Objective: To compare mortality and morbidity of inborn vs outborn very preterm infants <32 weeks in Western Australia between 2005 and 2018. Design: Retrospective cohort study Patients: Infants <32 weeks born in Western Australia. Main outcome measures: Mortality was assessed as death before discharge home from the tertiary NICU. Clinically significant short-term morbidities included combined brain injury (intracranial haemorrhage (ICH) Grade 3 and cystic periventricular leukomalacia (cPVL)) and other important major neonatal outcomes. Standardised developmental assessments up to 5 years of age were evaluated where available. We performed multivariable logistic regression analysis of outborn status on outcomes, controlling for gestational age, birthweight z score, sex and multiple birth. Results: A total of 4974 infants were born in WA between 22 and 32 weeks gestation between 2005 and 2018 of which 4237 (89.6%) inborn and 443 (10.4%) outborn were compared. Overall mortality to discharge was higher in outborn infants (20.5% (91/443) vs. 7.4% (314/4237); aOR 2.44, 95% CI 1.60;3.70, p<0.001). Outborn infants had higher rates of combined brain injury than those inborn (10.7% (41/384) vs. 6.0% (246/4115); adjusted OR 1.98, 95% CI 1.37;2.86), p<0.001). No difference in long term neurodevelopmental measures was detected, however, long-term follow-up data were available for only 65% of outborn and 79% of inborn infants. Conclusions: Outborn preterm infants <32 weeks in WA have increased odds of mortality, and combined brain injury than those inborn. Long-term outcome results is likely to be affected by incomplete follow-up data.
ObjectiveWe compared mortality and morbidity of inborn versus outborn very preterm infants <32 weeks’ gestation in Western Australia (WA) between 2005 and 2018.DesignRetrospective cohort study.PatientsInfants <32 weeks’ gestation who were born in WA.Main outcome measuresMortality was assessed as death before discharge home from the tertiary neonatal intensive care unit. Short-term morbidities included combined brain injury (intracranial haemorrhage grade ≥3 and cystic periventricular leukomalacia) and other major neonatal outcomes. Developmental assessments at age 2, 3 and 5 years were evaluated. We performed multivariable logistic regression analysis of outborn status on outcomes, controlling for gestational age, birth weight z-score, sex and multiple birth.ResultsA total of 4974 infants were born in WA between 22 and 32 weeks’ gestation between 2005 and 2018 of which 4237 (89.6%) were inborn and 443 (10.4%) were outborn. Overall mortality to discharge was higher in outborn infants (20.5% (91/443) vs 7.4% (314/4237); adjusted OR (aOR) 2.44, 95% CI 1.60 to 3.70, p<0.001). Outborn infants had higher rates of combined brain injury than those inborn (10.7% (41/384) vs 6.0% (246/4115); aOR 1.98, 95% CI 1.37 to 2.86), p<0.001). No difference in up to 5-year developmental measures was detected. Follow-up data were available for 65% of outborn and 79% of inborn infants.ConclusionsOutborn preterm infants <32 weeks in WA had increased odds of mortality and combined brain injury than those inborn. Developmental outcomes up to 5 years were similar between groups. Loss to follow-up may have impacted the long-term comparison.
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