Increased mortality of preterm infants transferred between tertiary perinatal centres.

Abstract

6 Lubin JH, Burns PE, Blot WJ, et al. Risk factors for breast cancer in women in northern Alberta, Canada, as related to age at diagnosis. J7NCI 1982;68: 211-7. 7 Janerich DT, Hoff MB. Evidence for a cross-over in breast cancer risk factors. confounding variables by logistic function regression the risk of dying for those transferred remained significantly higher than that for infants who remained (relative odds=4-6, 95% confidence interval 1-8 to 12-1).As the requirement for neonatal intensive care is episodic and unpredictable more flexibility has to be built into the perinatal health care system to enable preterm infants delivered in tertiary perinatal centres to be cared for where they are born.

The Effect of Neonatal Intensive Care Level and Hospital Volume on Mortality of Very Low Birth Weight Infants

“…This provides additional support for transport of pregnant women before delivery, as opposed to neonatal transport once delivery has already occurred, to achieve the best outcome for the fetus or neonate. 9,12,13,[21][22][23][24][25] We also noted that there are some antenatal factors that were associated with a lower odds of death. A potential contributor to this finding is that some of these factors, such as hypertension, preeclampsia, and intrauterine growth restriction, may lead to higher levels of intrauterine stress and result in accelerated lung maturation and fewer respiratory complications after birth.…”

“…This is because exisiting literature suggests that infants transferred after birth to a higher level have worse outcomes than infants who received treatment in the hospitals where they were born. 9,12,13,[21][22][23][24][25] Therefore, attributing an infant death to the receiving hospital would introduce bias to the study results. Because existing literature suggests an interaction between hospital level and volume, levels were further subdivided by annual hospital volume of VLBW infants in accordance with Phibbs et al 13 Hospital level and volume of VLBW infants were also evaluated separately to determine their independent effects.…”

Levels of Neonatal Care

“…In a study in Australia, 25% of infants less than 30 weeks' gestational age born at a tertiary care center during an 18-month period required transfer to another tertiary care center because the initial NICU was fully occupied. 14 After exclusion of lethal malformations and adjustment for confounding variables, mortality in the transferred infants was significantly greater than in those who remained at the birth hospital. Thus, to the extent possible, delivery of a high-risk infant should be planned to occur in a facility capable of providing the anticipated appropriate level of NICU care.…”

A study on status of neonatal transport to a level III neonatal intensive care unit

“…However, the status of neonatal transport still remains in primitive stage. 2 Hence a further fall in IMR will only achieve when neonatal transport facilities are improved. Though institutional delivery and in the utero transport of new-born is the safest way to transport a sick neonate, unfortunately, preterm delivery and perinatal illness cannot be always anticipated.…”