Frequency, causes and avoidability of outborn births in a French regional perinatal network

Lecoeur, Christelle; Thibon, Pascal; Prime, Ludovic; Mercier, Pierre-Yves; Balouet, P; Durin, Luc; Deon, Grégory; Lefevre, P.A.; Coutour, X. Le; Guillois, B.; Dreyfus, Michel

doi:10.1016/j.ejogrb.2014.05.009

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…The inborn rate of >90% of high-risk pregnancies at CHUV is among the highest when compared with literature. [15][16][17] Thanks to a rapid and direct alarm system and short transport distances within the network, the specialized NTT of the tertiary center was in charge of the outborn babies at birth or within the first 30 minutes in more than 98% of situations. The goal of the NTT as part of regionalization, that is, providing the highest level of neonatal care over the whole network area, ideally starting at birth, was therefore almost reached, as the equipped NTT can be considered as a mobile NICU.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Neonatal Transport in Western Switzerland: A Model of Perinatal Regionalization

McEvoy

Descloux

Barazzoni

et al. 2017

Clin Med Insights Pediatr

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Neonatal transport is an essential part of regionalization for highly specialized neonatal intensive care. This retrospective analysis of prospectively collected data on neonatal transport activity in a large Swiss perinatal network more than 1 year, aimed to quantify this activity, to identify the needs for staff, and the demands regarding know-how and equipment. Of the 565 admissions to the tertiary neonatology clinic, 176 (31.2%) were outborn patients, transported as emergencies to the level III unit. In 71.6% of cases, respiratory insufficiency was one of the reasons for transfer. Circadian and weekly distribution showed increased transport activity on workdays between 8 am and 10 pm, but regular demands for emergency transports regardless of the time frame require a neonatal transport team available 24/7. This study highlights the importance of neonatal transport and unveils several functional and infrastructural insufficiencies, which led to suggestions for improvement.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Neonatal Transport in Western Switzerland: A Model of Perinatal Regionalization

McEvoy

Descloux

Barazzoni

et al. 2017

Clin Med Insights Pediatr

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“…Our investigation of avoidable outborn deliveries raises questions about the organisation of care and in particular the strategy for antenatal transfers between maternity units. Very few studies have described the avoidability of outborn deliveries using a large cohort of preterm births, 29 and there is no definition available in the literature.…”

Section: Commentmentioning

confidence: 99%

Risk factors for very preterm delivery out of a level III maternity unit: The EPIPAGE‐2 cohort study

Desplanches

Morgan

Jones

et al. 2021

Paediatric Perinatal Epid

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Background Regionalisation programmes aim to ensure that very preterm infants are born in level III units (inborn) through antenatal referral or transfer. Despite widespread knowledge about better survival without disability for inborn babies, 10%‐30% of women deliver outside these units (outborn). Objective To investigate risk factors associated with outborn deliveries and to estimate the proportion that were probably or possibly avoidable. Methods We used a national French population‐based cohort including 2205 women who delivered between 24 and 30+6 weeks in 2011. We examined risk factors for outborn delivery related to medical complications, antenatal care, sociodemographic characteristics and living far from a level III unit using multivariable binomial regression. Avoidable outborn deliveries were defined by pregnancy risk (obstetric history, antenatal hospitalisation) and time available for transfer. Results 25.0% of women were initially booked in level III, 9.1% were referred, 49.8% were transferred, and 16.1% had outborn delivery. Risk factors for outborn delivery were gestational age <26 weeks (adjusted relative risk (aRR) 1.37, 95% confidence interval (CI) 1.13, 1.66), inadequate antenatal care (aRR 1.39, 95% CI 1.10, 1.81), placental abruption (aRR 1.66, 95% CI 1.27, 2.17), and increased distance to the closest level III unit ((aRR 2.79, 95% CI 2.00, 3.92) in the 4th versus 1st distance quartile). Among outborn deliveries, 16.7% were probably avoidable, and 25.6% possibly avoidable, which could increase the proportion of inborn deliveries between 85.9% and 92.9%. Avoidable outborn deliveries were mainly associated with gestational age, intrauterine growth restriction, preterm premature rupture of membranes, and haemorrhage, but not distance. Conclusions Our study identified some modifiable risk factors for outborn delivery; however, when regionalised care relies heavily on antenatal transfer, as it does in France, only some outborn deliveries may be prevented. Earlier referral of high‐risk women will be needed to achieve full access to tertiary care.

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“…Lecoeur et al studied the rate and circumstances of outborn deliveries within a French perinatal network to determine their avoidability. 23 Totally, 64 mothers and 71 neonates were included. Finally, fifty-two cases were considered to be born in inappropriate sites and 9.6% of these were avoidable.…”

Section: Discussionmentioning

confidence: 99%

Neonatal mortality among outborn versus inborn babies

Chen

Lin

et al. 2021

Pediatrics & Neonatology

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Background: Most previous studies reported there were higher survival rates if low birth weight babies were born in tertiary perinatal centers (inborn) than elsewhere (outborn). The objective of this study is to examine whether the number and ratio of outborn babies decrease and the neonatal mortality differs between inborn and outborn babies. Methods: We used the pooled data of the Taiwan Clinical Effectiveness Index for the years 2011e2016 obtained from the Joint Commission of Taiwan to study the outborn/inborn number and neonatal mortality rate. Results: We found that the number of outborn babies did not decrease year by year. The ratio of outborn to total babies was lower in the groups of birth body weight 750e999 g and S 2500 g than the other groups. The neonatal mortality rate in outborns was significantly higher than the inborns in the groups of birth body weight 1000e1499 g, 2000e2499 g and S 2500 g (6.9 AE 2.4 vs. 3.8 AE 0.9, P Z 0.009, 2.6 AE 0.6 vs. 0.6 AE 0.3, P Z 0.002 and 1.52 AE 0.67 vs. 0.08 AE 0.02, P Z 0.002, respectively) in medical centers. Conclusion: Improved maternal transport which promotes in utero transfer of patients may further improve neonatal outcome.

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Frequency, causes and avoidability of outborn births in a French regional perinatal network

Cited by 7 publications

References 14 publications

Evaluation of Neonatal Transport in Western Switzerland: A Model of Perinatal Regionalization

Evaluation of Neonatal Transport in Western Switzerland: A Model of Perinatal Regionalization

Risk factors for very preterm delivery out of a level III maternity unit: The EPIPAGE‐2 cohort study

Neonatal mortality among outborn versus inborn babies

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