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Data were obtained from the Japan Environment and Children\u2019s Study. A general population of 103,060 pregnancies with 104,062 fetuses was enrolled in the study in 15 Regional Centers between January 2011 and March 2014. Live-born singletons at various gestational ages, including term infants, without congenital anomalies who were followed up until 3\u00a0years were included. Neurodevelopmental impairment was assessed using the Ages and Stages Questionnaire, third edition (ASQ-3) at 3\u00a0years of age. Logistic regression was used to estimate the adjusted risk and 95% confidence interval (CI) for newborns with neonatal transfer. Socioeconomic and perinatal factors were included as potential confounders in the analysis. Among 83,855 live-born singletons without congenital anomalies, 65,710 children were studied. Among them, 2780 (4.2%) were transferred in the neonatal period. After adjustment for potential confounders, the incidence of neurodevelopmental impairment (scores below the cut-off value of all 5 domains in the ASQ-3) was higher in children with neonatal transfer compared with those without neonatal transfer (communication: 6.5% vs 3.5%, OR 1.42, 95% CI 1.19\u20131.70; gross motor: 7.6% vs 4.0%, OR 1.26, 95% CI 1.07\u20131.49; fine motor: 11.3% vs 7.1%, OR 1.19, 95% CI 1.03\u20131.36; problem solving: 10.8% vs 6.8%, OR 1.29, 95% CI 1.12\u20131.48; and personal-social: 6.2% vs 2.9%, OR 1.52, 95% CI 1.26\u20131.83).<\/jats:p><jats:p><jats:italic>\u00a0 \u00a0Conclusion<\/jats:italic>: Neonatal transfer was associated with a higher risk of neurodevelopmental impairment at 3 years of age.<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022\u00a0<\/jats:italic><jats:italic>Neonatal transfer after birth in preterm infants is associated with adverse short-term outcomes.<\/jats:italic><jats:italic>\u2022 Long-term outcomes of outborn infants with neonatal transfer in the general population remain unclear.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022\u00a0<\/jats:italic><jats:italic>This study suggests that neonatal transfer at birth is associated with an increased risk of neurodevelopmental impairment.<\/jats:italic>\u2022\u00a0<jats:italic>Efforts for referring high-risk pregnant women to higher level centers may reduce the incidence of neonatal transfer, leading to improved neurological outcomes in the general population.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  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