Transferring extremely premature (BMJ today.
Keeping these infants at lower level units after birth is also associated with a higher risk of death, compared with birth in a tertiary facility.
Researchers at the Imperial College London and the University of Turku, Finland assessed 17,577 extremely premature babies born before 28 weeks gestation in English hospitals between 2008 and 2015. Of these, 10,866 were born in hospitals with a neonatal intensive care unit, 2158 were transferred to a different hospital and 2668 stayed in hospitals without a neonatal intensive care unit.
Compared with controls (tertiary birth; not transferred), infants born in a non-tertiary hospital and transferred to a tertiary hospital had no significant difference in risk of death before discharge but had higher risk of severe brain injury and lower chance of survival without severe brain injury. Severe brain injury was recorded in 27.5 per cent of transferred vs 14 per cent of babies born in hospitals with a specialist neonatal unit.
Infants born in a non-tertiary hospital and not transferred had higher risk of death but no difference in risk of severe brain injury or survival without severe brain injury, compared with controls.
No differences in outcomes were found for infants transferred between tertiary hospitals and controls.
Dr Kjell Helenius, one of the study authors, said: "The UK should prioritise the development of a more effective national system of moving women at risk of premature birth to suitable hospitals before they give birth."