Long-term outcomes of children with neonatal transfer: the Japan Environment and Children’s Study

Abstract

This study aimed to evaluate the association of neonatal transfer with the risk of neurodevelopmental outcomes at 3 years of age. Data were obtained from the Japan Environment and Children’s Study. A general population of 103,060 pregnancies with 104,062 fetuses was enrolled in the study in 15 Regional Centers between January 2011 and March 2014. Live-born singletons at various gestational ages, including term infants, without congenital anomalies who were followed up until 3 years were included. Neurodevelopmental impairment was assessed using the Ages and Stages Questionnaire, third edition (ASQ-3) at 3 years of age. Logistic regression was used to estimate the adjusted risk and 95% confidence interval (CI) for newborns with neonatal transfer. Socioeconomic and perinatal factors were included as potential confounders in the analysis. Among 83,855 live-born singletons without congenital anomalies, 65,710 children were studied. Among them, 2780 (4.2%) were transferred in the neonatal period. After adjustment for potential confounders, the incidence of neurodevelopmental impairment (scores below the cut-off value of all 5 domains in the ASQ-3) was higher in children with neonatal transfer compared with those without neonatal transfer (communication: 6.5% vs 3.5%, OR 1.42, 95% CI 1.19–1.70; gross motor: 7.6% vs 4.0%, OR 1.26, 95% CI 1.07–1.49; fine motor: 11.3% vs 7.1%, OR 1.19, 95% CI 1.03–1.36; problem solving: 10.8% vs 6.8%, OR 1.29, 95% CI 1.12–1.48; and personal-social: 6.2% vs 2.9%, OR 1.52, 95% CI 1.26–1.83). Conclusion: Neonatal transfer was associated with a higher risk of neurodevelopmental impairment at 3 years of age. What is Known:• Neonatal transfer after birth in preterm infants is associated with adverse short-term outcomes.• Long-term outcomes of outborn infants with neonatal transfer in the general population remain unclear. What is New:• This study suggests that neonatal transfer at birth is associated with an increased risk of neurodevelopmental impairment.• Efforts for referring high-risk pregnant women to higher level centers may reduce the incidence of neonatal transfer, leading to improved neurological outcomes in the general population.

Identification of the Best Predictive Model for Mortality in Outborn Neonates—Retrospective Cohort Study

“…On the other hand, 40% of neonatal deaths occur on the first day of life [30] and 75% in the first 7 days of life [27,34]. Delayed neonatal transfer, inadequate stabilization before transport, and deficient care during transportation are recognized as important risk factors for neonatal mortality and morbidity [5,6,35]. Experts consider neonatal transport between medical institutions as part of neonatal intensive care and a major outcome predictor for sick neonates [36].…”

“…Experts consider neonatal transport between medical institutions as part of neonatal intensive care and a major outcome predictor for sick neonates [36]. Early recognition of sick neonates, optimal resuscitation if needed, prompt recognition and treatment of hypoglycemia, seizures, and respiratory distress, prevention of hypothermia, hypoxia, hypotension, adequate monitoring before and during neonatal transport, and rapid transfer are often challenging but extremely important for optimization of neonatal outcomes [5,8,9,[13][14][15][16]30,35,37]. Efforts to improve neonatal stabilization pretransport, neonatal care during transport, and the neonatal transport system itself-organization, training, equipment-are challenging in many countries but mandatory for decreasing neonatal morbidity and mortality rates as data in the literature shows that outborn neonates are facing significantly higher morbidity and mortality rates [8,11,12].…”

“…Starting the 1990s, clinicians have struggled to find an objective, rapid tool to evaluate the severity of the disease in newborns, especially in outborn infants, as the severity of the disease was described as an important factor for neonatal morbidity and mortality [19][20][21][22] and neonatal transfer after delivery was found as a risk factor for increased morbidity and mortality in outborn infants as compared with inborn infants [12,35,[47][48][49][50][51][52]]. Many severity system scorings were developed, some based on clinical knowledge and some based on strong statistical associations between different clinical and laboratory variables and outcomes.…”

Pregnancy outcomes after preterm premature rupture of membranes: The Japan Environment and Children's Study

“…Approximately 50% of deliveries are managed at birth centers or level I hospitals for maternal care where a pediatrician is not always available at delivery 31,32 . Severely ill neonates born in these facilities may face disadvantages of suboptimal resuscitation and requirement of neonatal transfer, which were associated with an increased risk of long‐term neurodevelopmental impairment 33 . On the contrary, in the case of PPROM, pregnant women were referred to and hospitalized in general or regional perinatal medical centers which provide tertiary obstetric maternal‐fetal care and neonatal intensive care, 15 which may be associated with improved fetal and neonatal mortality in the late PPROM group despite earlier GA at birth compared with the without PPROM group.…”