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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
  1. Abdul Qader Tahir Ismail1,2,
  2. Elaine M Boyle1,
  3. Thillagavathie Pillay2,3
  4. On behalf of The OptiPrem Study Group
    1. 1Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
    2. 2Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
    3. 3School of Medicine and Clinical Practice, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
    1. Correspondence to Dr Abdul Qader Tahir Ismail; aqt.ismail{at}


    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.

    • neonatology
    • evidence based medicine
    • health service

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) 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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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

    • Contributors AQTI, EMB and TP developed the idea for the systematic review. AQTI conducted the literature search and prepared the initial draft of the manuscript. AQTI, EMB and TP revised the manuscript and approved the final manuscript for submission.

    • Funding This work is supported by the NIHR HS&DR Stream, Project number 15/70/104, and by the Royal Wolverhampton NHS Trust, Protocol number 2016NEO87. AQTI is undertaking a PhD with the University of Leicester, with funding from the OptiPrem project. He is supervised by TP and EMB.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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