{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:32:14Z","timestamp":1786357934761,"version":"build-2736575974"},"reference-count":45,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy of Craiova, Romania"},{"id":[{"id":"https:\/\/ror.org\/031d5vw30","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Outborn neonates\u2014those born outside tertiary perinatal centres and transferred postnatally\u2014may experience higher mortality and morbidity than inborn infants. This systematic review without meta-analysis synthesised contemporary evidence on neonatal interfacility transfer to tertiary and quaternary neonatal centres, focusing on mortality, major morbidity, physiological instability, prognostic tools, and organisational determinants. Methods: Four electronic databases (PubMed\/MEDLINE, Scopus, Web of Science, and the Cochrane Library) were searched for English-language publications from January 2010 to December 2025. Study selection and data extraction were performed independently by two reviewers, with disagreements resolved by consensus. Narrative synthesis followed PRISMA 2020 and SWiM principles. Of the 2456 records identified, 44 publications were retained: 31 primary studies and 13 contextual or methodological sources. Results: Across the primary evidence, outborn status was generally associated with higher mortality and major morbidity, particularly among very preterm infants, although effect magnitude varied across healthcare systems. Hypothermia, respiratory deterioration, and haemodynamic instability were recurrent transport-related complications. Specialised teams, standardised stabilisation, and thermal-management bundles were associated with better physiological stability. TRIPS and TRIPS-II showed prognostic utility. Conclusions: Predominantly observational evidence suggests that neonatal transport outcomes reflect interactions between biological vulnerability, transport-related stress, and system organisation. Strengthening regionalised transport pathways and standardising stabilisation practices may improve outcomes, but causal inference remains limited.<\/jats:p>","DOI":"10.3390\/children13081064","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:24:53Z","timestamp":1786353893000},"page":"1064","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Neonatal Interfacility Transport to Tertiary and Quaternary Centres: Clinical Outcomes and System-Level Determinants\u2014A Systematic Review"],"prefix":"10.3390","volume":"13","author":[{"given":"Roni Octavian","family":"Damian","sequence":"first","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Department of Emergency Medicine and First Aid, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4817-1365","authenticated-orcid":false,"given":"Lidia","family":"Boldeanu","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5847-6480","authenticated-orcid":false,"given":"Mihai Gabriel","family":"Cucu","sequence":"additional","affiliation":[{"name":"Laboratory of Human Genomics, University of Medicine and Pharmacy of Craiova, 200638 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1835-2551","authenticated-orcid":false,"given":"Mirela Ani\u015foara","family":"Siminel","sequence":"additional","affiliation":[{"name":"Department of Neonatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai Alexandru","family":"Butoi","sequence":"additional","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Department of Emergency Medicine and First Aid, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6994-1914","authenticated-orcid":false,"given":"Vlad Ionu\u021b","family":"Belghiru","sequence":"additional","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Department of Emergency Medicine and First Aid, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Nica","sequence":"additional","affiliation":[{"name":"Department of Emergency and First Aid, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"University Emergency Hospital of Bucharest, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7398-5689","authenticated-orcid":false,"given":"Vlad","family":"P\u0103dureanu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3146-8769","authenticated-orcid":false,"given":"Mohamed-Zakaria","family":"Assani","sequence":"additional","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9028-7583","authenticated-orcid":false,"given":"Virginia Maria","family":"R\u0103dulescu","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiana","family":"Geormaneanu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and First Aid, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2481-6138","authenticated-orcid":false,"given":"Mihail Virgil","family":"Boldeanu","sequence":"additional","affiliation":[{"name":"Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3135-5456","authenticated-orcid":false,"given":"Luciana Teodora","family":"Rotaru","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and First Aid, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Committee on Fetus and Newborn, Barfield, W.D., Papile, L.A., Baley, J.E., Benitz, W., Cummings, J., and Eichenwald, E.C. 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