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Aim Methods Results Conclusion We evaluated the increased centralisation of extremely preterm (EPT) births in Sweden in relation to the changes in mortality and morbidity.Population‐based data covering Swedish live births from 22 + 0 to 26 + 6 weeks of gestation during 2004–2007 and 2014–2016 were analysed for associations between time‐period, birth within (inborn) or outside (outborn) regional centres, and outcomes.Among 1626 liveborn infants, 703 were born in 2004–2007 and 923 in 2014–2016. Birth outside (vs. within) regional centres was associated with a higher infant mortality even after adjustment for birth cohort, gestational age, birthweight standard deviation score and infant sex (adjusted odds ratio 2.01, 95% confidence interval 1.31–3.07, p = 0.001). The higher 1‐year mortality in outborn infants was mainly due to more deaths within 24 h after birth. Outborn infants had a higher incidence of intraventricular haemorrhage grade 3–4 than inborn infants (22% vs. 14% in 2004–2007, and 22% vs. 13% in 2014–2016, both p < 0.05). While survival to 1 year without major morbidity increased in inborn infants (33%–40%, p = 0.008), it remained unchanged in outborn infants (29% vs. 30%, p = 0.88).Centralisation of EPT births contributed to a lower 1‐year mortality in 2014–2016 than that in 2004–2007, attributed to a decrease in deaths before 24 h among inborn infants. [ABSTRACT FROM AUTHOR]

Background: Jaundice is the yellowish discoloration of the skin, sclera and mucous membranes resulting from deposition of bilirubin. Neonatal jaundice is a leading cause of neonatal admissions in the first week of life and risk factors such as sepsis, prematurity, glucose-6-phosphate dehydrogenase enzyme deficiencies, use of native herbs and contact with naphthalene balls contaminated clothes have been identified for neonatal jaundice. Objective: To determine the risk factors for neonatal jaundice at University of Benin Teaching Hospital, Benin City. Methods: This retrospective study was conducted at the Special Care Baby Unit of the University of Benin Teaching Hospital, Benin City. Case notes of babies admitted from January 2006 to December 2008 were retrieved and information on biodata, gestational age, anthropometric values, potential risk factors, level of serum bilirubin at presentation and discharge, mode of treatment and outcome were extracted. Results: Of the 1784 babies admitted during the period, 472 (26.5%) were admitted for neonatal jaudice. Fifty seven percent of the babies with neonatal jaundice were delivered in UBTH (in-born babies), while 202 (42.8%) of the babies were born before arrival (out-born babies) in UBTH. The Male: Female ratio was 1.02:1. The mean age at presentation with jaundice was 3.43 ± 3.76 days of life. Outborn babies tended to present at an older age (6.08 ± 5.19 days) than in -born babies (2.47 ± 2.48 days). The mean serum bilirubin value in out-born babies (14.00 ± 4.58 mg/ dL) was significantly higher than that observed among the in-born babies 9.35 ± 4.38 mg/dL: p = 0.000). The risk factors identified were use of mentholatum, naphthalene balls and native herbs in 40.0%, 16.7% and 7.0% respectively. ABO incompatibility was found in 7.6% of babies. No risk factor was identified in 36.3% of the babies. The case fatality rate in this study was relatively high particularly in association with sepsis, prematurity and asphyxia. Mortality was higher in out-born babies than in in-born babies (p= 0.00). Conclusion: Early presentation of babies and adequate management of sepsis and prematurity will reduce mortality associated with neonatal jaundice.

Objective: To compare unintended events in transfers performed by neonatal specialist (NS) and non-neonatal specialist (NNS) teams in Western Australia (WA). Study design: Retrospective comparison of neonatal transfers from the Kimberley and Pilbara regions (WA) to tertiary services, King Edward Memorial (perinatal) and Perth Children’s Hospital Neonatal Intensive Care Unit, in Perth (state capital, distance up to 2200 km) between January 2018 and June 2021. NS teams traveled from the tertiary to the referring center and back. NNS traveled from the referring to the tertiary center. Transport time, team composition, total unintended clinical and endotracheal tube (ETT) events were compared. Categorial data are expressed as numbers (%) and compared by χ2 test; continuous data are expressed as median (IQR) and compared by Mann-Whitney U test. Results: During the study period, 3709 infants were transported in WA to tertiary services for escalation of care: 119 of 3709 (3.2%) from the Kimberley and Pilbara, 49 with NS and 70 with NNS teams. NNS had shorter transport times than NS teams (508 [433-610] vs 675 [610- 735] minutes; P

Background: Transportation of sick newborns is a major predictor of outcome. Prompt identification of the sickest newborns allows adequate intervention and outcome optimization. An optimal scoring system has not yet been identified. Aim: To identify a rapid, accurate, and easy-to-perform score predictive for neonatal mortality in outborn neonates. Material and methods: All neonates admitted by transfer in a level III regional neonatal unit between 1 January 2015 and 31 December 2021 were included. Infants with congenital critical abnormalities were excluded (N = 15). Gestational age (GA), birth weight (BW), Apgar score, place of birth, time between delivery and admission (AT), early onset sepsis, and sick neonatal score (SNS) were collected from medical records and tested for their association with mortality, including in subgroups (preterm vs. term infants); GA, BW, and AT were used to develop MSNS-AT score, to improve mortality prediction. The main outcome was all-cause mortality prediction. Univariable and multivariable analysis, including Cox regression, were performed, and odds ratio and hazard ratios were calculated were appropriate. Results: 418 infants were included; 217/403 infants were born prematurely (53.8%), and 20 died (4.96%). Compared with the survivors, the non-survivors had lower GA, BW, and SNS scores (p < 0.05); only the SNS scores remained lower in the subgroup analysis. Time to admission was associated with an increased mortality rate in the whole group and preterm infants (p < 0.05). In multiple Cox regression models, a cut-off value of MSNS-AT score ≤ 10 was more precise in predicting mortality as compared with SNS (AUC 0.735 vs. 0.775) in the entire group and in the preterm infants group (AUC 0.885 vs. 0.810). Conclusions: The new MSNS-AT score significantly improved mortality prediction at admission in the whole study group and in preterm infants as compared with the SNS score, suggesting that, besides GA and BW, AT may be decisive for the outcome of outborn preterm infants. [ABSTRACT FROM AUTHOR]

