{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T21:11:05Z","timestamp":1793221865258,"version":"4.5.0"},"reference-count":54,"publisher":"BMJ","license":[{"start":{"date-parts":[[2019,10,16]],"date-time":"2019-10-16T00:00:00Z","timestamp":1571184000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Observational cohort study with propensity score matching.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>National health service neonatal care in England; population data held in the National Neonatal Research Database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Extremely preterm infants born at less than 28 gestational weeks between 2008 and 2015 (n=17\u2009577) grouped based on birth hospital and transfer within 48 hours of birth: upward transfer (non-tertiary to tertiary hospital, n=2158), non-tertiary care (born in non-tertiary hospital; not transferred, n=2668), and controls (born in tertiary hospital; not transferred, n=10\u2009866). Infants were matched on propensity scores and predefined background variables to form subgroups with near identical distributions of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Death, severe brain injury, and survival without severe brain injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly higher odds of severe brain injury (2.32, 1.78 to 3.06; number needed to treat (NNT) 8) and significantly lower odds of survival without severe brain injury (0.60, 0.47 to 0.76; NNT 9). Compared with controls, infants in the non-tertiary care group had significantly higher odds of death (1.34, 1.02 to 1.77; NNT 20) but no significant difference in the odds of severe brain injury (0.95, 0.70 to 1.30) or survival without severe brain injury (0.82, 0.64 to 1.05). Compared with infants in the upward transfer group, infants in the non-tertiary care group had no significant difference in death before discharge (1.10, 0.84 to 1.44) but significantly lower odds of severe brain injury (0.41, 0.31 to 0.53; NNT 8) and significantly higher odds of survival without severe brain injury (1.37, 1.09 to 1.73; NNT 14). No significant differences were found in outcomes between the horizontal transfer group (n=305) and controls (n=1525).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In extremely preterm infants, birth in a non-tertiary hospital and transfer within 48 hours are associated with poor outcomes when compared with birth in a tertiary setting. We recommend perinatal services promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj.l5678","type":"journal-article","created":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T00:05:12Z","timestamp":1571270712000},"page":"l5678","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":117,"title":["Association of early postnatal transfer and birth outside a tertiary hospital with mortality and severe brain injury in extremely preterm infants: observational cohort study with propensity score matching"],"prefix":"10.1136","author":[{"given":"Kjell","family":"Helenius","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Longford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liisa","family":"Lehtonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neena","family":"Modi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0707-876X","authenticated-orcid":false,"given":"Chris","family":"Gale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,10,16]]},"reference":[{"key":"key20191018000920_ref1","unstructured":"Office for National Statistics. www.ons.gov.uk\/. Accessed May 19, 2017."},{"key":"key20191018000920_ref2","first-page":"1","article-title":"Births: Final data for 2014","volume":"64","author":"Hamilton","year":"2015","journal-title":"Natl Vital Stat Rep"},{"key":"key20191018000920_ref3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.10244"},{"key":"key20191018000920_ref4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e7976"},{"key":"key20191018000920_ref5","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-0944"},{"key":"key20191018000920_ref6","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2016.1210"},{"key":"key20191018000920_ref7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1226"},{"key":"key20191018000920_ref8","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-004856"},{"key":"key20191018000920_ref9","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-1964"},{"key":"key20191018000920_ref10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa065029"},{"key":"key20191018000920_ref11","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-2820"},{"key":"key20191018000920_ref12","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-1999"},{"key":"key20191018000920_ref13","unstructured":"Ministry for Social Affairs and Health. Finland. Sosiaali- ja terveysministeri\u00f6: yhten\u00e4iset p\u00e4ivystyshoidon perusteet ty\u00f6ryhm\u00e4n raportti. http:\/\/urn.fi\/URN:ISBN:978-952-00-2963-0. Accessed November 23, 2018."},{"key":"key20191018000920_ref14","unstructured":"Queensland Government D of H. CSCF Neonatal Services. www.health.qld.gov.au\/__data\/assets\/pdf_file\/0023\/444272\/cscf-neonatal.pdf. Accessed November 23, 2018."},{"key":"key20191018000920_ref15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e2105"},{"key":"key20191018000920_ref16","unstructured":"Bliss. Bliss baby report 2015 - England. www.bliss.org.uk\/babyreport. Accessed July 17, 2017."