title: Perinatal outcomes for extremely preterm babies in relation to place of birth in England: the EPICure 2 study.
abstract: BACKGROUND
  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)).
  
  
  RESULTS
  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)).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Academic Neonatology, UCL Institute for Women's Health, , London.
authors.forename: N
authors.initials: N
authors.lastname: Marlow
authors.forename: C
authors.initials: C
authors.lastname: Bennett
authors.forename: E S
authors.initials: ES
authors.lastname: Draper
authors.forename: E M
authors.initials: EM
authors.lastname: Hennessy
authors.forename: A S
authors.initials: AS
authors.lastname: Morgan
authors.forename: K L
authors.initials: KL
authors.lastname: Costeloe
mesh_terms: D001724:Birth Weight; D002675:Child, Preschool; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D005865:Gestational Age; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000401:mortality*; D007363:Intensive Care Units, Neonatal / Q000145:classification / Q000706:statistics & numerical data*; D008297:Male; D016017:Odds Ratio; D010360:Patient Transfer / Q000706:statistics & numerical data*; D054238:Perinatal Mortality; D011446:Prospective Studies
keywords: Epidemiology; Neonatology