15 Transferring between Neonatal Intensive Care Units on Day One. Does it Matter?

Abstract

Background: Despite Australia's regionalised system of perinatal care it is still necessary to transfer very preterm infants between neonatal intensive care units (NICUs). Many NICUs have a policy of 'last in first out' when beds are scarce. The aim was 1) to compare risk factors for very preterm infants born in a tertiary hospital and transferred between NICUs during in the first 24 hours of life (early transfer) with those who remain in the tertiary hospital of birth (non transfer) and those who are born in a non tertiary hospital (outborn) and 2) to evaluate the risk factors associated with this policy. Methods: Ongoing prospective population based cohort study of all infants 22–31 weeks gestational age born 1/1/1992 to 31/12/2002 admitted to a tertiary neonatal intensive care unit. All infants were transferred by a specialist neonatal team. Results: There were 8654 infants of 22–31 weeks gestation, admitted to a NICU between 1/1/1992 and 31/12/2002. Of these 7674 remained in the hospital of birth, 143 had early transfer and 837 were outborn. Early transfer infants were more likely to have a birth weight <3rd centile (p=0.0006), a major congenital anomaly (p<0.0001), hydrocephalus (p=0.03), cystic leukomalacia (p=0.004) or patent ductus arteriosus (PDA) (p=0.01) requiring major surgery. They were also more likely to die before discharge (p=0.001) or during the first year (p=0.0006) than non transfer or outborn infants. Outborn infants were more likely to have a 5 minute Apgar score <5 (p<0.0001), be treated with surfactant (p<0.0001), require indomethacin for a PDA (p=0.003), require surgery for necrotising enterocolitis (p=0.02), have an intraventricular haemorrhage (p<0.0001) or require treatment for fits (p<0.0001). Their mothers were more likely to be teenaged (p<0.0001), Aboriginal and/or Torres Strait Islander (p<0.0001), live in a rural area (p<0.0001), have preterm labour (p=0.007) and antepartum haemorrhage (p=0.0001). Non transfer infants were more likely to be multiple births (p=0.0002) and have antenatal corticosteroids (p<0.0001). Their mothers were more likely to be aged 35 years or more (p<0.0001), have assisted conception (p<0.0001), pregnancy induced hypertension (p<0.0001) and a caesarean section (p<0.0001). Conclusion: A policy for transferring well stable infants may be more appropriate than a 'last in first out' policy when there are insufficient neonatal intensive care beds. Antenatal transfer to a tertiary unit may result in improved long term outcomes for very preterm babies.