Introduction: Newborn period is the most vulnerable phase of life and deaths during first 28 days of life account for 70% of all infant deaths and 56% of all deaths of under-5 year in children. Children who die within the first 28 days of birth suffer from conditions and diseases associated with lack of quality care at or immediately after birth and in the first few days of life. Aim: To study the morbidity and mortality profile of neonates admitted in Special Newborn Care Unit (SNCU) in a tertiary care hospital. Materials and Methods: This hospital-based retrospective study was carried out in SNCU, Department of Paediatrics, Gauhati Medical College and Hospital (GMCH), Guwahati, Assam, India. The study period was from 1st July 2021 to 30th June 2022. A total of 7439 neonates (both inborn and outborn) from birth to 28 days of life admitted in SNCU during the study period were included in the study. Morbidity and mortality data of admitted neonates were collected from the monthly reporting format and patient records and compiled in MS Excelsheet and analysed using arithmetic mean and also expressed in percentages. Results: During the study period, 7439 neonates were admitted in SNCU, inborn 4854 (65.3%) and outborn 2585 (34.7%). Male and female 4305 (57.9%) vs 3134 (42.1%). Normal birth weight and Low Birth Weight (LBW) babies 4200 (56.5%) vs 3239 (43.5%). Term and Preterm (PT) babies 4424 (59.5%) vs 3015 (40.5%). Neonatal jaundice, birth asphyxia and neonatal sepsis were common morbidities requiring admission. Mortality was 12.1% which was higher in outborn (21.5%) than inborn (7.1%). Birth asphyxia (45.3%) was the commonest cause of mortality followed by Respiratory Distress Syndrome (RDS) with prematurity (20.4%) and neonatal sepsis (15.1%). Birth asphyxia was higher in outborn (47.5%) than inborn (41.9%). Neonatal sepsis was higher in outborn (18.3%) than inborn (9.9%). Highest number of death occured within seven days of birth (70.2%) and among LBW babies (61%). Conclusion: Birth asphyxia, RDS with prematurity and neonatal sepsis are common causes of neonatal mortality. Outcomes of this study can be used for improving the existing healthcare services to reduce neonatal mortality. [ABSTRACT FROM AUTHOR]

Background and objectiveAcute kidney injury (AKI) was observed in sick neonates and was associated with poor outcomes. Our cohort represents the neonatal characteristics of those diagnosed with AKI using Kidney Disease: Improved Global Outcome (KDIGO) guidelines.MethodologyA cohort study was conducted in the NICU of FMH from June 2019 to May 2021. Data were collected on a proforma. All continuous variables were not normally distributed and expressed as the median and interquartile range. Categorical variables were analyzed by proportional differences with the Pearson chi-square test or Fisher's exact tests. A multinomial logistic regression model was used to explore the independent risk factors for AKI. Time to the event (death) and the cohort's survival curves were plotted using the Cox proportional hazard model.ResultsAKI occurred in 473 (37.6%) neonates. The risk factors of AKI were outborn birth [adjusted odds ratio (AOR): 3.987, 95% confidence interval (CI): 2.564–6.200, p: 0.000], birth asphyxia (AOR: 3.567, 95% CI: 2.093–6.080, p: 0.000), inotropic agent (AOR: 2.060, 95% CI: 1.436–2.957, p: 0.000), antenatal steroids (AOR: 1.721, 95% CI: 1.213–2.443, p: 0.002), central lines (AOR: 1.630, 95% CI: 1.155–2.298, p: 0.005) and intraventricular hemorrhage (IVH)/intracranial hemorrhage/disseminated intravascular coagulopathy (AOR: 1.580, 95% CI: 1.119–2.231, p: 0.009). AKI significantly increases the duration of stay and mortality rates by 16.5% vs. 3.9% in neonates with normal renal function (p

Background: Most previous studies reported there were higher survival rates if low birth weight babies were born in tertiary perinatal centers (inborn) than elsewhere (outborn). The objective of this study is to examine whether the number and ratio of outborn babies decrease and the neonatal mortality differs between inborn and outborn babies. Methods: We used the pooled data of the Taiwan Clinical Effectiveness Index for the years 2011–2016 obtained from the Joint Commission of Taiwan to study the outborn/inborn number and neonatal mortality rate. Results: We found that the number of outborn babies did not decrease year by year. The ratio of outborn to total babies was lower in the groups of birth body weight 750–999 g and ≧ 2500 g than the other groups. The neonatal mortality rate in outborns was significantly higher than the inborns in the groups of birth body weight 1000–1499 g, 2000–2499 g and ≧ 2500 g (6.9 ± 2.4 vs. 3.8 ± 0.9, P = 0.009, 2.6 ± 0.6 vs. 0.6 ± 0.3, P = 0.002 and 1.52 ± 0.67 vs. 0.08 ± 0.02, P = 0.002, respectively) in medical centers. Conclusion: Improved maternal transport which promotes in utero transfer of patients may further improve neonatal outcome.

