Objective Early postnatal transfer (PNT) of extremely preterm infants is associated with adverse outcomes compared with in utero transfer (IUT). We aimed to explore recent national trends of IUT and early PNT. Design Observational cohort study using the National Neonatal Research Database. Setting Neonatal units in England, Scotland and Wales. Patients Extremely preterm infants 23+0–27+6 weeks’ gestation admitted for neonatal care from 2011 to 2016. Main outcome The incidence of IUT or PNT within 72 hours of life. Secondary outcomes included mortality, hospital transfer level between centres and temporal changes across two equal epochs, 2011–2013 (epoch 1 (Ep1)) and 2014–2016 (epoch 2 (Ep2)). Results 14 719 infants were included (Ep1=7363 and Ep2=7256); 4005 (27%) underwent IUT; and 3042 (20.7%) had PNT. IUTs decreased significantly between epochs from 28.3% (Ep1=2089) to 26.0% (Ep2=1916) (OR 0.90, 95% CI 0.84 to 0.97, p<0.01). Conversely, PNTs increased from 19.8% (Ep1=1416) to 21.5% (Ep2=1581) (OR 1.11, 95% CI 1.02 to 1.20, p=0.01). PNTs between intensive care centres increased from 8.1% (Ep1=119) to 10.2% (Ep2=161, p=0.05). Mortality decreased from 21.6% (Ep1=1592) to 19.3% (Ep2=1421) (OR 0.90, 95% CI 0.83 to 0.97, p=0.01). Survival to 90 days of age was significantly lower in infants undergoing PNT compared with IUT (HR 1.31, 95% CI 1.18 to 1.46), with the greatest differences observed in infants <25 weeks’ gestational age. Conclusion In the UK, IUT of extremely preterm infants has significantly decreased over the study period with a parallel increase in early PNT. Strategies to reverse these trends, improve IUT pathways and optimise antenatal steroid use could significantly improve survival and reduce brain injury for these high-risk infants. Data are available upon reasonable request. All data were extracted and supplied by the Neonatal Data Analysis Unit (NDAU) and are available from the corresponding author on reasonable request and with permission of the study team and NDAU.

中文翻译：

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2011 年至 2016 年极早产儿宫内和产后早期转移的时间趋势：一项英国人口研究

目的与宫内移植（IUT）相比，极早产儿的早期产后移植（PNT）与不良结局相关。我们旨在探索 IUT 和早期 PNT 的近期国家趋势。使用国家新生儿研究数据库设计观察性队列研究。在英格兰、苏格兰和威尔士设置新生儿单位。患者 2011 年至 2016 年接受新生儿护理的 23+0–27+6 周极早产儿。主要结果 出生 72 小时内 IUT 或 PNT 的发生率。次要结果包括死亡率、中心之间的医院转移水平和两个相等时期的时间变化，2011-2013 年（时期 1 (Ep1)）和 2014-2016 年（时期 2 (Ep2)）。结果共纳入14 719名婴儿（Ep1=7363和Ep2=7256）；4005 (27%) 人接受了 IUT；3042 (20.7%) 人患有 PNT。IUT 在不同时期之间显着下降，从 28.3% (Ep1=2089) 到 26.0% (Ep2=1916) (OR 0.90, 95% CI 0.84 to 0.97, p<0.01)。相反，PNT 从 19.8% (Ep1=1416) 增加到 21.5% (Ep2=1581) (OR 1.11, 95% CI 1.02 到 1.20, p=0.01)。重症监护中心之间的 PNT 从 8.1% (Ep1=119) 增加到 10.2% (Ep2=161, p=0.05)。死亡率从 21.6% (Ep1=1592) 下降到 19.3% (Ep2=1421) (OR 0.90, 95% CI 0.83 到 0.97, p=0.01)。与 IUT 相比，接受 PNT 的婴儿的 90 日龄存活率显着降低（HR 1.31，95% CI 1.18 至 1.46），在小于 25 周胎龄的婴儿中观察到的差异最大。结论 在英国，极早产儿的 IUT 在研究期间显着下降，早期 PNT 平行增加。扭转这些趋势的策略，改善 IUT 通路并优化产前类固醇的使用可以显着提高这些高危婴儿的存活率并减少脑损伤。可根据合理要求提供数据。所有数据均由新生儿数据分析单位 (NDAU) 提取和提供，可在合理要求并经研究团队和 NDAU 许可的情况下从相应作者处获得。