Intended for healthcare professionals

  1. Colm P Travers, assistant professor of pediatrics,
  2. Waldemar A Carlo, Edwin M Dixon professor of pediatrics; director
  1. Division of Neonatology, University of Alabama at Birmingham, AL 35249, USA
  1. Correspondence to: C P Travers cptravers{at}

Do it before not after birth

Current evidence suggests that extremely preterm infants born at non-tertiary level facilities might be at increased risk for adverse outcomes, including death and major morbidities.12 Infants born at non-tertiary facilities who are transferred postnatally could also have worse outcomes than infants who are born in tertiary facilities,34 although these data were potentially confounded by differences in baseline risks.56 However, most of the evidence to date comes from studies that are not population based or do not reflect modern care of extremely preterm infants.

In a linked paper, Helenius and colleagues (doi:10.1136/bmj.l5678) report analyses of contemporary population based data from England showing that postnatal transfer (transport) from a non-tertiary level neonatal intensive care unit in the first 48 hours after birth is associated with an increased risk of death or severe brain injury among extremely …

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