This study aimed to evaluate the association of neonatal transfer with the risk of neurodevelopmental outcomes at 3 years of age. Data were obtained from the Japan Environment and Children's Study. A general population of 103,060 pregnancies with 104,062 fetuses was enrolled in the study in 15 Regional Centers between January 2011 and March 2014. Live-born singletons at various gestational ages, including term infants, without congenital anomalies who were followed up until 3 years were included. Neurodevelopmental impairment was assessed using the Ages and Stages Questionnaire, third edition (ASQ-3) at 3 years of age. Logistic regression was used to estimate the adjusted risk and 95% confidence interval (CI) for newborns with neonatal transfer. Socioeconomic and perinatal factors were included as potential confounders in the analysis. Among 83,855 live-born singletons without congenital anomalies, 65,710 children were studied. Among them, 2780 (4.2%) were transferred in the neonatal period. After adjustment for potential confounders, the incidence of neurodevelopmental impairment (scores below the cut-off value of all 5 domains in the ASQ-3) was higher in children with neonatal transfer compared with those without neonatal transfer (communication: 6.5% vs 3.5%, OR 1.42, 95% CI 1.19–1.70; gross motor: 7.6% vs 4.0%, OR 1.26, 95% CI 1.07–1.49; fine motor: 11.3% vs 7.1%, OR 1.19, 95% CI 1.03–1.36; problem solving: 10.8% vs 6.8%, OR 1.29, 95% CI 1.12–1.48; and personal-social: 6.2% vs 2.9%, OR 1.52, 95% CI 1.26–1.83). Conclusion: Neonatal transfer was associated with a higher risk of neurodevelopmental impairment at 3 years of age. What is Known: • Neonatal transfer after birth in preterm infants is associated with adverse short-term outcomes. • Long-term outcomes of outborn infants with neonatal transfer in the general population remain unclear. What is New: • This study suggests that neonatal transfer at birth is associated with an increased risk of neurodevelopmental impairment. • Efforts for referring high-risk pregnant women to higher level centers may reduce the incidence of neonatal transfer, leading to improved neurological outcomes in the general population. [ABSTRACT FROM AUTHOR]

The frequency of non-invasive respiratory support use has increased in neonates of all gestational ages with respiratory distress (RD). However, the impact of delayed initiation of non-invasive respiratory support in outborn neonates remains poorly understood. This study aimed to identify the impact of the delayed initiation of non-invasive respiratory support in outborn, late-preterm, and term neonates. Medical records of 277 infants (gestational age of ≥ 35 weeks) who received non-invasive respiratory support as primary respiratory therapy < 24 h of age between 2016 and 2020 were retrospectively reviewed. Factors associated with respiratory adverse outcomes were investigated in 190 outborn neonates. Infants with RD were divided into two groups: mild (fraction of inspired oxygen [FiO2] ≤ 0.3) and moderate-to-severe RD (FiO2 > 0.3), depending on their initial oxygen requirements from non-invasive respiratory support. The median time for the initiation of non-invasive respiratory support at a tertiary center was 3.5 (2.2-5.0) h. Male sex, a high oxygen requirement (FiO2 > 0.3), high CO2 level, and respiratory distress syndrome were significant factors associated with adverse outcomes. Subgroup analysis revealed that in the moderate-to-severe RD group, delayed commencement of non-invasive respiratory support (≥ 3 h) was significantly associated with pulmonary air leakage (p = 0.033).Conclusion: Our study shows that outborn neonates with moderate-to-severe RD, who were treated with delayed non-invasive respiratory support, were associated with an increased likelihood of pulmonary air leakage. Additional prospective studies are required to establish the optimal timing and methods of non-invasive respiratory support for outborn, late-preterm, and term infants.What Is Known: • Non-invasive respiratory support is widely used in neonates of all gestational ages. • Little is known on the impact of delayed initiation of non-invasive respiratory support in outborn, late preterm, and term neonates.What Is New: • Male sex, high oxygen requirement (FiO2 >0.3), high initial CO2 level, and respiratory distress syndrome significantly correlated with adverse outcomes. • Outborn late-preterm and term neonates with high oxygen requirement who were treated with delayed non-invasive respiratory support indicated an increased likelihood of pulmonary air leakage. [ABSTRACT FROM AUTHOR]

Congenital diaphragmatic hernia (CDH) is a morbid and potentially fatal condition that challenges providers. The aim of this study is to compare outcomes in neonates with prenatally diagnosed CDH that are inborn (delivered in the institution where definitive care for CDH is provided) versus outborn. Prenatally diagnosed CDH cases were identified from the Congenital Diaphragmatic Hernia Study Group (CDHSG) database between 2007 and 2019. Using risk adjustment based on disease severity, we compared inborn versus outborn status using baseline risk and multivariable logistic regression models. The primary endpoint was mortality and the secondary endpoint was need for extracorporeal life support (ECLS). Of 4195 neonates with prenatally diagnosed CDH, 3087 (73.6%) were inborn and 1108 (26.4%) were outborn. There was no significant difference in birth weight, gestational age, or presence of additional congenital anomalies. There was no difference in mortality between inborn and outborn infants (32.6% versus 33.8%, P = 0.44) or ECLS requirement (30.9% versus 31.5%, P = 0.73). Among neonates requiring ECLS, outborn status was a risk factor for mortality (OR 1.51, 95% CI 1.13-2.01, P = 0.006). After adjusting for post-surgical defect size, which is not known prenatally, outborn status was no longer a risk factor for mortality for infants requiring ECLS. Risk of mortality and need for ECLS for inborn CDH patients is not different to outborn infants. Future studies should be directed to establishing whether highest risk infants are at risk for worse outcomes based on center of birth. [ABSTRACT FROM AUTHOR]

