Big hospitals are safest for preterm births

Chris Smyth in The Times 8th July reports on a study in BMJ Open: Big hospitals are safest for preterm births 

Premature babies are a third less likely to die if they are born in the biggest specialist centres, according to analysis that will intensify calls for more centralisation of maternity care.

Mothers at risk of giving birth early have been urged to consider shunning their local hospital in favour of one with a busy neonatal unit after researchers found that centres which saw the most preterm babies tended to be safest.

They looked at data on 20,554 babies born before 33 weeks from 165 neonatal units in English hospitals, of whom 789 died. The researchers said in the journal BMJ Open that premature babies were 30 per cent less likely to die in the quarter of units that included the biggest.

“This is one of the arguments in favour of centralising specialist services,” the senior author, Neena Modi, from Imperial College London, said. She added that this did not mean “axing all smaller hospitals”, but arranging for low-risk women to give birth locally while those with complications could be taken quickly to specialist centres.

“The lesson for mums is that if you are considered to be at risk of delivering prematurely, you don’t want necessarily to go to the closest hospital,” she said.

It should be good news that pre-term babies do better… The chances of problems are on eMedicine: What to Expect When You Have an Extremely Premature Baby

Chances of having problems
Weeks of pregnancy, or birth weight Number of infants who had problems later on
Weight less than 1000 g (2 lb) Up to 4 out of 10 had one or more moderate or severe problems by the time they were age 8.3 These problems included intellectual disability, cerebral palsy, blindness, and deafness.
23 to 25 weeks At age 2½, about 3 out of 10 had one or more of the severe problems listed above.4 This means that about 7 out of 10 did not get these problems. At age 6, about 5 out of 10 children born at these early ages were more likely than other children to have attention problems, behavior problems, and problems adjusting to school.5
25 to 26 weeks Nearly 4 out of 10 had problems at age 19, including problems with hearing, sight, intellectual disability, and having a job.6 This means that more than 6 out of 10 did not have these problems.

For a tool that can help estimate the outcome for babies born at 22 to 25 weeks of age, go to

The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England: retrospective population-based cohort study BMJ Open 2014;4:e004856 doi:10.1136/bmjopen-2014-004856 Author: S I Watson et al.



This entry was posted in Good News, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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