The impact of level of neonatal care provision on outcomes for preterm babies born between 27 and 31 weeks of gestation, or with a birth weight between 1000 and 1500 g: a review of the literature

Abdul Qader Tahir Ismail, Elaine M Boyle, Thillagavathie Pillay, OptiPrem Study Group, Neena Modi, Oliver Rivero-Arias, Brad Manktelow, Sarah E Seaton, Natalie Armstrong, Miaoqing Yang, Vasiliki Bountziouka, Caroline S Cupit, Alexis Paton, Victor L Banda, Elizabeth S Draper, Kelvin Dawson, Abdul Qader Tahir Ismail, Elaine M Boyle, Thillagavathie Pillay, OptiPrem Study Group, Neena Modi, Oliver Rivero-Arias, Brad Manktelow, Sarah E Seaton, Natalie Armstrong, Miaoqing Yang, Vasiliki Bountziouka, Caroline S Cupit, Alexis Paton, Victor L Banda, Elizabeth S Draper, Kelvin Dawson

Abstract

Objective: There is evidence that birth and care in a maternity service associated with a neonatal intensive care unit (NICU) is associated with improved survival in preterm babies born at <27 weeks of gestation. We conducted a systematic review to address whether similar gains manifested in babies born between 27+0 and 31+6 weeks (hereafter 27 and 31 weeks) of gestation, or in those with a birth weight between 1000 and 1500 g.

Methods: We searched Embase, Medline and CINAHL databases for studies comparing outcomes for babies born between 27 and 31 weeks or between 1000 and 1500 g birth weight, based on designation of the neonatal unit where the baby was born or subsequently cared for (NICU vs non-NICU setting). A modified QUIPS (QUality In Prognostic Studies) tool was used to assess quality.

Results: Nine studies compared outcomes for babies born between 27 and 31 weeks of gestation and 11 studies compared outcomes for babies born between 1000 and 1500 g birth weight. Heterogeneity in comparator groups, birth locations, gestational age ranges, timescale for mortality reporting, and description of morbidities facilitated a narrative review as opposed to a meta-analysis.

Conclusion: Due to paucity of evidence, significant heterogeneity and potential for bias, we were not able to answer our question-does place of birth or care affect outcomes for babies born between 27 and 31 weeks? This supports the need for large-scale research to investigate place of birth and care for babies born in this gestational age range.

Keywords: evidence based medicine; health service; neonatology.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow diagram showing results from systematic review search strategy for studies categorising neonates by gestational age and birth weight. *Miscellaneous include studies excluded due to comparing outcomes in NICU versus NICU/a geographical area/paediatric hospitals/neonatal care in a non-regionalised healthcare system; studies investigating degree of regionalisation/incidence and avoidability of ex utero transfers; and studies comparing birth asphyxia in term infants/success of using early nasal CPAP. BW, birth weight; CPAP, continuous positive airway pressure; NICU, neonatal intensive care unit.

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