Background & objectives: Data on neonatal COVID-19 are limited to the immediate postnatal period, with a primary focus on vertical transmission in inborn infants. This study was aimed to assess the characteristics and outcome of COVID-19 in outborn neonates. Methods: All neonates admitted to the paediatric emergency from August 1 to December 31, 2020, were included in the study. SARS-CoV-2 reverse transcription- (RT)-PCR test was done on oro/nasopharyngeal specimens obtained at admission. The clinical characteristics and outcomes of SARS-CoV-2 positive and negative neonates were compared and the diagnostic accuracy of a selective testing policy was assessed. Results: A total of 1225 neonates were admitted during the study period, of whom SARS-CoV-2 RT-PCR was performed in 969. The RT-PCR test was positive in 17 (1.8%). Mean (standard deviation) gestation and birth weight of SARS-CoV-2-infected neonates were 35.5 (3.2) wk and 2274 (695) g, respectively. Most neonates (11/17) with confirmed COVID-19 reported in the first two weeks of life. Respiratory distress (14/17) was the predominant manifestation. Five (5/17, 29.4%) SARS-CoV-2 infected neonates died. Neonates with COVID-19 were at a higher risk for all-cause mortality [odds ratio (OR): 3.1; 95% confidence interval (CI): 1.1-8.9, P=0.03]; however, mortality did not differ after adjusting for lethal malformation (OR: 2.4; 95% CI: 0.7-8.7). Sensitivity, specificity, accuracy, positive and negative likelihood ratios (95% CI) of selective testing policy for SARS-CoV-2 infection at admission was 52.9 (28.5-76.1), 83.3 (80.7-85.6), 82.8 (80.3-85.1), 3.17 (1.98-5.07), and 0.56 (0.34-0.93) per cent, respectively. Interpretation & conclusions: SARS-CoV-2 positivity rate among the outborn neonates reporting to the paediatric emergency and tested for COVID-19 was observed to be low. The selective testing policy had poor diagnostic accuracy in distinguishing COVID-19 from non-COVID illness. [ABSTRACT FROM AUTHOR]

Most previous studies reported there were higher survival rates if low birth weight babies were born in tertiary perinatal centers (inborn) than elsewhere (outborn). The objective of this study is to examine whether the number and ratio of outborn babies decrease and the neonatal mortality differs between inborn and outborn babies. We used the pooled data of the Taiwan Clinical Effectiveness Index for the years 2011–2016 obtained from the Joint Commission of Taiwan to study the outborn/inborn number and neonatal mortality rate. We found that the number of outborn babies did not decrease year by year. The ratio of outborn to total babies was lower in the groups of birth body weight 750–999 g and ≧ 2500 g than the other groups. The neonatal mortality rate in outborns was significantly higher than the inborns in the groups of birth body weight 1000–1499 g, 2000–2499 g and ≧ 2500 g (6.9 ± 2.4 vs. 3.8 ± 0.9, P = 0.009, 2.6 ± 0.6 vs. 0.6 ± 0.3, P = 0.002 and 1.52 ± 0.67 vs. 0.08 ± 0.02, P = 0.002, respectively) in medical centers. Improved maternal transport which promotes in utero transfer of patients may further improve neonatal outcome. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the receipt of therapeutic services of very-low-birth-weight (VLBW; ≤1500 g) neonates inadvertently delivered at community Level 2 and 3 neonatal intensive care units (NICUs) compared with those born at a well-baby nursery (WBN; Level 1) differed. Methods: This is a retrospective study of neonates who were born at Level 1 (WBN), 2, 3, and 4 NICUs and discharged from a Level 4 hospital (n = 529). All infants were evaluated at the Regional Neonatal Follow-up Program at 12 ± 1 months corrected gestational age (CA) and assessed for use of therapeutic services including: early intervention (EI), occupational therapy (OT), physical therapy (PT), speech therapy (ST), and special education (SE). Results: Compared to infants born at community Level 2 and 3 NICU hospitals, those outborn at a community Level 1 WBN had significantly higher utilization of EI (90% vs. 62%) and PT (83% vs. 61%) at 12 months CA. This association persisted when controlling for covariates. Infants who required EI had significantly lower Bayley-III cognitive scores at 3 years of age. Conclusion: VLBW infants outborn at WBN (Level 1) hospitals required more outpatient therapeutic services than those born at hospitals with NICU facilities. These results suggest that delivering at the appropriate community hospital level of care might be advantageous for long-term outcomes. [ABSTRACT FROM AUTHOR]

Background. The Groote Schuur Hospital (GSH) neonatal nursery provides level 3 care for the Metro West Health District in the Western Cape Province of South Africa. Worldwide, very-low-birth-weight (VLBW) neonates delivered in level 3 neonatal units have better outcomes than those transported from other facilities. Objectives. To identify the characteristics and outcomes of VLBW neonates at GSH, with emphasis on differences between inborns and outborns. Methods. This was a retrospective cohort study. VLBW neonates admitted to the GSH neonatal nursery between 1 January 2012 and 31 December 2013 were enrolled on the Vermont Oxford Network database and reviewed. Results. Of 1 032 VLBW neonates enrolled, 906 (87.8%) were delivered at GSH and 126 (12.2%) were outborn. Access to antenatal care, antenatal steroids and inborn status were statistically significant predictors of mortality and survival without morbidity. The mothers of inborn patients were more likely than those of outborn patients to have received antenatal care (89.1% v. 57.9%; p

