PC.98 Has the Implementation of Network Antenatal Referral Pathways Decreased Ex-Utero Transfers of the Extreme Preterm Infant?

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Abstract

Background

The West Midlands Neonatal Transfer Service (WMNTS) is commissioned to transfer babies between designated neonatal intensive care (NICU), local neonatal (LNU) and special care units (SCU) in two neighbouring operational delivery networks (ODNs). The DoH Toolkit (2009) recommended that extreme preterm babies of less than 27 weeks gestation should not be delivered in LNUs or SCUs unless there are extenuating circumstances. This recommendation had been in place in the region since 2007.

Data

Collection: Retrospective data analysis of WMNTS Excel© database (2009–2013) by a single investigator

Results

There has been no significant decrease in the number of extreme preterm infants transferred by WMNTS from LNUs and SCUs over the 5 year period (Figure 1). Analysing by ODNs we report a decrease in ex-utero transfer in ODN 1 compared with ODN 2 over the study period (Figure 2).

Conclusion

In the study period there is no overall decrease in ex-utero referrals numbers. However, there is a difference in the change of referral rates between the two networks and further work is necessary to understand this. Possible hypotheses include lack of maternity and obstetric capacity in NICUs, lack of understanding of referral patterns, and different rates of antenatal complications, preventing in-utero transfers.

Limitation

We are aware that the West Midlands has a rising birth rate, which has not been taken into account in this analysis.

Reference

DoH. Toolkit for High Quality Neonatal Services, 2009.

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