Pillay Thillagavathie, Seaton Sarah E, Yang Miaoqing, Bountziouka Vasiliki, Banda Victor, Campbell Helen, Dawson Kelvin, Manktelow Bradley N, Draper Elizabeth S, Modi Neena, Boyle Elaine M, Rivero-Arias Oliver
Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
Neonatology, University Hospitals of Leicester NHS Trust, Leicester, UK.
Arch Dis Child Fetal Neonatal Ed. 2025 Mar 3. doi: 10.1136/archdischild-2024-327474.
Babies born between 27 and 31 weeks of gestation contribute substantially towards infant mortality and morbidity. In England, their care is delivered in maternity services colocated with highly specialised neonatal intensive care units (NICU) or less specialised local neonatal units (LNU). We investigated whether birth setting offered survival and/or morbidity advantages to inform National Health Service delivery.
Retrospective national cohort study.
LNU, NICU, England.
UK National Neonatal Research Database whole population data for births between 27 and 31 weeks of gestation, discharged from/died within neonatal units between 1 January 2014 and 31 December 2018. We linked baby-level data to mortality information from the Office for National Statistics.
Death during neonatal care, up to 1 year (infant mortality), surgically treated necrotising enterocolitis, retinopathy of prematurity, severe brain injury (SBI), bronchopulmonary dysplasia.
Birth in NICU versus LNU setting. We used an instrumental variable (maternal excess travel time between the nearest NICU and LNU) estimation approach to determine treatment effect.
Of 18 847 babies (NICU: 10 379; LNU: 8468), 574 died in NICU/LNU care, and 121 postdischarge (infant mortality 3.7%). We found no effect of birth setting on neonatal or infant mortality. Significantly more babies born into LNU settings experienced SBI (mean difference -1.1% (99% CI -2.2% to -0.1%)). This was attenuated after excluding births at 27 weeks, and early postnatal transfers.
In England, LNU teams should use clinical judgement, risk assessing benefits of transfer versus risk of SBI for preterm births at 27 weeks of gestation. 28 weeks of gestation is a safe threshold for preterm birth in either NICU/LNU settings.
NCT02994849/ISRCTN74230187.
妊娠27至31周出生的婴儿对婴儿死亡率和发病率有重大影响。在英格兰，他们在与高度专业化的新生儿重症监护病房（NICU）或专业化程度较低的当地新生儿病房（LNU）同址的产科服务机构接受护理。我们调查了分娩地点是否对生存和/或发病率有优势，以为英国国民医疗服务体系的服务提供参考。
回顾性全国队列研究。
英格兰的LNU、NICU。
英国国家新生儿研究数据库中妊娠27至31周出生的全部人口数据，于2014年1月1日至2018年12月31日期间从新生儿病房出院或在病房内死亡。我们将婴儿层面的数据与国家统计局的死亡率信息相链接。
新生儿护理期间直至1岁的死亡（婴儿死亡率）、接受手术治疗的坏死性小肠结肠炎、早产儿视网膜病变、严重脑损伤（SBI）、支气管肺发育不良。
在NICU与LNU环境中出生。我们采用工具变量（产妇在最近的NICU和LNU之间的额外出行时间）估计方法来确定治疗效果。
在18847名婴儿中（NICU：10379名；LNU：8468名），574名在NICU/LNU护理期间死亡，121名在出院后死亡（婴儿死亡率3.7%）。我们发现分娩地点对新生儿或婴儿死亡率没有影响。出生在LNU环境中的婴儿发生SBI的明显更多（平均差异-1.1%（99%CI-2.2%至-0.1%））。在排除27周出生的婴儿和早期产后转运后，这种情况有所减轻。
在英格兰，LNU团队应运用临床判断，对妊娠27周的早产评估转运的益处与SBI风险。妊娠28周是NICU/LNU环境中早产的安全阈值。
NCT02994849/ISRCTN74230187。
