By Lisa Rapaport

Extremely premature infants born at hospitals lacking the specialized care they need are more likely to die or suffer severe brain damage, a UK study suggests.

Researchers examined data on 17,577 infants born before 28 weeks gestation in England from 2008 to 2015. Overall, about 62% of these babies were born in so-called tertiary hospitals with specialized neonatal units and remained there; another 12% were transferred to tertiary hospitals within 48 hours of birth; and 15% were born at local hospitals with neonatal units and remained there.

Compared to babies born at tertiary hospitals, infants transferred to tertiary hospitals soon after birth were more than twice as likely to have severe brain injury and 40% less likely to survive without brain injury, the study found.

And, infants born at local hospitals with neonatal units and kept there were 34% more likely to die in the hospital than babies born at tertiary hospitals.

“This study is extremely significant as it shows that preterm infants born at non-tertiary-level facilities are indeed at higher risk of mortality and preterm infants transferred after birth are at higher risk for brain injury,” said Dr. Colm Travers, an assistant professor of pediatrics at the University of Alabama at Birmingham who co-authored an editorial accompanying the study.

“This study suggests that women with threatened preterm labor should be transferred to tertiary level facilities before delivery with the infant still in utero whenever possible,” Travers said by email.

Pregnancy normally lasts about 40 weeks, and babies born after 37 weeks of gestation are considered full-term. Babies born earlier than 37 weeks often have difficulty breathing and digesting food in the weeks immediately following birth. They can also encounter longer-term challenges such as impaired vision, hearing and cognitive skills, as well as social and behavioral problems.

About one in 20 babies in high-income countries are born at less than 28 weeks gestation, when they have the worst survival odds and the highest potential for complications and severe disabilities, researchers note in The BMJ.

Tertiary hospitals have delivery units equipped to handle pregnancy and labor complications as well as the wide range of acute health issues that these vulnerable preemies may have immediately after birth.

In the UK, local neonatal units often manage babies born after 28 weeks gestation but transfer babies born sooner to tertiary hospitals where possible, the study team notes.

Avoiding transfers by delivering these early arrivals at tertiary care hospitals can help them get the care they need to minimize the risk of brain injuries and other potentially fatal complications, said Dr. Chris Gale, a co-author of the study and researcher at Imperial College London and Chelsea and Westminster Hospital NHS Foundation Trust.

“Very preterm babies need to be carefully stabilized and supported after birth as their organ systems are more immature,” Gale said by email. “This affects all their body systems but particularly their lungs and brain.”

Because these babies’ lungs are immature, they may need breathing support or a mechanical ventilator and require close monitoring by specially trained neonatal clinicians, Gale said.

“Extremely preterm babies’ brains are also very fragile – particularly some of the blood vessels inside the brain,” Gale added. “These are not as well protected from changes in blood pressure in the rest of the baby’s body as they are in term babies, children or adults and, as a result, extremely preterm babies are at much higher risk of these fragile blood vessels breaking which can lead to bleeding in the brain.”

SOURCE: and The BMJ, online October 16, 2019.