{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:18:16Z","timestamp":1787897896047,"version":"build-2784847793"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008439","name":"Texas Christian University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008439","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Out-of-hospital births have increased in the United States, yet their neonatal safety remains debated, particularly in states with lower midwifery integration. This study aimed to describe neonatal outcomes following out-of-hospital births, compare home vs. birth center deliveries, and evaluate birth center features associated with neonatal transfers. We conducted a retrospective cohort study at a Texas Level IV NICU which included 226 neonates admitted post-out-of-hospital births (2020\u20132024). Analysis included electronic record derived outcomes and resource utilization, supplemented by surveys of six regional birth centers on staffing, equipment, protocols, and transfers. Birth centers had more admissions (48.7% vs. 43.8% home births), but home-born infants showed worse outcomes: median NICU LOS (11.5 vs. 5 days), prolonged antibiotics (median 2 vs. 1d), Mortality (6% vs. 1.8%). Surveys revealed substantial variability: all centers screened for GBS, but only half mandated prophylaxis; 50% had IVs; there was no access to defibrillators. Hospital distance averaged 3.15 miles (travel time \u223c12\u2005min), yet transfer delays were common due to late recognition of complications. Neonates from out-of-hospital births exhibited elevated morbidity, mortality, and healthcare utilization. Standardized safety protocols, enhanced regulatory oversight, and improved emergency preparedness are needed, especially in states like Texas with lower midwifery integration.<\/jats:p>","DOI":"10.3389\/fped.2026.1843232","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:33:43Z","timestamp":1787895223000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Out-of-hospital births and neonatal outcomes: a retrospective cohort study from a level IV NICU and review of regulatory frameworks"],"prefix":"10.3389","volume":"14","author":[{"given":"Lucy","family":"Eletel","sequence":"first","affiliation":[{"name":"Pediatrics, Anne Burnett School of Medicine at Texas Christian University","place":["Fort Worth, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Corkum","sequence":"additional","affiliation":[{"name":"Cook Children\u2019s Medical Center","place":["Fort Worth, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Hazard","sequence":"additional","affiliation":[{"name":"Cook Children\u2019s Medical Center","place":["Fort Worth, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Riley","sequence":"additional","affiliation":[{"name":"Pediatrics, Anne Burnett School of Medicine at Texas Christian University","place":["Fort Worth, TX, United States"]},{"name":"Cook Children\u2019s Medical Center","place":["Fort Worth, TX, United States"]},{"name":"Pediatrix Medical Group of Texas \u2014 Fort Worth Neonatology","place":["Fort Worth, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e117","DOI":"10.1097\/AOG.0000000000002024","article-title":"Committee opinion No. 697: planned home birth","volume":"129","year":"2017","journal-title":"Obstet Gynecol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1111\/birt.12411","article-title":"Trends and state variations in out-of-hospital births in the United States, 2004\u20132017","volume":"46","author":"MacDorman","year":"2019","journal-title":"Birth"},{"key":"B3","volume-title":"Final Natality Data for 2023. 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