Introduction  In Canada, more than 4,000 critically ill newborns per year require transfer. Transports are initially managed based on information conveyed by referral practitioners. Objectives  To identify the frequency of diagnostic discordance between the referring facility, transport team, and tertiary care center in our outborn neonatal population and to verify the association between discordance events (DEs), prolonged transport stabilization times, and potential risk factors to further inform and facilitate the development of future outreach education initiatives. Study Design  In this retrospective chart review, we identified and categorized DEs for patients transported by our service in a 1-year period. Associations between DE, transport stabilization times, and patient variables were studied using univariate and multivariable approaches. Results  From 233 eligible patients, 10.7% of patients had referral to discharge discordance events. No significant association was identified between stabilization time and DE. Birth weight and presence of a neurologic diagnosis were associated with DE. Conclusion  Diagnostic discordance was identified in 1 of every 10 neonates transported and found to be associated with patients with higher birth weight and the presence of neurologic diagnoses. Outreach initiatives will be developed and adapted accordingly, with a focus on this population. [ABSTRACT FROM AUTHOR]

Context: India accounts for 27.3% of total neonatal deaths in the world. This rate is highest in poor and marginalized areas like hilly regions of Uttarakhand that lack medical facilities. The newborns referred from here and admitted as outborn neonates contribute to the high neonatal mortality rate (NMR) of India. Aims : To study the demographic profile and morbidity-mortality pattern of neonates admitted in Sick Neonatal Care Unit (SNCU) and study the difference between inborn and outborn neonates. Study Design: Retrospective study of medical records for 1 year (2013-2014). Subjects and Methods: The age, sex, gestational age, and morbidity and mortality profile of all SNCU admissions in 1 year was determined, and the difference between inborn (those born in Teaching Hospital) and outborn (neonates delivered outside and referred) was calculated. Modifiable risk factors to reduce NMR in Uttarakhand were determined. Statistics: The data were analyzed using appropriate statistical tools in software Statistical Package for the Social Sciences (SPSS)-18. Results : Of the 721 neonates admitted, 63.25% neonates were males, and 53.54% were outborn and 46.46% inborn. Approximately, 60% were low birth weight and 50% preterm. Respiratory distress syndrome (RDS) (21.9%), sepsis (19%), perinatal asphyxia (16.37%), and jaundice (12.9%) were the chief morbidities. The chief causes of mortality were prematurity (25.6%), sepsis (21.6%), perinatal asphyxia (19.5%), and RDS (17.3%) with a statistically higher rate in the outborn in comparison with inborn. Total 20.5% neonates died due to poor outcome of outborn neonates. Conclusion: Huge burden of neonatal death among the outborn is due to preventable causes like asphyxia and infections in Uttarakhand. Health policies must ensure increased access to essential services to target sick neonates born here.

Objectives: To compare mortality and serious morbidity rates between outborn and inborn livebirths at 22-27 weeks' gestation.Design: Population-based cohort study.Setting: Victoria, Australia.Patients: Livebirths at 22-27 weeks' gestation free of major malformations in 2010-2011.Interventions: Outcome data for outborn (born outside a tertiary perinatal centre) infants compared with inborn (born in a tertiary perinatal centre) infants were analysed by logistic regression, adjusted for gestational age, birth weight and sex.Main Outcome Measures: Infant mortality and serious morbidity rates to hospital discharge.Results: 541 livebirths free of major malformations were recorded. By 1 year, 49 (58%) outborns and 140 (31%) inborns died (adjusted OR (aOR) 2.78, 95% CI 1.52 to 5.09, p=0.001). In total, 445 infants were admitted to neonatal intensive care unit (NICU); 93 died by 1 year (14/49 outborns and 79/396 inborns), (aOR 1.75, 95% CI 0.87 to 3.55, p=0.12). There were no significant differences in rates of necrotising enterocolitis, intraventricular haemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia (BPD) or the combined outcome of death or BPD in outborn infants compared with inborn infants. Outborns had an increased risk of cystic periventricular leukomalacia (cPVL) compared with inborns (12.2% vs 2.8%, respectively; aOR 5.34, 95% CI 1.84 to 15.54, p=0.002).Conclusions: Mortality rates remained higher for outborn livebirths at 22-27 weeks' gestation compared with inborn peers in 2010-2011. Outborn infants admitted to NICU did not have substantially different rates of mortality or serious morbidity compared with inborns, with the exception of cPVL. Longer-term health consequences of outborn birth before 28 weeks' gestation need to be determined. [ABSTRACT FROM AUTHOR]

Objective: To compare neurodevelopmental outcomes at 2-3 years in extremely premature outborn and inborn infants.Design: Population-based retrospective cohort study.Setting: Geographically defined area of New South Wales (NSW) and the Australian Capital Territory (ACT) served by a network of 10 neonatal intensive care units (NICUs).Patients: All premature infants <29 weeks gestation born between 1998 and 2004 in the setting.Intervention: At 2-3 years, corrected age, 1473 children were assessed with either the Griffiths Mental Developmental Scales (GMDS) or the Bayley Scales of Infant Development (BSID-II).Main Outcome Measure: Moderate/severe functional disability (FD) defined as: developmental delay (GMDS general quotient (GQ) or BSID-II mental developmental index (MDI)) > 2 standard deviations (SD) below the mean; cerebral palsy (CP) requiring aids; sensorineural or conductive deafness (requiring amplification); or bilateral blindness (visual acuity <6/60 in better eye).Results: At 2-3 years, moderate/severe functional disability does not appear to be significantly different between outborn and inborn infants (adjusted OR 0.782; 95% CI 0.424-1.443). However, there were a significant number of outborn infants lost to follow up (23.3% versus 42.9%).Conclusion: In this cohort, at 2-3 years follow up neurodevelopmental outcome does not appear to be significantly different between outborn and inborn infants. These results should be interpreted with caution given the limitation of this study. [ABSTRACT FROM AUTHOR]

