New findings put focus on extremely premature babies being born in specialised units

A new study has revealed the importance of (where possible) ensuring that the birth of extremely premature babies happens in a tertiary care setting. This is to avoid transferring babies shortly after birth.

Maternity ward sign in hospital.

Tertiary care happens at any hospitals that can provide highly specialised treatment that is sometimes necessary for babies who are born very early (before 28 weeks). 

The BMJ has published results from a study showing that babies who are transferred in the first 48 hours after birth could have an increased risk of severe brain injury.  The study also found that babies born in a non-tertiary unit who were not transferred may not receive the care they need, which results in a lower chance of survival.  As a conclusion, the study recommends that healthcare pathways should always try to allow for transfer before, not after birth, if babies are at risk of being born prematurely.  

“[Perinatal health services should] promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.” BMJ 2019;367:l5678

Although these findings are alarming, particularly if you are at risk of preterm birth, try not to worry.  Firstly, this is an observational study. This means that researchers have no way of guaranteeing that the outcomes were not due to other unmeasured factors unrelated to the hospital transfer.  

Although these findings are alarming, particularly if you are at risk of preterm birth, try not to worry.  Firstly, this is an observational study. This means that researchers have no way of guaranteeing that the outcomes were not due to other unmeasured factors unrelated to the hospital transfer. 

Secondly, your healthcare team will always try to do what is best for you and your baby.  Usually, doctors will try to plan for women who are at high risk of preterm birth to deliver the baby in a tertiary unit or if not, transfer them before the baby is born (called in utero transfer).  However, sometimes the birth is an emergency and it is not possible to transfer before the baby is born.  In this case, the best thing is for the baby to have access to any life-saving treatment it may need, wherever that may be.

The baby will be taken to the nearest hospital that is able to care for their needs in a specialised portable incubator and neonatal care ambulance. They will be monitored closely during the journey and hospital staff will be alerted and will prepare for them to arrive. Where possible, you will also be transferred along with the baby, but sometimes you may still need care before being well enough to move hospitals.  If this happens, a partner or loved one can visit the baby while you recover.  

17,577 extremely premature babies (born before 28 weeks) were recorded in the study, which was performed by researchers based in Finland and the UK.  These babies were born in NHS hospitals in England between 2008 and 2015. 

Premature birth

‘Premature’ or ‘preterm’ birth happens when a baby is born before 37 weeks.  ‘Extremely premature’ is defined as less than 28 weeks. If you are at high risk of preterm birth, your doctors will try to extend the pregnancy for as long as possible. This is because the earlier a baby is born, the greater their risk of developing health problems.  Try not to worry about this, because neonatal units, specialised care units and doctors are well equipped to support the baby if they have been born too early.  

We have lots more information on what happens when your baby is transferred.

We also have lots more information about giving birth to a premature baby.

You can read more about the study here.

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