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Observational Study
. 2025 Aug 19;110(5):444-451.
doi: 10.1136/archdischild-2024-327474.

Improving outcomes for very preterm babies in England: does place of birth matter? Findings from OPTI-PREM, a national cohort study

Thillagavathie Pillay #  1   2 , Sarah E Seaton  3 , Miaoqing Yang  4 , Vasiliki Bountziouka  5 , Victor Banda  6 , Helen Campbell  7 , Kelvin Dawson  8 , Bradley N Manktelow  3 , Elizabeth S Draper  3 , Neena Modi  9 , Elaine M Boyle  3 , Oliver Rivero-Arias #  7 ; OPTI-PREM study group; Contributing neonatal units and leads
Collaborators, Affiliations
Observational Study

Improving outcomes for very preterm babies in England: does place of birth matter? Findings from OPTI-PREM, a national cohort study

Thillagavathie Pillay et al. Arch Dis Child Fetal Neonatal Ed. .

Abstract

Objective: Babies born between 27+0 and 31+6 weeks of gestation contribute substantially towards infant mortality and morbidity. In England, their care is delivered in maternity services colocated with highly specialised neonatal intensive care units (NICU) or less specialised local neonatal units (LNU). We investigated whether birth setting offered survival and/or morbidity advantages to inform National Health Service delivery.

Design: Retrospective national cohort study.

Setting: LNU, NICU, England.

Patients: UK National Neonatal Research Database whole population data for births between 27+0 and 31+6 weeks of gestation, discharged from/died within neonatal units between 1 January 2014 and 31 December 2018. We linked baby-level data to mortality information from the Office for National Statistics.

Outcome measures: Death during neonatal care, up to 1 year (infant mortality), surgically treated necrotising enterocolitis, retinopathy of prematurity, severe brain injury (SBI), bronchopulmonary dysplasia.

Intervention: Birth in NICU versus LNU setting. We used an instrumental variable (maternal excess travel time between the nearest NICU and LNU) estimation approach to determine treatment effect.

Results: Of 18 847 babies (NICU: 10 379; LNU: 8468), 574 died in NICU/LNU care, and 121 postdischarge (infant mortality 3.7%). We found no effect of birth setting on neonatal or infant mortality. Significantly more babies born into LNU settings experienced SBI (mean difference -1.1% (99% CI -2.2% to -0.1%)). This was attenuated after excluding births at 27 weeks, and early postnatal transfers.

Conclusions: In England, LNU teams should use clinical judgement, risk assessing benefits of transfer versus risk of SBI for preterm births at 27 weeks of gestation. 28 weeks of gestation is a safe threshold for preterm birth in either NICU/LNU settings.

Trial registration number: NCT02994849/ISRCTN74230187.

Keywords: Intensive Care Units, Neonatal; Mortality; Neonatology.

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Conflict of interest statement

Competing interests: TP declared additional funding from the Leicestershire Leicester Rutland Clinical Commissioning Group for qualitative work on reducing risks for infant mortality, from Leicester Local Maternity and Neonatal Systems for qualitative research on perinatal dashboards in health inequalities, and from De Montford University as visiting lecturer, and an unpaid audit lead role with the Children’s HIV Association, UK. SES is funded through an NIHR Advanced Fellowship and declared honorariums from The Lancet Child & Adolescent Health for expediated peer reviews. She is a member of the data monitoring and ethics committee for HENRY III (Health, Exercise, Nutrition for the Really Young—2022 onwards) and is an independent member of PICnIC (Paediatric Intensive Care and Infection Control) Trial Steering Committee (an NIHR-funded study). OR-A is a member of the Foetal Maternal and Child Health Reference Group, National Screening Committee. VBa declared funding through Imperial College for attendances at OPTI-PREM-related meetings. NM is Director of the UK National Neonatal Research Database. ESD declared funding through HQIP (Healthcare Quality Improvement) for MBRRACE-UK (Mothers and Babies; Reducing Risks through Audit and Confidential Enquiry), PICANet (Paediatric Intensive Care Audit Network) and PICANet L2.

Figures

Figure 1
Figure 1. OPTI-PREM data study flow chart. IMD, Index of Multiple Deprivation; IV, instrumental variable; SCU, special care baby unit.
See this image and copyright information in PMC

References

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