Background: The extent of lung hypoplasia in neonates with congenital diaphragmatic hernia (CDH) can be assessed from gas exchange. We examined the role of preductal capillary blood gases in prognosticating outcome in patients with CDH.Methods: We retrospectively reviewed demographic data, disease characteristics, and preductal capillary blood gases on admission and within 24 h following admission for 44 high-risk outborn neonates. All neonates were intubated after delivery due to acute respiratory distress, and were emergently transferred via ground ambulance to our unit between 1/2000 and 12/2014. The main outcome measure was survival to hospital discharge and explanatory variables of interest were preductal capillary blood gases obtained on admission and during the first 24 h following admission.Results: Higher ratio of preductal partial pressure of oxygen to fraction of inspired oxygen (PcO2/FIO2) on admission predicted survival (AUC = 0.69, P = 0.04). However, some neonates substantially improve PcO2/FIO2 following initiation of treatment. Among neonates who survived at least 24 h, the highest preductal PcO2/FIO2 achieved in the initial 24 h was the strongest predictor of survival (AUC = 0.87, P = 0.002). Nonsurvivors had a mean admission preductal PcCO2 higher than survivors (91 ± 31 vs. 70 ± 25 mmHg, P = 0.02), and their PcCO2 remained high during the first 24 h of treatment.Conclusion: The inability to achieve adequate gas exchange within 24 h of initiation of intensive care treatment is an ominous sign in high-risk outborn neonates with CDH. We suggest that improvement of oxygenation during the first 24 h, along with other relevant clinical signs, should be used when making decisions regarding treatment options in these critically ill neonates. [ABSTRACT FROM AUTHOR]

Aim: Preterm infants have a high risk of morbidity and mortality, which increases with decreasing gestational age. Inborn infants (infants born in tertiary perinatal centres) have higher survival and lower morbidity than outborn infants. We aimed to compare short-term and 1-year developmental outcomes of outborn infants at the borderline of viability (≥23 to ≤25 + 6 weeks gestation) with a similar cohort of inborn infants in the sole tertiary perinatal centre in Western Australia from 2001 to 2011.Methods: This was a retrospective cohort study. Outborn infants ≥23 to ≤25 + 6 weeks gestation who survived to be transported to the Neonatal Intensive Care Unit (NICU) in the perinatal centre were contemporaneously matched to the next inborn infant of comparable gestation and birth weight. We compared mortality, morbidity (including intraventricular haemorrhage, necrotising enterocolitis and chronic lung disease) and Griffiths General Quotient scores at 1-year corrected age.Results: There were 54 outborn and 519 inborn births in the gestational age range during the study period. Thirty-five (65%) outborn infants were transported to the NICU. Of the outborn infants, 21/54 (39%) survived to discharge compared with 375/519 (72%) inborn infants. For the 35 outborn infants transported to NICU, 14 (40%) died, compared with 6/35 (17%) of inborn infants. There were no differences in short-term and developmental outcomes in surviving infants.Conclusions: Outborn extremely preterm infants <26 weeks gestation have higher mortality than inborn counterparts. However, those transported to a tertiary NICU have similar morbidity and developmental outcomes. [ABSTRACT FROM AUTHOR]

Introduction Gastroschisis (GS) is a common abdominal wall defect necessitating neonatal surgery and intensive care. We hypothesized that inborn patients had improved outcomes compared to patients born at an outside hospital (outborn) and transferred for definitive treatment. Methods A single center, retrospective chart review at a pediatric tertiary care center was performed from 2010 to 2015. All patients whose primary surgical treatment of GS was performed at this center were included. We compared patients delivered within our center (inborn) to patients delivered outside of our center and transferred for surgical care (outborn). Babies with complicated gastroschisis were excluded. Results During the study period 79 patients with GS were identified. Of these, 53 were inborn and 26 were outborn. Sixteen patients were excluded for complicated GS. The rate of complicated GS was higher in the outborn group (32%) compared to the inborn population (11%) (p = 0.03). Duration of stay, readmission rate and time on TPN were all significantly decreased for inborn patients, while time to definitive closure was similar. Mortality was 0% for both inborn and outborn patients. Conclusion Patients with uncomplicated GS seem to benefit from delivery with immediate pediatric surgical care available eliminating the need for transfer. Level of evidence III [ABSTRACT FROM AUTHOR]

Objectives To evaluate the rate and circumstances of outborn deliveries within a French perinatal network, and to determine their avoidability. Study design Cohort study including preterm infants <33 weeks gestation and/or weighing <1500 g born outside a level III maternity unit in Lower Normandy region, France, in 2008-2010. In 2008 and 2009, only neonates transferred to the Caen University Teaching Hospital (CHU) were included. In 2010, all outborn neonates in the region were included by means of a medical information system program. A panel of 7 experts was set up to determine the avoidability of each outborn case using a two-stage modified Delphi procedure. Inter-expert agreement was evaluated using the kappa index. Results Sixty-four cases (71 neonates) were included. The outborn rate in 2010 was 16.1% (40/248, 95% CI (116-207%)). The most common reason for delivery was spontaneous onset of labour (57.8%). In 12 cases, the place of birth (level 2b maternity unit) was considered to be appropriate by the experts (term ≥32 WG), but 8 cases involved infants of low birth weight (<1500 g). For the 52 cases born in inappropriate sites, 9.6% were considered to be avoidable (kappa index = 0.42 (p < 10-3)). Conclusion Our outborn rate meets regionalisation targets. Our method of expert evaluation identified a small percentage of avoidable births in inappropriate sites. Regular reassessment of obstetric practices and good coordination between network actors are crucial to improve the management of pregnancies at risk of outborn delivery. [ABSTRACT FROM AUTHOR]

