatal/maternal characteristics, neonatal outcomes, and treatment of survivors.
Main Results:
- Transfer group had higher birth weight and lower multiple pregnancy rates.
- Survival rates, severe periventricular-intraventricular hemorrhage (PIVH), severe bronchopulmonary dysplasia (sBPD), and severe retinopathy of prematurity (ROP) were similar between groups.
- Transfer group showed higher rates of severe birth asphyxia, PIVH, and extrauterine growth retardation (EUGR), with less surfactant use.
Conclusions:
- Postnatal transfer of EPIs did not significantly increase mortality or rates of severe PIVH, ROP, or sBPD.
- Increased risks of severe asphyxia, PIVH, and EUGR observed in the transfer group, potentially due to differing characteristics and management.
- Recommend in utero transfer for EPIs to mitigate risks and improve physical and neurological development outcomes.
Introduction:
Extremely preterm infants (EPIs) have high morbidity and mortality, and are recommended to be born in a tertiary perinatal center (inborn). However, many EPIs in central China are born in lower-level hospitals and transferred postnatally, the outcomes of which remain to be investigated.
Methods:
EPIs admitted to the Department of Neonatology, Maternal and Child Health Hospital of Hubei Province from January 2013 to December 2022 were retrospectively recruited and divided into the control (inborn) and transfer groups (born in other hospitals). The neonatal and maternal characteristics, neonatal outcomes, and the treatment of survival EPIs were analyzed.
Results:
A total of 174 and 109 EPIs were recruited in the control and transfer groups, respectively. EPIs in the transfer group have a higher birth weight and a lower proportion of multiple pregnancies than the control group (all P < 0.05). The proportions of antenatal steroids, magnesium sulfate, cesarean delivery, premature rupture of membranes ≥18 h, gestational diabetes, and amniotic fluid abnormalities were lower in the transfer group (all P < 0.05). Survival rates (64.22% vs. 56.32%), proportions of severe periventricular-intraventricular hemorrhage (PIVH) (11.93% vs. 11.49%), severe bronchopulmonary dysplasia (sBPD) (21.05% vs. 20%), and severe retinopathy of prematurity (ROP) (24.77% vs. 20.11%) were similar in the transfer and control groups (all P > 0.05). However, the transfer group had higher proportions of severe birth asphyxia (34.86% vs. 13.22%, P < 0.001), PIVH (42.20% vs. 29.89%, P = 0.034), and extrauterine growth retardation (EUGR) (17.43% vs. 6.32%, P = 0.003). Less surfactant utilization was found in the transfer group among survival EPIs (70.00% vs. 93.88%, P < 0.001).
Conclusion:
EPIs born outside a tertiary perinatal center and transferred postnatally did not have significantly higher mortality and rates of severe complications (severe PIVH, severe ROP, and sBPD), but there may be an increased risk of severe asphyxia, PIVH and EUGR. This may be due to differences in maternal and neonatal characteristics and management. Further follow-up is needed to compare neurodevelopmental outcomes, and it is recommended to transfer the EPIs in utero to reduce the risk of poor physical and neurological development.
