NO Shanghai Children’s Medical Center,School of Medicine,Shanghai Jiao Tong University Shanghai, shanghai, Shanghai, China (People's Republic)
Background: In the last decade, international studies have demonstrated the disparity in neonatal outcomes based on birth site. Studies regarding outcomes of inborn and outborn very preterm infants in many countries have been done. But, outcomes of outborn very preterm infants between perinatal centers and independent children’s hospitals remain uncertain. Objective: This study was aimed to examine whether admission hospital type (perinatal centers vs independent children’s hospitals) is associated with outcomes among outborn preterm infants after adjustment of perinatal risk factors and illness severity. Design/Methods: A retrospective cohort study enrolling all outborn infants less than 32 weeks admitted to tertiary NICUs in 51 perinatal centers and 19 children’s hospitals in China from January 1st, 2019 to December 31th, 2021. Outcomes of outborn infants including rates of discharge against medical advice (DAMA), mortality, severe intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), severe retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and sepsis were compared between perinatal centers and independent children’s hospitals. A multivariate logistic regression model was used to examine whether admission hospital type (perinatal centers vs independent children’s hospitals) is associated with differences in mortality and morbidity among outborn preterm infants after adjustment of perinatal risks and admission illness severity. Results: Of the 6528 eligible infants, 2517 (38.6%) were transferred to perinatal centers, whereas 4011(61.4%) were transferred to independent children’s hospitals. For infants transferred to two types of hospitals, respectively, mean (SD)gestation age was 29.4(1.7) weeks, 29.4(1.8) weeks, and mean birth weight (SD) was 1330.3(328.3) g, 1311.2(319.7) g. There was no significant difference between two types of hospitals. Baseline characteristics of infants and mothers were shown in Table 1. Outborn infants transferred to independent children’s hospitals were at significantly higher risk of severe ROP and severe brain injury, but lower risk of mortality, BPD and PDA compared with transferred to perinatal centers (Fig 1).
Conclusion(s): Type of admission hospitals was significantly associated with outcomes of outborn very preterm. Further study is needed to determine factors that are associated with different outcomes in two types of hospitals and that might be amenable to intervention.