Summary: Background: The neonatal intensive care unit (NICU) is a high-risk setting for transmission of meticillin-resistant Staphylococcus aureus (MRSA). Very few studies have investigated the impact of pre-emptive contact precautions applied to outborn neonates transferred to an NICU on the incidence of healthcare-associated (HA)-MRSA transmission. Aim: To assess the efficacy of pre-emptive contact precautions for outborn neonates implemented in an NICU. Methods: A before-and-after intervention study was conducted in the NICU of Kobe University Hospital. Pre-emptive contact precautions for outborn neonates were introduced in September 2008. The period before the introduction of pre-emptive contact precautions (January 2007–August 2008) was compared with the period after the introduction of pre-emptive contact precautions (September 2008–December 2010). Data for all admitted neonates, neonates who stayed in the NICU for more than three days, length of NICU stay, incidence of MRSA-positive outborn neonates on admission, hand hygiene compliance and incidence of HA-MRSA transmission were compared between the two periods. Findings: There were no significant differences in the percentage of outborn patients admitted to the NICU, percentage of patients who stayed in the NICU for more than three days, length of NICU stay, and incidence of MRSA-positive outborn patients at NICU admission between the groups enrolled before and after the introduction of pre-emptive contact precautions. However, hand hygiene compliance increased, and the incidence of HA-MRSA transmission reduced significantly from 3.5/1000 to 1.3/1000 patient-days after the introduction of pre-emptive contact precautions (P < 0.0001). Conclusion: Pre-emptive contact precautions for outborn neonates were effective in reducing the incidence of HA-MRSA transmission in a Japanese NICU. [Copyright &y& Elsevier]

This study designed to evaluate the short- and long-term outcomes of outborn and inborn preterm infants enhancing the regional perinatal system in South Korea. It is a prospective cohort study of the Korean neonatal network database for infants born at <29 weeks of gestation between 2013 and 2015. Of 2995 eligible infants, 312 were outborn, and 976 completed the assessment of long-term outcome at 18-24 months of corrected age. The mean gestational age was significantly younger in outborn infants than in inborn infants ( p = 0.004). The mean Apgar score at 5 min was higher in inborn infants ( p = 0.046). More inborn preterm infants died before discharge ( p < 0.001); however, most of the other short-term outcomes occurred significantly more often in outborn infants than in inborn infants. The outborn infants had higher odds of neurodevelopmental impairment (adjusted odds ratio (aOR) 2.412, 95% confidence interval (CI) 1.585-3.670), cerebral palsy (aOR 4.460, 95% CI 2.249-8.845) and developmental impairment (aOR 2.238, 95% CI 1.469-3.408). In preterm infants, the location of birth may be a key factor influencing short- and long-term outcomes. Thus, to provide adequate care and efficiently allocate medical resources to high-risk preterm infants, nationwide regional perinatal systems need to be improved and standardized.

Background: Delivery of premature infants outside tertiary care centers is not always preventable. The aim of this study was to compare rates of survival and common morbidities in extremely premature babies transported to a level III facility versus those born at the level III center. Methods: Retrospective chart review was performed on all neonates born at ≤ 28 weeks of gestation with birthweight ≤1500 g who were admitted to the Newborn Intensive Care Unit at Kapi'olani Medical Center for Women and Children (KMCWC) between 1 January 2000 and 31 December 2005. Infants were divided into two groups, those born at KMCWC (Inborn) and those born at level I institutions and subsequently transported (Transport) to KMCWC. Results: A total of 394 neonates met the study criteria; 349 were inborn while 45 were transported. Survival rates were identical for both groups. However, the Transport group survivors displayed a significantly longer mean length of stay and higher rate of severe retinopathy of prematurity than those in the Inborn group ( P≤ 0.01). Conclusion: Identical rates of survival in both groups suggest that community medical professionals are providing satisfactory care to stabilize critical neonates without reducing their chances of survival. However, increased length of stay and higher rate of retinopathy of prematurity in the Transport group suggest that differences in medical management during the first few hours of life may adversely affect outcomes. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to compare the neonatal outcome of very low-birthweight (VLBW) preterm infants with regard to inborn and outborn status in a medical center of Southern Taiwan, where short-distance neonatal transport is the rule and maternal transport was not well established. Methods: This retrospective study included outborn VLBW preterm infants admitted to the neonatal intensive care unit of Chang Gung Memorial Hospital at Kaohsiung after neonatal transport during the period from 1999 through 2003. An equal number of inborn preterm infants matched for gender and birthweight were included as controls. Infants with lethal congenital anomalies or who died in the delivery room were excluded. Data were collected from reviewing medical charts. Results: A total of 34 inborn VLBW infants and 34 outborn VLBW infants with neonatal transport were included. Chronic lung disease (CLD) was significantly more frequent in the outborn group according to McNemar test ( P = 0.0124) and logistic regression. Logistic regression also showed that outborn status ( P = 0.0173) and birthweight ( P = 0.0024) were the two most important risk factors for development of CLD. Conclusion: Well-trained short distance neonatal transport is useful and valuable for VLBW infants with gestation age of 27–34 weeks in Southern Taiwan. The respiratory outcome, however, was poor in the outborn group in terms of incidence of CLD. To improve the respiratory outcome, further modification of respiratory care during transportation or antenatal maternal transport is crucial. [ABSTRACT FROM AUTHOR]

Objective:To determine the effect of a dedicated lactation consultant (LC) on the percentage of neonates receiving any human milk in the neonatal intensive care unit (NICU) and at discharge over time.Study Design:Retrospective chart review of three time periods of 3 months each; Time period 1 (before LC hire), Time period 2 (T2; after LC arrival) and Time period 3 (subsequent period after T2).Result:Percentage of infants receiving any HM during hospital stay and at discharge increased significantly over time after LC hire and with LC experience. Outborn (OB) infants receiving any HM in the NICU and at discharge increased over time, but there was no significant change for inborn infants, as the proportion receiving any HM remained consistently high over time.Conclusion:Addition of a dedicated LC to the NICU increased the percentage of neonates receiving any HM, specifically in the OB population.Journal of Perinatology (2008) 28, 136–140; doi:10.1038/sj.jp.7211888; published online 20 December 2007 [ABSTRACT FROM AUTHOR]