},{"key":"key20191018000920_ref17","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-1540"},{"key":"key20191018000920_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2015.10.062"},{"key":"key20191018000920_ref19","unstructured":"Parturients, deliveries and births - THL. www.thl.fi\/en\/web\/thlfi-en\/statistics\/statistics-by-topic\/sexual-and-reproductive-health\/parturients-deliveries-and-births. Accessed July 17, 2017."},{"key":"key20191018000920_ref20","doi-asserted-by":"publisher","DOI":"10.1515\/jpme.1983.11.4.200"},{"key":"key20191018000920_ref21","first-page":"729","article-title":"Maternal and neonatal transport: results of a national collaborative survey of preterm and very low birth weight infants in The Netherlands","volume":"72","author":"Koll\u00e9e","year":"1988","journal-title":"Obstet Gynecol"},{"key":"key20191018000920_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(89)80022-5"},{"key":"key20191018000920_ref23","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-994178"},{"key":"key20191018000920_ref24","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2010.183236"},{"key":"key20191018000920_ref25","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2012.126"},{"key":"key20191018000920_ref26","doi-asserted-by":"publisher","DOI":"10.1016\/S0378-3782(00)00128-6"},{"key":"key20191018000920_ref27","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211239"},{"key":"key20191018000920_ref28","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211263"},{"key":"key20191018000920_ref29","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0201815"},{"key":"key20191018000920_ref30","unstructured":"www.datadictionary.nhs.uk. Accessed March 18, 2019."},{"key":"key20191018000920_ref31","unstructured":"NHS Clinical Reference Group. E08\/S\/a. Neonatal Critical Care. SCHEDULE 2-THE SERVICES A. Service Specifications. www.england.nhs.uk\/commissioning\/spec-services\/npc-crg\/group-e\/e08\/. Accessed March 18, 2019."},{"key":"key20191018000920_ref32","doi-asserted-by":"publisher","DOI":"10.3109\/03014460.2011.544139"},{"key":"key20191018000920_ref33","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(78)80282-0"},{"key":"key20191018000920_ref34","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2017-313707"},{"key":"key20191018000920_ref35","unstructured":"Safer Maternity Care -The National Maternity Safety Strategy -Progress and Next Steps. www.nationalarchives.gov.uk\/doc\/open-government-licence\/. Published 2017. Accessed May 28, 2018."},{"key":"key20191018000920_ref36","doi-asserted-by":"publisher","DOI":"10.1002\/sim.5753"},{"key":"key20191018000920_ref37","doi-asserted-by":"publisher","DOI":"10.2307\/2287653"},{"key":"key20191018000920_ref38","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9781139025751"},{"key":"key20191018000920_ref39","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(16)30117-0"},{"key":"key20191018000920_ref40","doi-asserted-by":"publisher","DOI":"10.21307\/stattrans-2018-006"},{"key":"key20191018000920_ref41","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004454.pub3"},{"key":"key20191018000920_ref42","doi-asserted-by":"publisher","DOI":"10.1214\/09-STS313"},{"key":"key20191018000920_ref43","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwj149"},{"key":"key20191018000920_ref44","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2013.4248"},{"key":"key20191018000920_ref45","doi-asserted-by":"publisher","DOI":"10.1542\/peds.113.5.1230"},{"key":"key20191018000920_ref46","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2013-305555"},{"key":"key20191018000920_ref47","unstructured":"New ambition to halve rate of stillbirths and infant deaths - GOV.UK. www.gov.uk\/government\/news\/new-ambition-to-halve-rate-of-stillbirths-and-infant-deaths. Accessed April 12, 2019."},{"key":"key20191018000920_ref48","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2011.07.016"},{"key":"key20191018000920_ref49","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-1064"},{"key":"key20191018000920_ref50","doi-asserted-by":"publisher","DOI":"10.3109\/07853890.2011.586359"},{"key":"key20191018000920_ref51","doi-asserted-by":"publisher","DOI":"10.1177\/0954411916680235"},{"key":"key20191018000920_ref52","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.297.6656.1098"},{"key":"key20191018000920_ref53","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.1993.tb00469.x"},{"key":"key20191018000920_ref54","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000482"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.l5678","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.l5678","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,25]],"date-time":"2020-09-25T23:48:55Z","timestamp":1601077735000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.l5678"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,16]]},"references-count":54,"alternative-id":["10.1136\/bmj.l5678"],"URL":"https:\/\/doi.org\/10.1136\/bmj.l5678","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.736768497.793577036","asserted-by":"object"}]},"ISSN":["0959-8138","1756-1833"],"issn-type":[{"value":"0959-8138","type":"print"},{"value":"1756-1833","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,16]]}}}