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Improving outcomes for very preterm babies in England: does place of birth matter? Findings from OPTI-PREM, a

Thillagavathie Pillay1,2, Sarah E Seaton3, Miaoqing Yang4

  • 1Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK tilly.pillay@uhl-tr.nhs.uk.

Archives of Disease in Childhood. Fetal and Neonatal Edition
|December 27, 2024
PubMed

Insights

Birth setting for preterm infants (27-31 weeks) did not affect mortality. However, local neonatal units (LNU) had higher rates of severe brain injury (SBI), suggesting careful risk assessment for 27-week births.

Area of Science:

  • Neonatal care
  • Perinatal medicine
  • Public health

Background:

  • Infants born between 27 and 31 weeks gestation face significant mortality and morbidity risks.
  • Care for these vulnerable infants in England is provided in either highly specialized Neonatal Intensive Care Units (NICU) or less specialized Local Neonatal Units (LNU).

Purpose of the Study:

  • To investigate potential survival and/or morbidity advantages associated with birth setting (NICU vs. LNU) for preterm infants.
  • To inform National Health Service (NHS) delivery strategies for neonatal care.

Main Methods:

  • Retrospective national cohort study using whole population data from the UK National Neonatal Research Database (2014-2018).
  • Inclusion criteria: births between 27+0 and 31+6 weeks gestation, discharged from or died within neonatal units.
  • Outcomes included neonatal/infant mortality, necrotising enterocolitis, retinopathy of prematurity, severe brain injury (SBI), and bronchopulmonary dysplasia. Instrumental variable estimation was used.

Main Results:

  • A total of 18,847 infants were analyzed (NICU: 10,379; LNU: 8,468).
  • No significant difference in neonatal or infant mortality was observed between NICU and LNU settings.
  • Infants born in LNU settings showed a significantly higher incidence of severe brain injury (SBI), though this was attenuated after excluding 27-week births and early transfers.

Conclusions:

  • Birth setting (NICU vs. LNU) does not appear to impact mortality for preterm infants between 27 and 31 weeks gestation in England.
  • Local Neonatal Unit (LNU) teams should exercise clinical judgment for 27-week gestation births, balancing transfer benefits against the risk of SBI.
  • 28 weeks of gestation is suggested as a safe threshold for preterm birth in either NICU or LNU settings.
Abstract

Keywords:
Intensive Care Units, NeonatalMortalityNeonatology

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