Objective: To determine whether outcomes among infants with very low birth weight (VLBW) vary according to the birthplace (Japan or California) controlling for maternal ethnicity.Study Design: Severe intraventricular hemorrhage (IVH) and mortality were ascertained for infants with VLBW born at 24-29 weeks of gestation during 2008-2017 and retrospectively analyzed by the country of birth for mothers and infants (Japan or California).Results: Rates of severe IVH, mortality, or combined IVH/mortality were lower in the 24 095 infants born in Japan (5.1%, 5.0%, 8.8% respectively) compared with infants born in California either to 157 mothers with Japanese ethnicity (12.5%, 9.7%, 17.8%) or to a comparison group of 6173 non-Hispanic white mothers (8.4%, 8.8%, 14.6%). ORs for adverse outcomes were increased for infants born in California to mothers with Japanese ethnicity compared with infants born in Japan for severe IVH (OR, 3.31; 95% CI, 1.93-5.68), mortality (3.73; 95% CI, 2.03-6.86), and the combined outcome (3.26; 95% CI, 2.02-5.27). The odds of these outcomes also were increased for infants born in California to non-Hispanic white mothers compared with infants born in Japan. Outcomes of infants born in California did not differ by Japanese or non-Hispanic white maternal ethnicity.Conclusions: Low rates of severe IVH and mortality for infants with VLBW born in Japan were not seen in infants born in California to mothers with Japanese ethnicity. Differences in systems of regional perinatal care, social environment, and the quality of perinatal care may partially account for these differences in outcomes. [ABSTRACT FROM AUTHOR]

When a newborn baby is in need of rapid care outside the hospital where the mother has given birth, the nursery nurses work specifically to support the baby during the separation from its parents. They intervene before, during and after the separation of mother and child, particularly during the transfer of the baby to the mobile paediatric emergency and resuscitation unit., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: To describe the incidence of outborns among very preterm infants (VPIs, <32 weeks of gestation) in Chinese perinatal centers and to examine the association of outborn status with adverse outcomes., Methods: A cohort study enrolling all VPIs admitted to 18 perinatal centers in China from May 1st, 2015 to April 30th, 2018. Neonatal outcomes including rates of discharge against medical advice (DAMA), in-hospital mortality, overall mortality, severe intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL), sepsis, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC) and severe retinopathy of prematurity (ROP) were compared between outborn and inborn infants. A multivariate logistic regression model was used to estimate the independent association of outborn status with neonatal outcomes., Results: Among 12,014 VPIs, 1,991 (16.6%) infants were outborn. Outborn infants had lower Apgar scores and higher illness severity score on admission. Mothers of outborn infants were less likely to receive antenatal steroids, prenatal care and caesarean section. The incidence of DAMA (18.0% vs. 12.5%, P<0.001), overall mortality (19.9% vs. 15.8%, P<0.001) and severe brain injury (10.8% vs. 9.1%, P=0.024) of outborn infants were significantly higher than inborn infants. Outborn status was independently associated with increased risks of DAMA (aOR, 1.6; 95% CI: 1.4-1.8), overall-hospital mortality (aOR, 1.3; 95% CI: 1.1-1.5) and severe IVH/PVL (aOR, 1.2; 95% CI: 1.0-1.5)., Conclusions: The incidence of outborn VPIs was high in China. Outborn infants were more likely to be delivered in an uncontrolled situation and were at significantly higher risk of neonatal mortality and severe brain injury compared with inborn infants. Quality improvement efforts are needed to facilitate in-utero transfer of high-risk pregnancies to tertiary centers., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tp-20-232). Dr. Shoo K. Lee serves as an unpaid editorial board member of Translational Pediatrics from Feb 2013 to Jan 2021. The other authors have no conflicts of interest to declare., (2021 Translational Pediatrics. All rights reserved.)

Objective: To compare mortality and neurodevelopmental outcomes of outborn and inborn preterm infants born at <29 weeks of gestation admitted to Canadian neonatal intensive care units (NICUs).Study Design: Data were obtained from the Canadian Neonatal Network and Canadian Neonatal Follow-up Network databases for infants born at <29 weeks of gestation admitted to NICUs from April 2009 to September 2011. Rates of death, severe neurodevelopmental impairment (NDI), and overall NDI were compared between outborn and inborn infants at 18-21 months of age, corrected for prematurity.Results: Of 2951 eligible infants, 473 (16%) were outborn. Mean birth weight (940 ± 278 g vs 897 + 237 g), rates of treatment with antenatal steroids (53.9% vs 92.9%), birth weight small for gestational age (5.3% vs 9.4%), and maternal college education (43.7% vs 53.9%) differed between outborn and inborn infants, respectively (all P values <.01). The median Score for Neonatal Acute Physiology-II (P = .01) and Apgar score at 5 minutes (P < .01) were higher in inborn infants. Severe brain injury was more common among outborn infants (25.3% vs 14.7%, P < .01). Outborn infants had higher odds of death or severe NDI (aOR 1.7, 95% CI 1.3-2.2), death or overall NDI (aOR 1.6, 95% CI 1.2-2.2), death (aOR 2.1, 95% CI 1.5-3.0), and cerebral palsy (aOR 1.9, 95% CI 1.1-3.3).Conclusions: The composite outcomes of death or neurodevelopmental impairment were significantly higher in outborn compared with inborn infants admitted to Canadian NICUs. Adverse outcomes were mainly attributed to increased mortality and cerebral palsy in outborn neonates. [ABSTRACT FROM AUTHOR]