Rosemarie Anne Boland1,2,3, Peter Graham Davis2,4, Jennifer Anne Dawson1,2,4, Lex William Doyle1,2,4. 1. Murdoch Childrens Research Institute, Parkville, Victoria, Australia. 2. Department of Obstetrics and Gynecology, University of Melbourne, Royal Women's Hospital, Parkville, Victoria, Australia. 3. Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Parkville, Victoria, Australia. 4. Department of Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia.
Abstract
OBJECTIVES: To compare mortality and serious morbidity rates between outborn and inborn livebirths at 22-27 weeks' gestation. DESIGN: Population-based cohort study. SETTING: Victoria, Australia. PATIENTS: Livebirths at 22-27 weeks' gestation free of major malformations in 2010-2011. INTERVENTIONS: Outcome data for outborn (born outside a tertiary perinatal centre) infants compared with inborn (born in a tertiary perinatal centre) infants were analysed by logistic regression, adjusted for gestational age, birth weight and sex. MAIN OUTCOME MEASURES: Infant mortality and serious morbidity rates to hospital discharge. RESULTS: 541 livebirths free of major malformations were recorded. By 1 year, 49 (58%) outborns and 140 (31%) inborns died (adjusted OR (aOR) 2.78, 95% CI 1.52 to 5.09, p=0.001). In total, 445 infants were admitted to neonatal intensive care unit (NICU); 93 died by 1 year (14/49 outborns and 79/396 inborns), (aOR 1.75, 95% CI 0.87 to 3.55, p=0.12). There were no significant differences in rates of necrotising enterocolitis, intraventricular haemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia (BPD) or the combined outcome of death or BPD in outborn infants compared with inborn infants. Outborns had an increased risk of cystic periventricular leukomalacia (cPVL) compared with inborns (12.2% vs 2.8%, respectively; aOR 5.34, 95% CI 1.84 to 15.54, p=0.002). CONCLUSIONS: Mortality rates remained higher for outborn livebirths at 22-27 weeks' gestation compared with inborn peers in 2010-2011. Outborn infants admitted to NICU did not have substantially different rates of mortality or serious morbidity compared with inborns, with the exception of cPVL. Longer-term health consequences of outborn birth before 28 weeks' gestation need to be determined. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVES: To compare mortality and serious morbidity rates between outborn and inborn livebirths at 22-27 weeks' gestation. DESIGN: Population-based cohort study. SETTING: Victoria, Australia. PATIENTS: Livebirths at 22-27 weeks' gestation free of major malformations in 2010-2011. INTERVENTIONS: Outcome data for outborn (born outside a tertiary perinatal centre) infants compared with inborn (born in a tertiary perinatal centre) infants were analysed by logistic regression, adjusted for gestational age, birth weight and sex. MAIN OUTCOME MEASURES: Infant mortality and serious morbidity rates to hospital discharge. RESULTS: 541 livebirths free of major malformations were recorded. By 1 year, 49 (58%) outborns and 140 (31%) inborns died (adjusted OR (aOR) 2.78, 95% CI 1.52 to 5.09, p=0.001). In total, 445 infants were admitted to neonatal intensive care unit (NICU); 93 died by 1 year (14/49 outborns and 79/396 inborns), (aOR 1.75, 95% CI 0.87 to 3.55, p=0.12). There were no significant differences in rates of necrotising enterocolitis, intraventricular haemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia (BPD) or the combined outcome of death or BPD in outborn infants compared with inborninfants. Outborns had an increased risk of cystic periventricular leukomalacia (cPVL) compared with inborns (12.2% vs 2.8%, respectively; aOR 5.34, 95% CI 1.84 to 15.54, p=0.002). CONCLUSIONS: Mortality rates remained higher for outborn livebirths at 22-27 weeks' gestation compared with inborn peers in 2010-2011. Outborn infants admitted to NICU did not have substantially different rates of mortality or serious morbidity compared with inborns, with the exception of cPVL. Longer-term health consequences of outborn birth before 28 weeks' gestation need to be determined. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Zeyar T Htun; Elizabeth V Schulz; Riddhi K Desai; Jaime L Marasch; Christopher C McPherson; Lucy D Mastrandrea; Alan H Jobe; Rita M Ryan Journal: J Perinatol Date: 2021-05-19 Impact factor: 2.521
Authors: Laure Dombrecht; Kim Beernaert; Ellen Roets; Kenneth Chambaere; Filip Cools; Linde Goossens; Gunnar Naulaers; Luc De Catte; Joachim Cohen; Luc Deliens Journal: BMC Pediatr Date: 2018-08-03 Impact factor: 2.125
Authors: Jeanie L Y Cheong; Joy E Olsen; Li Huang; Kim M Dalziel; Rosemarie A Boland; Alice C Burnett; Anjali Haikerwal; Alicia J Spittle; Gillian Opie; Alice E Stewart; Leah M Hickey; Peter J Anderson; Lex W Doyle Journal: BMJ Open Date: 2020-09-10 Impact factor: 2.692
Authors: Helena Watson; James McLaren; Naomi Carlisle; Nandiran Ratnavel; Tim Watts; Ahmed Zaima; Rachel M Tribe; Andrew H Shennan Journal: F1000Res Date: 2020-08-13