Vol 99: Perinatal outcomes for extremely preterm babies in relation to place of birth in England: the EPICure 2 study.Report as inadecuate



 Vol 99: Perinatal outcomes for extremely preterm babies in relation to place of birth in England: the EPICure 2 study.


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This article is from Archives of Disease in Childhood. Fetal and Neonatal Edition, volume 99.AbstractBackground: Expertise and resources may be important determinants of outcome for extremely preterm babies. We evaluated the effect of place of birth and perinatal transfer on survival and neonatal morbidity within a prospective cohort of births between 22 and 26 weeks of gestation in England during 2006. Methods: We studied the whole population of 2460 births where the fetus was alive at the admission of the mother to hospital for delivery. Outcomes to discharge were compared between level 3 most intensive and level 2 maternity services, with and without transfers, and by activity level of level 3 neonatal unit; ORs were adjusted for gestation at birth and birthweight for gestation adjusted ORs aOR. Findings: Of this national birth cohort, 56% were born in maternity services with level 3 and 34% with level 2 neonatal units; 10% were born in a setting without ongoing intensive care facilities level 1. When compared with level 2 settings, risk of death in level 3 services was reduced aOR 0.73 95% CI 0.59 to 0.90, but the proportion surviving without neonatal morbidity was similar aOR 1.27 0.93 to 1.74. Analysis by intended hospital of birth confirmed reduced mortality in level 3 services. Following antenatal transfer into a level 3 setting, there were fewer intrapartum or labour ward deaths, and overall mortality was higher for those remaining in level 2 services aOR 1.44 1.09 to 1.90. Among level 3 services, those with higher activity had fewer deaths overall aOR 0.68 0.52 to 0.89. Interpretation: Despite national policy, only 56% of births between 22 and 26 weeks of gestation occurred in maternity services with a level 3 neonatal facility. Survival was significantly enhanced following birth in level 3 services, particularly those with high activity; this was not at the cost of increased neonatal morbidity.



Author: Marlow, N; Bennett, C; Draper, E S; Hennessy, E M; Morgan, A S; Costeloe, K L

Source: https://archive.org/







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