A study involving researchers at Oxford Population Health is the first to explore whether the place of birth for very premature babies born between 27─31 weeks of gestation affects the risk of death up to one year after birth in England.
Babies born between 27─31 weeks of gestation are at increased risk of mortality and morbidity within their first year. In England, these babies are delivered and receive care from maternity services colocated with highly specialised neonatal intensive care units (NICUs) or less specialised local neonatal units (LNUs).
Previous research has shown that there are improved outcomes for babies born before 27 weeks in maternity services with a NICU. However, little was known about the outcomes related to different places of birth for those born between 27─31 weeks.
The study, called OPTI-PREM, investigated whether place of birth between 27─31 weeks affected the likelihood of survival for 18,500 babies born in neonatal units across England between 1 January 2014 and 31 December 2018, as well as their risk of adverse neonatal outcomes (surgically treated necrotising enterocolitis, retinopathy of prematurity, severe brain injury (SBI), and bronchopulmonary dysplasia).
Published in Archives of Disease in Childhood, the study found no difference in mortality and early care for babies born in maternity services colocated with a NICU or LNU. However, there was a higher risk of SBI for babies born at 27 weeks in maternity services with a LNU, compared to those with a NICU. To reduce this risk, the authors suggest targeting maternity services colocated with a NICU for very premature births anticipated at 27 weeks.
Senior and joint first author Oliver Rivero-Arias, Associate Professor of Health Economics at Oxford Population Health, said ‘While maternity services colocated with a NICU improve outcomes for babies born before 27 weeks of gestation, our study shows that birth and early care from 28 weeks onwards can be provided safely by those with NICUs and LNUs, allowing births to take place closer to home.
‘With increasing pressure on maternity services, there was an urgent need to identify whether there is an optimal place of birth for this group of babies. Our findings have implications for the reorganisation of neonatal health service delivery in England that could be changed to allow more effective redistribution of birth and care of very premature babies. We will be supporting our clinical findings with a forthcoming health economics analysis.’
A group of 10 parents (mothers or fathers) of babies born between 27─31 weeks of gestation in England provided advice to the researchers throughout the study.