Please use this identifier to cite or link to this item: http://hdl.handle.net/2381/32828
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dc.contributor.authorMarlow, N.-
dc.contributor.authorBennett, C.-
dc.contributor.authorDraper, Elizabeth S.-
dc.contributor.authorHennessy, E. M.-
dc.contributor.authorMorgan, A. S.-
dc.contributor.authorCosteloe, K. L.-
dc.date.accessioned2015-07-29T10:13:13Z-
dc.date.available2015-07-29T10:13:13Z-
dc.date.issued2014-03-06-
dc.identifier.citationArchives of disease in childhood. Fetal and neonatal Edition, 2014, 99 (3), F181en
dc.identifier.urihttp://fn.bmj.com/content/99/3/F181en
dc.identifier.urihttp://hdl.handle.net/2381/32828-
dc.description.abstractBACKGROUND: Expertise and resources may be important determinants of outcome for extremely preterm babies. We evaluated the effect of place of birth and perinatal transfer on survival and neonatal morbidity within a prospective cohort of births between 22 and 26 weeks of gestation in England during 2006. METHODS: We studied the whole population of 2460 births where the fetus was alive at the admission of the mother to hospital for delivery. Outcomes to discharge were compared between level 3 (most intensive) and level 2 maternity services, with and without transfers, and by activity level of level 3 neonatal unit; ORs were adjusted for gestation at birth and birthweight for gestation (adjusted ORs (aOR)). FINDINGS: Of this national birth cohort, 56% were born in maternity services with level 3 and 34% with level 2 neonatal units; 10% were born in a setting without ongoing intensive care facilities (level 1). When compared with level 2 settings, risk of death in level 3 services was reduced (aOR 0.73 (95% CI 0.59 to 0.90)), but the proportion surviving without neonatal morbidity was similar (aOR 1.27 (0.93 to 1.74)). Analysis by intended hospital of birth confirmed reduced mortality in level 3 services. Following antenatal transfer into a level 3 setting, there were fewer intrapartum or labour ward deaths, and overall mortality was higher for those remaining in level 2 services (aOR 1.44 (1.09 to 1.90)). Among level 3 services, those with higher activity had fewer deaths overall (aOR 0.68 (0.52 to 0.89)). INTERPRETATION: Despite national policy, only 56% of births between 22 and 26 weeks of gestation occurred in maternity services with a level 3 neonatal facility. Survival was significantly enhanced following birth in level 3 services, particularly those with high activity; this was not at the cost of increased neonatal morbidity.en
dc.language.isoenen
dc.publisherBMJ Publishing Groupen
dc.relation.urihttp://www.ncbi.nlm.nih.gov/pubmed/24604108-
dc.rightsCopyright © the authors, 2014. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/en
dc.subjectEpidemiologyen
dc.subjectNeonatologyen
dc.subjectBirth Weighten
dc.subjectChild, Preschoolen
dc.subjectCohort Studiesen
dc.subjectEnglanden
dc.subjectFemaleen
dc.subjectFetal Deathen
dc.subjectGestational Ageen
dc.subjectHospitals, Maternityen
dc.subjectHumansen
dc.subjectInfanten
dc.subjectInfant Mortalityen
dc.subjectInfant, Extremely Prematureen
dc.subjectInfant, Newbornen
dc.subjectInfant, Premature, Diseasesen
dc.subjectIntensive Care Units, Neonatalen
dc.subjectMaleen
dc.subjectOdds Ratioen
dc.subjectPatient Transferen
dc.subjectPerinatal Mortalityen
dc.subjectProspective Studiesen
dc.titlePerinatal outcomes for extremely preterm babies in relation to place of birth in England: the EPICure 2 studyen
dc.typeJournal Articleen
dc.identifier.doi10.1136/archdischild-2013-305555-
dc.identifier.eissn1468-2052-
dc.identifier.piiarchdischild-2013-305555-
dc.description.statusPeer-revieweden
dc.description.versionPublisher Versionen
dc.type.subtypeJournal Article;Research Support, Non-U.S. Gov't-
pubs.organisational-group/Organisationen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGYen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicineen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Health Sciencesen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/Themesen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/Themes/Populationen
dc.dateaccepted2014-01-26-
Appears in Collections:Published Articles, Dept. of Health Sciences

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