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Comparative mortality and morbidity of infants transferred in utero or postnatally
Insights
In utero transfer significantly improves outcomes for infants needing neonatal intensive care. This approach reduces mortality and intraventricular hemorrhage rates compared to neonatal transfers.
Area of Science:
- Neonatal Medicine
- Perinatology
- Pediatric Critical Care
Background:
- Infants requiring neonatal intensive care often necessitate specialized transfer protocols.
- Comparing outcomes between in utero and neonatal transfers is crucial for optimizing care pathways.
Purpose of the Study:
- To compare the outcomes of infants transferred in utero versus neonatally to a regional neonatal intensive care center.
- To assess the impact of transfer timing on infant mortality and intraventricular hemorrhage rates.
Main Methods:
- Retrospective comparison of 212 infants transferred in utero with 166 infants transferred neonatally.
- Analysis of survival rates and incidence of intraventricular hemorrhage (IVH) diagnosed via ultrasound.
- Standardization using birthweight-specific perinatal mortality and IVH rates.
Main Results:
- The in utero transfer group showed a higher survival rate (83%) compared to the neonatal transfer group (70%) (p < 0.01).
- The incidence of intraventricular hemorrhage was lower in the in utero group (30%) versus the neonatal group (45%) (p < 0.01).
- In utero transfer was associated with an estimated 27 additional survivors and protection from IVH for 31 infants.
Conclusions:
- Infants at risk for neonatal intensive care benefit from in utero transfer.
- Transferring high-risk infants before birth to specialized centers reduces mortality and morbidity.
- Optimizing transfer strategies is essential for improving outcomes in neonatal critical care.
Abstract:
The outcome of two hundred and twelve infants transferred in utero and delivered in the regional neonatal intensive care center is compared with one hundred and sixty-six infants born elsewhere and transferred neonatally to the same unit, during the same period of time. The mean birthweight (+/- 1 S.D.) was 1391 g (+/- 415 g) for the infants transferred in utero, and 1398 g (+/- 415 g) for the infants transferred neonatally. The mean gestational age of the two groups was 29.9 completed weeks for both groups. Survival was defined as discharge from the neonatal unit and intraventricular hemorrhage was diagnosed ultrasonically. The survival rate was 83% for the group transferred in utero and 70% for the group transferred postnatally (p = less than 0.01). The incidence of intraventricular hemorrhage was 30% and 45% respectively (p = less than 0.01). Using birthweight specific perinatal mortality rates and intraventricular hemorrhage rates of the neonatally transferred group for standardisation, it can be calculated that 27 infants survived and 31 were protected from intraventricular hemorrhage because of in utero transfer. It is concluded that infants likely to require neonatal intensive care have decreased mortality and morbidity if transferred in utero to a center with these facilities rather than being transferred neonatally.