Objective To determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes.
Design Observational cohort study with propensity score matching.
Setting National health service neonatal care in England; population data held in the National Neonatal Research Database.
Participants Extremely preterm infants born at less than 28 gestational weeks between 2008 and 2015 (n=17 577) grouped based on birth hospital and transfer within 48 hours of birth: upward transfer (non-tertiary to tertiary hospital, n=2158), non-tertiary care (born in non-tertiary hospital; not transferred, n=2668), and controls (born in tertiary hospital; not transferred, n=10 866). Infants were matched on propensity scores and predefined background variables to form subgroups with near identical distributions of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio.
Main outcome measures Death, severe brain injury, and survival without severe brain injury.
Results 2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly higher odds of severe brain injury (2.32, 1.78 to 3.06; number needed to treat (NNT) 8) and significantly lower odds of survival without severe brain injury (0.60, 0.47 to 0.76; NNT 9). Compared with controls, infants in the non-tertiary care group had significantly higher odds of death (1.34, 1.02 to 1.77; NNT 20) but no significant difference in the odds of severe brain injury (0.95, 0.70 to 1.30) or survival without severe brain injury (0.82, 0.64 to 1.05). Compared with infants in the upward transfer group, infants in the non-tertiary care group had no significant difference in death before discharge (1.10, 0.84 to 1.44) but significantly lower odds of severe brain injury (0.41, 0.31 to 0.53; NNT 8) and significantly higher odds of survival without severe brain injury (1.37, 1.09 to 1.73; NNT 14). No significant differences were found in outcomes between the horizontal transfer group (n=305) and controls (n=1525).
Conclusions In extremely preterm infants, birth in a non-tertiary hospital and transfer within 48 hours are associated with poor outcomes when compared with birth in a tertiary setting. We recommend perinatal services promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.

中文翻译：

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极早产儿的早期出生后转移和三级医院外出生与死亡率和严重脑损伤的关联：具有倾向得分匹配的观察性队列研究

目的确定产后转移或在非三级医院出生是否与不良后果相关。
设计具有倾向得分匹配的观察性队列研究。在英格兰
设置国家卫生服务新生儿护理；国家新生儿研究数据库中保存的人口数据。
参加者在2008年至2015年之间少于28个孕周出生的极早产婴儿（n = 17 577）根据出生医院进行分组，并在出生后48小时内转移：向上转移（非三级至三级医院，n = 2158），非三级护理（出生于非三级医院；未转移； n = 2668）和对照（出生于三级医院；未转移； n = 10 866）。根据倾向得分和预定义的背景变量对婴儿进行匹配，以形成混杂因子分布几乎相同的亚组。在三级医院之间转移的婴儿（水平转移）以1：5的比例分别与对照组匹配。
主要结局指标死亡，严重脑损伤和无严重脑损伤的生存率。
结果2181名婴儿（每组727名）（向上转移，非三级照护和对照）相匹配。与对照组相比，向上转移组的婴儿出院前的死亡几率无显着差异（优势比为1.22，95％置信区间为0.92至1.61），但严重脑损伤的几率则更高（2.32，1.78至3.06；数字需要治疗（NNT）8）并显着降低无严重脑损伤的生存几率（0.60，0.47至0.76; NNT 9）。与对照组相比，非三级护理组的婴儿死亡几率（1.34，1.02至1.77; NNT 20）高得多，但严重脑损伤的几率（0.95，0.70至1.30）或无重度生存率无显着差异。脑损伤（0.82，0.64至1.05）。与向上转运组的婴儿相比，非三级护理组的婴儿出院前死亡无显着差异（1.10，0.84至1.44），但严重脑损伤的几率显着较低（0.41，0.31至0.53； NNT 8），无严重脑部的生存几率显着较高伤害（1.37，1.09至1.73； NNT 14）。在水平转移组（n = 305）和对照组（n = 1525）之间的结局上没有发现显着差异。
结论在极早产儿中，与三级分娩相比，在非三级医院分娩并在48小时内分娩会导致不良的预后。我们建议围产期服务促进促进优先于产后转移而在三级医院分娩的早产婴儿的途径。